NONPF 39th Annual Meeting
Accelerating the development of the NP student’s diagnostic reasoning skills is high on the wish list for faculty. In our DNP program the question became, can problem-based learning that culminates in an illness script provide vicarious clinical experience and expedite the process?
Diagnostic reasoning develops over time and is a function of clinical experience. In an effort to expedite this process, problem-based learning (PBL) was chosen as the teaching method for our online DNP program. To promote pattern recognition, a prominent method novice NPs use to store data in cognitive structures, four cases based on the same symptom that unfolded differently were discussed in small groups over a two-week period. Once the simultaneous collaborative discussion ended, students were encouraged to review all four cases, comparing and contrasting the salient features. To promote this mindful review and ensure that students were on the right track, faculty developed an individual assignment, called an illness script based on Barrow’s original conceptualization.
An illness script is a mental model composed of disease-specific information such as signs and symptoms (the consequences), the context (enabling condition), and the pathophysiological causes of the signs and symptoms (the fault). Perceived in medicine as a transition from memorizing basic science content to applying it in a clinical context, the articulated illness script provided a glimpse into the diagnostic reasoning development of the physician-in-training.
Recognizing the value of such an exercise for NP students to explicate the diagnostic reasoning process, faculty created a grid that included the components of an illness script; consequences or symptoms as anchor, enabling condition, and pathophysiological insult. After reviewing the four PBL cases built on the same symptom, students completed this grid to promote symptom-anchored organization of data in cognitive structures, similar to the manner in which it would be retrieved in a patient encounter.
This presentation will review symptom-based case creation, the history of illness scripts as used in medicine, the simple grid created as a means to make the script explicit, and the value added to case-based teaching.
