Assessment of Diagnostic Reasoning Using Digital Standardized Patients
In this study, DSPs were used on a weekly basis to supplement a differential diagnosis course in a doctoral nursing degree program, prior to clinical immersion. Eighteen nurse practitioner students participated. Reflective journals provided insight into students’ diagnostic reasoning process. Students developed preliminary diagnostic hypotheses based on a core nursing knowledge, intuition, and pattern recognition. Hypotheses were tested and refined through further data collection, with students weighing the relative value of the collective evidence to arrive at a working diagnosis. By comparing their diagnostic reasoning process and outcomes to an exemplary model, students were able to self-critique their performance and identify the source of any diagnostic errors. Over time, students were able to refine their data collection and analytic skills, moving from a disorganized and overly broad approach to a more honed and focused interaction. This resulted in faster and more accurate assessments, coupled with cost-effective utilization of diagnostic studies. Students reported increased confidence in and cognitive awareness of the diagnostic reasoning process, and appreciated the forgiving nature of the simulated environment. Broader implications are discussed.