Building a shared language for better diagnosis

Clinical Professor Sheila Smith and Clinical Professor Mary Benbenek co-edited a six-part symposium, published in the Advanced Critical Care journal, on diagnostic reasoning.

After publishing a first-of-its-kind series in the journal AACN Advanced Critical Care about diagnostic reasoning for nurse practitioners, faculty at the School of Nursing launched a new course this summer focused on the essential competency required for nurse practitioner practice.

Diagnostic reasoning is the iterative process used to collect, interpret and integrate patient signs and symptoms into decision-making to make an accurate diagnosis and develop a treatment plan. Historically, diagnostic reasoning has been treated as an implicit part of the learning process. More recently, there is acknowledgement that a more structured approach to diagnostic reasoning needs to be an active focus of teaching.

“Diagnostic reasoning is important for nurse practitioners as it is one of our primary areas of expertise that we’re bringing to the patient,” says Clinical Professor Sheila Smith, PhD, ANP-BC, FAANP. “Our thinking about their problem and our ability to engage with them to help solve that particular problem is the primary expertise that we bring to health care. The stakes are high. If we don’t get the right diagnosis, we’re not going to get the right management plan. If we don’t get the right management plan, there can be significant harms.”

In 2022, Smith and Clinical Professor Mary Benbenek, PhD, APRN, CPNP-PC, FNP-BC, FAANP, FNAP, conducted a scoping review of diagnostic reasoning content in U.S. nurse practitioner education literature. Their scoping review determined that a robust teaching scholarship for diagnostic reasoning had not yet been established.

“In 2022, we found that there was very little uniformity across nurse practitioner education, so we decided we needed to be involved in advancing the whole process of diagnostic reasoning for nurse practitioner education,” says Smith.

The six-part symposium, published in the Advanced Critical Care journal in the summer, advances the literature with articles about foundational concepts, diagnostic error, teaching strategies, and assessment tools. It was coedited by Smith and Benbenek, with several authors from the School of Nursing. Contributors included Clinical Associate Professor Stephanie Delkoski, DNP, APRN, WHNP-BC, PNAP, Clinical Associate Professor Jenna Herman, DNP, APRN, FNP-BC, Clinical Assistant Professor Sarah McCarthy, DNP, APRN, CNP, and Clinical Assistant Professor Lauren Petersen, DNP, MPH, APRN, PNP-PC. 

“Our intention with the series was to bring attention to the topic within the world of nursing and nurse practitioners and introduce them to the science and the research. Using the preferred model based on the National Academies of Sciences, we want to establish some uniformity and help to frame a common language that nurse practitioner educators can use to teach students and evaluate their competencies,” says Smith.

An introduction to diagnostic reasoning

This summer, students across six nurse practitioner specialties in the Doctor of Nursing Practice program enrolled in the first course dedicated to diagnostic reasoning offered by the school.

Smith and Benbenek launched the 10-week course, which included lectures, seminal articles and a case study that unfolded throughout the course.

“The goal of the course is to improve diagnostic reasoning skills among our advanced practice nursing students and to provide the foundation for students before they enter the clinical setting,” says Benbenek.

National Organization of Nurse Practitioner Faculties webinar series

The National Organization of Nurse Practitioner Faculties recognizes the critical role of diagnostic reasoning and has launched a webinar series to help faculty deepen their understanding of its models, concepts and tools. Smith and Benbenek are part of a group that is creating and presenting the series of six webinars.

“We will lay out the different components of diagnostic reasoning so that faculty gain greater insight. I think that in many programs, we have been incorporating elements of this but haven’t always called it diagnostic reasoning or recognized its complexity,” says Benbenek. “We weren’t consistently using the same terminology used by other disciplines. Part of our initiative was to inform faculty and students of the common language and roots in cognitive science, so that we’re on the same page as other disciplines.”