Nursing faculty member creates tool to improve diagnostic skills

Almost all of us will experience a diagnostic error in our lifetime, according to the National Academies of Sciences, Engineering, and Medicine, and some of those errors will have devastating consequences. 

For nurse practitioners — who reported to the American Association of Nurse Practitioners in a 2020 survey that making diagnoses is one of the most common tasks they engage in — making well-reasoned diagnoses is a critical skill.  

And yet, diagnostic reasoning is an area that has not received enough attention in nursing and medical education, said Leah Burt, PhD ’20, MS ’10, APRN, ANP-BC. 

“In terms of educating our students, this is critically important because the stakes are so high for our patients,” she said. 

Burt, a UIC College of Nursing clinical assistant professor and director of the Adult-Gerontology Nurse Practitioner Program, created a first-of-its kind tool to help improve diagnostic competency within the context of health care simulation.  

She published the results of a pilot study of her tool in the March-April issue of the Journal of Professional Nursing. Andrew Olson at the University of Minnesota Medical School was co-author. 

How does it work? 

Burt’s tool, the Diagnostic Competency During Simulation-based learning tool, focuses on six individual competencies to improve diagnostic skills (the competencies were established by an interprofessional, international consensus group).  

Using the tool, faculty observe students during an encounter with a standardized patient (an actor playing a patient) and assign individual scores to observed behaviors reflecting each of the competencies, broadly defined as: collecting key findings; problem representation; prioritized differential diagnosis; diagnosis justification; decision support; and cognition. 

For instance, for a student to be rated highly in competency No. 3 — prioritized differential diagnosis — they would need to include worst-case diagnoses that might be rare, but are nonetheless important to include, she said.  

“One of the standardized patients came in with epigastric pain,” Burt said. “The correct diagnosis was GERD, or acid reflux, but the worst-case scenario was that the patient was having a massive heart attack. The student who performs this competency well will communicate in a way that acknowledges ‘can’t-miss diagnoses,’ because if the patient happens to be one of the minority cases, it is really serious,” Burt said. 

No other educational tools like this 

Burt said the results of the pilot study showed that it’s a “good-quality tool,” measuring diagnostic competency “in a moderately consistent way between users, when implemented in a variety of simulation cases with students of varying skill levels.”  

Burt was inspired to work on the project while completing a fellowship through the Society to Improve Diagnosis in Medicine in 2021-2022. An estimated 40,000 to 80,000 people die each year from diagnostic failures in U.S. hospitals, according to an analysis cited by the society.   

Currently, there are no other educational tools to specifically assess individual diagnostic reasoning competencies during simulation-based learning experiences, according to the paper, including in physician training. Burt said her tool would be “highly appropriate” for medical education as well, given that the competencies are interprofessional. 

She noted that “the time was right to do this” because nursing schools are switching to competency-based education. In competency-based diagnostic education, faculty must be able to identify areas where students need additional training — “where along the spectrum from novice to expert students lie with respect to each competency,” according to the paper.  

Simulation is ideal for this style of teaching because it allows faculty to directly observe student behaviors, allowing for significant control over the encounter and its context, according to the paper. 

Burt’s next steps are to conduct additional psychometric testing and to seek ways to support faculty using the tool.  Currently, she is collaborating with nursing faculty at Rush University to develop simulation scenarios specific to the tool for use in nurse practitioner education.   

— Written by Deborah Ziff Soriano