Computer-Based or Human Patient Simulation-Based Case Analysis: Which Works Better for Teaching Diagnostic Reasoning Skills?

Article excerpt


AIM The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation.

BACKGROUND Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases.

METHOD A total of 54 nursing students participated in two case analyses using human patient and computer-based simulations. Participant performance and diagnostic reasoning skills were analyzed.

RESULT Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer-based simulation. CONCLUSION Both human patient and computer-based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.


Patient Simulation--Computer Simulation-Diagnostic Reasoning - Nursing Education Baccalaureate--Education Research-Teaching Methods


Identifying client health issues is among the first clinical judgments made in the nurse-patient encounter, and accurate identification is critical to the overall effectiveness of the encounter (Wong & Chung, 2002). Undergraduate nursing students are frequently taught these diagnostic reasoning skills using case analysis (Rowles & Brigham, 2005). Nurse educators may select from a variety of methods for presenting cases to learners, including paper-based, computer-based, or simulation-based case presentations. Clarifying the potential differences in the types of diagnostic reasoning processes practiced by students and the diagnostic reasoning outcomes would support an effective selection of case presentation methods. The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used based on the method of case presentation, specifically, cases presented using a simulated electronic medical record (computer-based) or a human patient simulator (simulation-based).


Diagnostic Reasoning

Diagnostic reasoning can be defined as the process of recognizing cues and analyzing clinical data that leads to the application of a diagnostic label (Wong & Chung, 2002). Diagnostic reasoning requires several skills, including collecting data through physical examination, eliciting subjective information from the patient, integrating the results of diagnostic testing, and collaborating with other health care professionals (Carpenito, 2000). Once the initial data are collected, they must be analyzed, primarily by differentiating normal and abnormal findings and determining which findings are the most important. The nurse generates hypotheses regarding potential patient problems, searches the data at hand for patterns, and compares the evidence with the hypotheses to select the most likely problem. This hypothesis-selection step may require a collection of focused data to confirm or disconfirm the hypotheses (O'Brien, 2004).

Carpenito (2000) identified several potential pitfalls in the diagnostic reasoning process. Errors may occur in data collection, either through collecting erroneous data (e.g., incorrectly obtaining vital signs such as pulse or blood pressure) or not collecting all the necessary data. Common mistakes that occur during the hypothesizing phase include not considering alternative explanations, discounting the disconfirming data, or not including the correct hypothesis in the initial list (Carpenito).

Teaching Diagnostic Reasoning

Given the importance and potential complexity of diagnostic reasoning, selecting the most effective and efficient strategies for teaching diagnostic reasoning in undergraduate nursing programs is an important question to be answered. …