An international comparison of student nurse practitioner diagnostic reasoning skills

Melanie Rogers, Catherine Lyden, Mary Steinke, Angela Windle, Daniela Lehwaldt

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Nurse practitioners (NPs) play a pivotal role in health care provision. Diagnostic reasoning is an important core skill of advanced practice.
Purpose: The purpose of this study was to compare diagnostic reasoning skills of NP students. It also identified the variability in clinical teaching components of a sample of international NP curricula.
Methods: An international group of NP students completed an online survey using a validated diagnostic reasoning scale during the first year of their NP program. Program faculty surveyed provided data on core curricula.
Results: The NP students’ (n = 152) mean diagnostic thinking inventory (DTI) score was 142, flexibility in thinking subscale score mean of 73 with a knowledge structure in memory of 69. The programs surveyed required bioscience courses. Most programs provided opportunities for students to practice diagnostic thinking using individual precepted clinical hours (range 500–950) and objective structured clinical examinations.
Conclusion: The lower scores of this group of NP students were similar to other NP students and first-year medical residents. Higher mean scores in the DTI reflect expertise and are developed over time. Courses providing a foun- dation of biomedical knowledge were identified in each program, with opportunities for the NP students to practice diagnostic thinking using objective structured clinical examinations and clinical practice hours.
Implications: The use of the diagnostic reasoning inventory is a useful tool for evaluating student NP’s diagnostic reasoning during their NP program. Nurse practitioner programs should consider the provision of dedicated clinical hours, including supervised clinical practice experiences and objective structured clinical examinations to improve diagnostic reasoning.

Original languageEnglish
Pages (from-to)477-486
Number of pages10
JournalJournal of the American Association of Nurse Practitioners
Issue number8
Early online date19 Jul 2023
Publication statusPublished - 14 Aug 2023

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