Retooling Health
Assessment: It
Takes More Than a
Hammer
Cheryl Wilson
MSN, ARNP, ANP-BC
Objectives
 Understand the gap between knowledge and skill
 Identify strategies to bridge knowledge and skill
from Advance Health Assessment across to
clinical courses
 Understand the continuum of simulated learning
and how to apply in blended courses
Who Am I?
 Advanced Registered
Nurse PractitionerAdult Health Board
Certified
 Instructor Graduate
and Undergraduate
programs

Disclosure-provide noncompensated consultation as a
SME to Shadow Health
What were the challenges?
 Hybrid course only met 3
times a semester
 No simulation integrated
into Health Assessment
course
 Identified a gap between
knowledge and skills
 Application of skills in the
clinical setting
Faculty challenges
 Use of simulation
 Faculty background and
training
 Preparation for lab
 Ratio of faculty to
students
 Consistency of lab
experiences
Modalities of Learning
 Task Trainers
 Digital Clinical Experience
(DCE)
 Problem Based Learning (PBL)
 Clinical Reasoning exercises
 Case Studies
 Electronic Health Records
(EHR)
 Observed Structured Clinical
Exam (OSCE)
 Standardized Patients (SP’s)
Digital Clinical Experiences
 Students interview the
patient for a full health
history
 Go through full
physical exam of each
system
 Documentation of
findings
Digital Clinical Experience
 Standardized
experience
 Communication
skills
 Physical exam
skills
 Clinical judgment
Problem Based Learning
 Case presentation in
small groups
 Provide partial information
in history
– Students ask additional
History questions
– Discuss physical exam they
would perform
– 4-5 differential diagnosis
– Match up signs and
symptoms from case
Observed Structured Clinical Exam
 Utilization of
standardized patients
 Full health history
 Focused physical
exam
 Differential diagnosis
 Final course
competency-putting all
the pieces together
Continuum of Simulated Learning
 Why Simulation?
– Provide opportunities to enhance critical
thinking and clinical judgment
– Ability to evaluate students effectively
– Provide scenarios to enhance learning
• Clinical situations possibly encountered in practice
and how to work through clinical problems.
Continuum
OSCE
Standardized
Patients
DCE
High Fidelity
Low Fidelity
Task
Trainers
Faculty involvement





Role of course coordinator
Integration of simulation
Digital clinical examination
Facilitation of clinical reasoning
Consistency of skills taught across all
sections
Pedagogical Background
 Development of
expertise
 Clinical
competence
 Benner (1984)
From Novice to
Expert
Expert
Proficient
Competent
Advanced Beginner
Novice
Benner, P. (1984)
Training
 Provide faculty training in integration of the
digital clinical experience
– How to review results
– Synthesize results
– Troubleshoot student problems with software
application
 Weekly schedule of all lab activities
– Assigned to each faculty
– Resource to prepare for upcoming lab sessions
Documentation
 Integrated documentation
of patient findings within
the DCE
– Model notes provided
in grading rubric
 Documentation in EHR of
Problem Based Learning
group work
Strategies
 Provide consistent
training of all faculty in
lab
 Integration of
simulation throughout
the course
 Inter-rater reliability of
grading and
evaluation
Conclusion
 Re-tooling of the course to integrate
simulation and strengthen diagnostic
reasoning/clinical judgment skills.
 Utilization of multiple modalities of learning
 Training of faculty for reliability in
evaluation and consistency of delivery
 Continuous evaluation of course to improve
student learning outcomes
References
Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing
Practice. Menlo Park: Addison Wesley.
Fitzgerald, C., Kantrowitz-Gordon, I., Katz, J., & Hirsch, A. (2012). Advanced practice
nursing education: Challenges and strategies. Nursing Research and Practice.
doi:10.1155/2012/854918
Jerlock, M., Falk, K., & Severinsson, E. (2003). Academic nursing education
guidelines: Tools for bridging the gap between theory, research and practice.
Nursing and Health Sciences, 5, 219-228.