Facing the Dilemma of Teaching Diagnostic Reasoning Skill to Advanced Practice Nurses

The development of diagnostic reasoning skills when preparing for an advanced practice role as a nurse practitioner is a challenge to students.  Building on the concept of completion of the 3 “P’s” (pathophysiology, pharmacology, and physical assessment), a course in diagnostic reasoning and testing enhances the student's skill set prior to their first clinical rotation.  A course that simulates situations where the student applies diagnostic reasoning skills to develop a differential diagnosis and select appropriate testing, provides a framework for the student's clinical practice. In this course an approach to developing a differential diagnosis, identification of pertinent positives and negatives to select a diagnosis of high suspicion, and principles of diagnostic testing are taught.  Interpretation of laboratory, chest x-ray, EKG and hemodynamic concepts are facilitated by weekly case simulations and case studies.  Preparation for the clinical rotations is enhanced by having the student present the simulated case and document a history and physical or focused SOAP note.  The goal of the course is to provide the student with a complete set of “tools” prior to their first clinical course.