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Ways that nurse practitioner students self-explain during diagnostic reasoning

  • Leah Burt EMAIL logo , Susan Corbridge , Colleen Corte , Laurie Quinn , Lorna Finnegan and Lou Clark
Published/Copyright: April 26, 2021
Diagnosis
From the journal Diagnosis Volume 9 Issue 1

Abstract

Objectives

An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners’ memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning?

Methods

Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis.

Results

Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students’ understanding of clinical data and reflect shallow information processing.

Conclusions

Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

Keywords: diagnostic reasoning; education; nurse practitioner; self-explanation
Corresponding author: Leah Burt, PhD, APRN, ANP-BC, Department of Biobehavioral Nursing Science (MC 802), College of Nursing, University of Illinois Chicago, 845 South Damen Avenue, 758 NURS, Chicago, IL 60612, USA, Phone: +262 227 0045, Fax: +312 996 4979, E-mail:

Funding source: American Association of Nurse Practitioners

Acknowledgments

The authors thank Kevin Grandfield, Publication Manager for the UIC Department of Biobehavioral Nursing Science, for editorial assistance.

  1. Research funding: This research was funded by a grant from the American Association of Nurse Practitioners (AANP).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: A waiver of written consent was presented to each student.

  5. Ethical approval: Research ethics approval was received from the University’s Office for the Protection of Research Subjects, IRB # 2019-0668.

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Received: 2020-10-13
Accepted: 2021-03-02
Published Online: 2021-04-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. From Camille Nούς to Apollonian and the Dionysian scientists
  4. Review
  5. The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
  6. Mini Reviews
  7. Updated picture of SARS-CoV-2 variants and mutations
  8. Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
  9. Opinion Papers
  10. The 6C model for accurately capturing the patient’s medical history
  11. Webside manner: maskless communication
  12. Original Articles
  13. Ways that nurse practitioner students self-explain during diagnostic reasoning
  14. Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
  15. Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
  16. Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
  17. Analyzing diagnostic errors in the acute setting: a process-driven approach
  18. Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
  19. Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
  20. Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
  21. Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
  22. Short Communication
  23. Characterizing the relationship between diagnostic intensity and quality of care
  24. Case Reports – Lessons in Clinical Reasoning
  25. Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
  26. Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
  27. Letters to the Editor
  28. Three learning concepts to improve diagnosis and enhance the practice of medicine
  29. Distributed cognition: a framework for conceptualizing telediagnosis in teams
  30. Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
https://doi.org/10.1515/dx-2020-0136
Keywords for this article
diagnostic reasoning; education; nurse practitioner; self-explanation

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. From Camille Nούς to Apollonian and the Dionysian scientists
  4. Review
  5. The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
  6. Mini Reviews
  7. Updated picture of SARS-CoV-2 variants and mutations
  8. Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
  9. Opinion Papers
  10. The 6C model for accurately capturing the patient’s medical history
  11. Webside manner: maskless communication
  12. Original Articles
  13. Ways that nurse practitioner students self-explain during diagnostic reasoning
  14. Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
  15. Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
  16. Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
  17. Analyzing diagnostic errors in the acute setting: a process-driven approach
  18. Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
  19. Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
  20. Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
  21. Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
  22. Short Communication
  23. Characterizing the relationship between diagnostic intensity and quality of care
  24. Case Reports – Lessons in Clinical Reasoning
  25. Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
  26. Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
  27. Letters to the Editor
  28. Three learning concepts to improve diagnosis and enhance the practice of medicine
  29. Distributed cognition: a framework for conceptualizing telediagnosis in teams
  30. Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
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