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Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain

  • Leah Burt EMAIL logo , Lorna Finnegan , Alan Schwartz , Colleen Corte , Laurie Quinn , Lou Clark und Susan Corbridge
Veröffentlicht/Copyright: 26. April 2021
Diagnosis
Aus der Zeitschrift Diagnosis Band 9 Heft 1

Abstract

Objectives

To improve diagnostic ability, educators should employ multifocal strategies. One promising strategy is self-explanation, the purposeful technique of generating self-directed explanations during problem-solving. Students self-explain information in ways that range from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. In a previous phase of research, unique ways that family nurse practitioner (NP) students self-explain during diagnostic reasoning were identified and described. This study aims to (a) explore relationships between ways of self-explaining and diagnostic accuracy levels and (b) compare differences between students of varying expertise in terms of ways of self-explaining and diagnostic accuracy levels. Identifying high-quality diagnostic reasoning self-explanation types may facilitate development of more refined self-explanation educational strategies.

Methods

Thirty-seven family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern university diagnosed three written case studies while self-explaining. During the quantitative phase of a content analysis, associational and comparative data analysis techniques were applied.

Results

Expert students voiced significantly more clinical and biological inference self-explanations than did novice students. Diagnostic accuracy scores were significantly associated with biological inference scores. Clinical and biological inference scores accounted for 27% of the variance in diagnostic accuracy scores, with biological inference scores significantly influencing diagnostic accuracy scores.

Conclusions

Not only were biologically focused self-explanations associated with diagnostic accuracy, but also their spoken frequency influenced levels of diagnostic accuracy. Educational curricula should support students to view patient presentations in terms of underlying biology from the onset of their education.

Keywords: differential diagnosis; education; nurse practitioner; self-explanation
Corresponding author: Leah Burt, PhD, APRN, ANP-BC, Department of Biobehavioral Nursing Science (MC 802), University of Illinois Chicago College of Nursing, 845 South Damen Avenue, 758 NURS, Chicago, IL 60612, USA, Phone: +1 262 227 0045, Fax: +1 312 996 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: Informed consent was waived by all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013) and has been approved by the authors’ Institutional Review Board (# 2019-0668).

References

1. Newman-Toker, DE, Schaffer, AC, Yu-Moe, CW, Nassery, N, Saber Tehrani, AS, Clemens, GD, et al.. Serious misdiagnosis-related harms in malpractice claims: the “Big Three” – vascular events, infections, and cancers. Diagnosis (Berl) 2019;6:227–40.10.1515/dx-2019-0019Suche in Google Scholar PubMed

2. Saber Tehrani, AS, Lee, H, Mathews, SC, Shore, A, Makary, MA, Pronovost, PJ, et al.. 25-year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf 2013;22:672–80.10.1136/bmjqs-2012-001550Suche in Google Scholar PubMed

3. Singh, H, Meyer, AN, Thomas, EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014;23:727–31.10.1136/bmjqs-2013-002627Suche in Google Scholar PubMed PubMed Central

4. Singh, H, Giardina, TD, Meyer, AN, Forjuoh, SN, Reis, MD, Thomas, EJ. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med 2013;173:418–25.10.1001/jamainternmed.2013.2777Suche in Google Scholar PubMed PubMed Central

5. Sorinola, OO, Weerasinghe, C, Brown, R. Preventable hospital mortality: learning from retrospective case record review. JRSM Short Rep 2012;3:77.10.1258/shorts.2012.012077Suche in Google Scholar PubMed PubMed Central

6. Olson, A, Rencic, J, Cosby, K, Rusz, D, Papa, F, Croskerry, P, et al.. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis (Berl) 2019;6:335–41.10.1515/dx-2018-0107Suche in Google Scholar PubMed

7. Chi, MT. Self-explaining expository texts: the dual processes of generating inferences and repairing mental models. In: Glaser, R, editor. Advances in instructional psychology. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 2000:161–238 p.Suche in Google Scholar

8. Chi, MT, Bassok, M, Lewis, MW, Reimann, P, Glaser, R. Self-explanations: how students study and use examples in learning to solve problems. Cognit Sci 1989;13:145–82.10.1207/s15516709cog1302_1Suche in Google Scholar

9. Chi, MT, VanLehn, KA. The content of physics self-explanations. J Learn Sci 1991;1:69–105.10.21236/ADA229737Suche in Google Scholar

10. Chi, MTH, de Leeuw, N, Chiu, M-H, LaVancher, C. Eliciting self-explanations improves understanding. Cognit Sci 1994;18:439–77.10.1207/s15516709cog1803_3Suche in Google Scholar

11. Renkl, A. Learning from worked-out examples: a study on individual differences. Cognit Sci 1997;21:1–29.10.1207/s15516709cog2101_1Suche in Google Scholar

12. Rittle-Johnson, B, Loehr, AM. Eliciting explanations: constraints on when self-explanation aids learning. Psychon Bull Rev 2017;24:1501–10.10.3758/s13423-016-1079-5Suche in Google Scholar PubMed

13. Neuman, Y, Leibowitz, L, Schwarz, B. Patterns of verbal mediation during problem solving: a sequential analysis of self-explanation. J Exp Educ 2000;68:197–213.10.1080/00220970009600092Suche in Google Scholar

14. Pirolli, P, Recker, M. Learning strategies and transfer in the domain of programming. Cognit Instruct 1994;12:235–75.10.1207/s1532690xci1203_2Suche in Google Scholar

15. Nokes, TJ, Hausmann, RGM, VanLehn, K, Gershman, S. Testing the instructional fit hypothesis: the case of self-explanation prompts. Instr Sci 2011;39:645–66.10.1007/s11251-010-9151-4Suche in Google Scholar

16. Renkl, A, Stark, R, Gruber, H, Mandl, H. Learning from worked-out examples: the effects of example variability and elicited self-explanations. Contemp Educ Psychol 1998;23:90–108.10.1006/ceps.1997.0959Suche in Google Scholar PubMed

17. Schworm, S, Renkl, A. Learning argumentation skills through the use of prompts for self-explaining examples. J Educ Psychol 2007;99:285–96.10.1037/0022-0663.99.2.285Suche in Google Scholar

18. Chamberland, M, Mamede, S, St-Onge, C, Setrakian, J, Bergeron, L, Schmidt, H. Self-explanation in learning clinical reasoning: the added value of examples and prompts. Med Educ 2015;49:193–202.10.1111/medu.12623Suche in Google Scholar PubMed

19. Heitzmann, N, Fischer, F, Kuhne-Eversmann, L, Fischer, MR. Enhancing diagnostic competence with self-explanation prompts and adaptable feedback. Med Educ 2015;49:993–1003.10.1111/medu.12778Suche in Google Scholar PubMed

20. Peixoto, JM, Mamede, S, de Faria, RMD, Moura, AS, Santos, SME, Schmidt, HG. The effect of self-explanation of pathophysiological mechanisms of diseases on medical students’ diagnostic performance. Adv Health Sci Educ: Theory Pract 2017;22:1183–97.10.1007/s10459-017-9757-2Suche in Google Scholar PubMed

21. Burt, L, Corbridge, S. Teaching diagnostic reasoning: a review of evidence-based interventions. Int J Nurs Educ Scholarsh 2018;15. https://doi.org/10.1515/ijnes-2018-0003.Suche in Google Scholar PubMed

22. American Association of Nurse Practitioners. Standards of practice for nurse practitioners; 2019. Available from: https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners.Suche in Google Scholar

23. American Association of Nurse Practitioners. The state of the nurse practitioner profession. American Association of Nurse Practitioner; 2018.Suche in Google Scholar

24. Kuo, YF, Adhikari, D, Eke, CG, Goodwin, JS, Raji, MA. Processes and outcomes of congestive heart failure care by different types of primary care models. J Card Fail 2018;24:9–18.10.1016/j.cardfail.2017.08.459Suche in Google Scholar PubMed PubMed Central

25. Kurtzman, ET, Barnow, BS. A comparison of nurse practitioners, physician assistants, and primary care physicians’ patterns of practice and quality of care in health centers. Med Care 2017;55:615–22.10.1097/MLR.0000000000000689Suche in Google Scholar PubMed

26. Morgan, PA, Smith, VA, Berkowitz, TSZ, Edelman, D, Van Houtven, CH, Woolsen, SL, et al.. Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Aff 2019;38:1028–36.10.1377/hlthaff.2019.00014Suche in Google Scholar PubMed

27. Burt, L, Corbridge, S, Finnegan, L, Clark, L, Schwartz, A, Corte, C, et al.. Ways that nurse practitioner students self-explain during diagnostic reasoning. Diagnosis 2020;9:50–8.10.1515/dx-2020-0136Suche in Google Scholar PubMed

28. Chamberland, M, Mamede, S, St-Onge, C, Rivard, MA, Setrakian, J, Levesque, A, et al.. Students’ self-explanations while solving unfamiliar cases: the role of biomedical knowledge. Med Educ 2013;47:1109–16.10.1111/medu.12253Suche in Google Scholar PubMed

29. State of Illinois. Occupational employment statistics: wage data, 2018th ed. State of Illinois (Illinois Department of Employment Security); 2018.Suche in Google Scholar

30. Elo, S, Kyngas, H. The qualitative content analysis process. J Adv Nurs 2008;62:107–15.10.1111/j.1365-2648.2007.04569.xSuche in Google Scholar PubMed

31. Chi, MT. Quantifying qualitative analyses of verbal data: a practical guide. J Learn Sci 1997;6:271–315.10.1207/s15327809jls0603_1Suche in Google Scholar

32. Toy, EC, Patlan, JT. Case files for internal medicine, 4th ed. New York McGraw Hill Education, Medical 2013.Suche in Google Scholar

33. Kanmen, DL, Hingle, ST. Resident readiness: internal medicine. New York, NY: McGraw Hill Education; 2013.Suche in Google Scholar

34. Lombard, M, Snyder-Duch, J, Bracken, CC. Content analysis in mass communication: assessment and reporting of intercoder reliability. Hum Commun Res 2002;28:587–604.10.1111/j.1468-2958.2002.tb00826.xSuche in Google Scholar

35. Chamberland, M, St-Onge, C, Setrakian, J, Lanthier, L, Bergeron, L, Bourget, A, et al.. The influence of medical students’ self-explanations on diagnostic performance. Med Educ 2011;45:688–95.10.1111/j.1365-2923.2011.03933.xSuche in Google Scholar PubMed

36. Chamberland, M, Mamede, S, St-Onge, C, Setrakian, J, Schmidt, HG. Does medical students’ diagnostic performance improve by observing examples of self-explanation provided by peers or experts? Adv Health Sci Educ: Theory Pract 2015;20:981–93.10.1007/s10459-014-9576-7Suche in Google Scholar PubMed

37. Mamede, S, van Gog, T, Moura, AS, de Faria, RM, Peixoto, JM, Rikers, RM, et al.. Reflection as a strategy to foster medical students’ acquisition of diagnostic competence. Med Educ 2012;46:464–72.10.1111/j.1365-2923.2012.04217.xSuche in Google Scholar PubMed

38. Mamede, S, van Gog, T, Sampaio, AM, de Faria, RM, Maria, JP, Schmidt, HG. How can students’ diagnostic competence benefit most from practice with clinical cases? The effects of structured reflection on future diagnosis of the same and novel diseases. Acad Med 2014;89:121–7.10.1097/ACM.0000000000000076Suche in Google Scholar PubMed

39. Schmidt, HG, Norman, GR, Boshuizen, HP. A cognitive perspective on medical expertise: theory and implication. Acad Med 1990;65:611–21.10.1097/00001888-199010000-00001Suche in Google Scholar PubMed

40. Schmidt, HG, Rikers, RM. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ 2007;41:1133–9.10.1111/j.1365-2923.2007.02915.xSuche in Google Scholar PubMed

41. Boshuizen, HPA, Schmidt, H. On the role of biomedical knowledge in clinical reasoning by experts, intermediates, and novices. Cognit Sci 1992;16:153–84.10.1207/s15516709cog1602_1Suche in Google Scholar

42. Charlin, B, Tardif, J, Boshuizen, HP. Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Acad Med 2000;75:182–90.10.1097/00001888-200002000-00020Suche in Google Scholar PubMed

43. Woods, NN. Science is fundamental: the role of biomedical knowledge in clinical reasoning. Med Educ 2007;41:1173–7.10.1111/j.1365-2923.2007.02911.xSuche in Google Scholar PubMed

44. Woods, NN, Brooks, LR, Norman, GR. The value of basic science in clinical diagnosis: creating coherence among signs and symptoms. Med Educ 2005;39:107–12.10.1111/j.1365-2929.2004.02036.xSuche in Google Scholar PubMed

45. Woods, NN, Brooks, LR, Norman, GR. It all makes sense: biomedical knowledge, causal connections and memory in the novice diagnostician. Adv Health Sci Educ: Theory Pract 2007;12:405–15.10.1007/s10459-006-9055-xSuche in Google Scholar PubMed

46. Woods, NN, Brooks, LR, Norman, GR. The role of biomedical knowledge in diagnosis of difficult clinical cases. Adv Health Sci Educ: Theory Pract 2007;12:417–26.10.1007/s10459-006-9054-ySuche in Google Scholar PubMed

47. Cicchetti, DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 1994;6:284–90.10.1037/1040-3590.6.4.284Suche in Google Scholar
Received: 2020-10-13
Accepted: 2021-03-17
Published Online: 2021-04-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  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-2020-0137
Schlagwörter für diesen Artikel
differential diagnosis; education; nurse practitioner; self-explanation

Artikel in diesem Heft

  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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