Burt Leah, Finnegan Lorna, Schwartz Alan, Corte Colleen, Quinn Laurie, Clark Lou, Corbridge Susan
University of Illinois at Chicago College of Nursing, Chicago, IL, USA.
Loyola University Chicago, Chicago, IL, USA.
Diagnosis (Berl). 2021 Apr 26;9(1):50-58. doi: 10.1515/dx-2020-0137.
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.
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.
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.
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.
为提高诊断能力，教育工作者应采用多焦点策略。一种有前景的策略是自我解释，即在解决问题过程中有目的地进行自我引导式解释的技巧。学生自我解释信息的方式多种多样，从简单复述到多维思考。成功的问题解决者经常使用特定的、高质量的自我解释类型。在之前的研究阶段，已识别并描述了家庭执业护士（NP）学生在诊断推理过程中自我解释的独特方式。本研究旨在：（a）探讨自我解释方式与诊断准确性水平之间的关系；（b）比较不同专业水平学生在自我解释方式和诊断准确性水平方面的差异。识别高质量的诊断推理自我解释类型可能有助于制定更完善的自我解释教育策略。
在一所位于中西部的大型大学攻读护理学实践博士学位的37名家庭NP学生，在自我解释的同时诊断三个书面案例研究。在内容分析的定量阶段，应用了关联和比较数据分析技术。
与新手学生相比，专家级学生做出的临床和生物学推理自我解释明显更多。诊断准确性得分与生物学推理得分显著相关。临床和生物学推理得分占诊断准确性得分方差的27%，其中生物学推理得分对诊断准确性得分有显著影响。
不仅以生物学为重点的自我解释与诊断准确性相关，而且其出现频率也会影响诊断准确性水平。教育课程应从学生教育之初就支持他们从潜在生物学角度看待患者表现。
