Carnival Games and Diagnostic Reasoning

Diagnostic reasoning, a complex cognitive process used to determine an accurate diagnosis¹,  is one of the most challenging concepts to teach to nurse practitioner students. This process is fundamental to addressing the vast spectrum of clinical challenges they will face in the rapidly evolving, decision-dense environment of today’s health care system². Nurse’s clinical judgments are often based more on their clinical background than the data collected from the current patient³.  While skilled clinicians often combine a high level of knowledge and experience to form an intuitive hypothesis, nurse practitioner students must use a more logical and analytical process that requires a synthesis of collected data to formulate a hypothesis¹. Traditional teaching strategies, such as lecture, do not allow for the interactive thought process that is required for students to take a chief complaint and work towards a prioritized differential diagnosis. Additionally it only engages the students’ auditory learning and is a passive teaching strategy. Tanner suggests a conceptual model of clinical judgment³ (noticing, interpreting, and responding) that can be applied to an interactive method of teaching diagnostic reasoning. In order to better engage all of the senses and utilize a more active learning method, the School of Nursing developed an innovative teaching modality to better model and develop nurse practitioner students diagnostic reasoning ability. The formulation of a differential diagnosis list is paired with a simulated “horse race” where each “horse” in the race represents a potential diagnosis based on a patient’s chief complaint. The “horse” or potential diagnosis advances based on the answers to history questions and exam findings.  Once a comprehensive history and physical is obtained it is clear that one “horse” or diagnosis stands out from the rest and is the “winner” or final diagnosis. During this presentation the concepts of adult learning theory and diagnostic reasoning will be reviewed. Participants will then participate in a brief interactive demonstration of this diagnostic reasoning learning activity.