Comparing Nurse Practitioner Student Diagnostic Reasoning Outcomes in Telehealth and Face-to-Face Standardized Patient Encounters

Abstract

Introduction Standardized patient (SP) encounters support development of nurse practitioner (NP) students’ diagnostic reasoning ability in a uniquely authentic way. Telehealth technologies present an opportunity to increase access to SP experiences. Aim We evaluated NP students’ diagnostic reasoning performance in telehealth-enabled SP encounters (TSPEs) compared to face-to-face SP encounters (FSPEs). Methods This study used a randomized, crossover design. A convenience sample of 41 participants were assigned to one of four treatment groups: FSPE/pneumonia first, TSPE/pneumonia first, FSPE/asthma first, or TSPE/asthma first. Faculty evaluators used the Diagnostic Reasoning Assessment (DRA) to rate students’ observed diagnostic reasoning performance and SOAP (subjective, objective, assessment, and plan) notes and assessed whether their diagnoses were correct. Results There were no significant differences in students’ DRA scores or ability to make the correct diagnosis between TSPE and FSPE. However, a sequence effect was noted for DRA score. Students who experienced TSPE first had significantly lower DRA scores than on their subsequent FSPE encounters. In addition, both sequence of cases and sequence of encounters had a significant effect on students’ ability to make the correct diagnosis. Students who experienced either asthma or FSPE first were more likely to obtain the right diagnosis. Conclusion This study provides evidence that students can demonstrate equivalent diagnostic reasoning in TSPEs and FSPEs. Future research should investigate the effectiveness of TSPEs in different settings to teach and assess varied clinical practice competencies with diverse groups of NP students.