Differential Diagnoses: How Is It Taught to NPs? One School's Experience

The role transition from RN to CRNP can be especially daunting in the development of differential diagnoses (Baid 2006). Many students struggle to integrate the history and physical into their analysis. Based on clinical preceptor input, NP students at our institution needed to grow in their ability to quickly list a differential and appropriately defend their choice in the clinical setting. One of the ways students work on this skill is through student led case studies in their didactic management class. Input from students and faculty confirmed that the current method of presenting case studies inconsistently elicited knowledge about differentials and plan development. There was sporadic class discussion and only one PowerPoint slide stating the potential differential. Also, there was little discussion about why one diagnosis was chosen over another. In order to more thoroughly address the need for skills in developing a differential and eliciting the diagnosis, a more regimented rubric for the students’ case studies was adopted. This rubric required that after every section of the case presentation, the student presenter would ask the class specifically about the differential. For example, if the chief complaint was “headache”, a discussion would ensue before any information about the patient’s medical history, history of present illness and physical exam findings were explored. At each stage in the presentation, the student presenter would go back to the differential and ask the class how it had changed with the addition of another component of the exam. Thus far, the findings from this rubric change demonstrate much more class participation. Students appear more engaged in the critical thinking aspect of differential development. The transition from RN to CRNP requires a change in the types of diagnoses made, requiring knowledge of both nursing and medical diagnoses. Therefore, a change in how the student NP elicits and processes the patient data must also occur (Baid, 2006). The hope is that this new systematic approach to student led case studies will aid in the development of critical thinking skills required in differential development. Baid. Differential diagnosis in advanced nursing practice. British Journal of Nursing 2006; 15(18):1007-1011.