Using screen-based simulation to examine diagnostic test ordering in family nurse practitioner students

ABSTRACT Excessive ordering of laboratory tests exposes patients to risk of unnecessary treatments, complications, and psychological and financial burden. Nurse practitioner education programs have the opportunity to develop students' test ordering skills. This project examined family nurse practitioner students' appropriate diagnostic test ordering during a screen-based simulation. Students in their final clinical course were invited to complete 25 patient cases in the i-Human Patients (iHP) platform, including the opportunity to order and interpret tests. Quantitative data, collected in the iHP platform, were analyzed using descriptive statistics. Qualitative analysis of transcripts from weekly faculty debriefing sessions identified common themes among student responses. Ninety-eight students completed the intervention. Data from a single patient case of a 65-year-old woman with a chief complaint of insomnia and weight loss were used for this analysis. Only 46% of students ordered the required tests for this case, and all students ordered extraneous tests. Extraneous orders included tests beyond the reasonable standard of care. Qualitative data showed students recognized their test ordering choices were not always appropriate. Top reasons for ordering extraneous tests included fear of missing key data and uncertainty of appropriate tests. Screen-based simulation is effective to assess nurse practitioner students' test ordering skills. Debriefing with experienced faculty provides an opportunity for students to reflect on their diagnostic reasoning and test ordering competencies. Screen-based simulation provided students with a safe, controlled environment to develop awareness of test utilization in the context of delivering efficient and responsible patient care.