7NH016 Clinical and Diagnostic Reasoning for Advanced Clinical Practice

Summative Assessment

You are required to submit a 3000-word assignment.

This assignment should outline a patient of your choice from your role as a trainee Advanced Clinical Practitioner and should ideally be one who is pertinent to your area of advanced clinical practice that you have seen within this current semester.

The patient should present with an undifferentiated and undiagnosed problem that links to your role as a trainee Advanced Clinical Practitioner.

You should utilise the model of problem-solving presented by Crumbie (2006) and Barratt (2018) as a tool for critical analysing clinical reasoning in advanced clinical practice.

Within your work you should utilise appropriate literature and research to support your clinical and diagnostic reasoning and this poster should demonstrate your critical use of clinical reasoning. You must utilise your case study to demonstrate effective understanding and application of skills relating to clinical and diagnostic reasoning and your role as a trainee Advanced Clinical Practitioner.

Assignment format: 

• 3000 words
• Write in third person academic style.
• Maintain confidentiality.
• Size 12 font, double line space, Ariel or Verdana font
• Ensure the poster is fully referenced using the Modified Harvard system – see University of Wolverhampton website.

Points to consider:

• Provide a clear overview of the undifferentiated and undiagnosed case study.
• Make reference to your role as a trainee Advanced Clinical Practitioner within your organisation and your responsibilities within the case study – please remember to ensure anonymity to place and person throughout the assignment.
• Adopt an appropriate model of clinical reasoning.
• Demonstrate wide reading and critical consideration of contemporary literature.
• Apply clinical reasoning and problem-solving process to the assessment.
• Demonstrate your analytic skills from gathering the focused patient history including presenting symptoms, clinical findings, investigations aiding your differential diagnosis and appropriate management plan.
• Demonstrate your knowledge and applied understanding of pathophysiological principles for your chosen patient presentation.
• Critically analyse and evaluate the concept of evidence-based practice, including using the most appropriate resources and terminologies for advanced practice.
• Evaluate your learning from the case study by reflecting on strategies used to continue to develop as an advanced clinical practitioner.

Assessment

This assignment accounts for 100% of the module grade and therefore must be written in accordance with the principles for level 7 study.

The submission date can be found on the module timetable.

You must submit an electronic copy of your assignment no later than 2pm on the submission date.

Indicative Content Overview

Give an overview of the presenting case study and your role as an Advanced Clinical Practitioner

Evidence of the use of the problem-solving model. A brief overview of this model is provided at the end of this section.

Critically discuss elements such as Red Flags, Differential Diagnoses and additional tests.

Reflect upon the process, considering the positive areas and areas for potential improvement.

A reference list, utilising Harvard Refencing.

Overview of the problem-solving model

Introduction

In this section you should indicate the topic of your case study and the structural content of your case study. You should also introduce the context of your advanced clinical role and current workplace, followed by a brief introduction to your selected patient, including a brief overview of their past medical history. It is important that you maintain the selected patient’s anonymity by using a pseudonym.

Forming the initial concept

This section should detail how you developed your first impressions of the patient and / or carer. This section should include a one-sentence summary of your initial concept.

Generating multiple hypotheses

These are provisional explanations for your patient’s problem based on your initial concept and the patient’s opening statement. These multiple hypotheses should be prioritised as: likely; not likely; red flags. You are not expected to consider every conceivable multiple hypothesis for explaining the patient’s initial concept. You should present the hypotheses you actually considered at the time you cared for the patient, and then present other hypotheses you could have potentially considered but did not do so at the time.

Formulating an inquiry strategy

This is the patient’s health history section. You should present and comment on details of the patient’s presenting complaint as collected during your history taking. You should include rationale for asking your chosen history questions, in relation to your list of multiple hypotheses.

Incorporating the patient’s / carer’s perspective

You should use this section to show how you have attempted to discover the patient’s and / or carer’s ideas and concerns regarding their presenting problem. You should also demonstrate that you have attempted to elicit the patient’s and / or carer’s expectations for treatment. This section may also, but necessarily, consider the effects of the presenting problem on the patient’s life and their feelings about the problem.

Applying appropriate clinical skills

This section relates to your physical and / or psychological examination of the patient. You should explain your reasons for choosing to examine particular body systems, and you should present the interpreted details of your examination findings. This section includes general inspection of the patient and, if indicated, their vital signs.

Developing the problem synthesis

This section is where you combine the information from your history taking and physical examination in order to understand the implications of these findings in comparison to your list of multiple hypotheses. This comparison will lead you to develop a summary problem synthesis for your patient. Using this summary problem synthesis you should be able to retain or refute a number of your initially generated multiple hypotheses, whilst providing coherent rationale for doing so based on the preceding history and examination findings.

Laboratory and diagnostic findings

In this section you should discuss the selection with rationale, and results of any clinical tests you may have used such as dipstick urinalysis, laboratory tests, or imaging requests.

Diagnostic decision-making

In section you should state your selected differential diagnosis or diagnoses, whether these are tentative or final, and the reasons why you have chosen the particular diagnosis or diagnoses, with reference to underlying pathophysiology linked to observed clinical signs and symptoms.

Therapeutic decision-making

This is where in conjunction with the patient and / or carer you make a treatment decision. For example, this could be the decision to supply or prescribe a medicine. You must provide brief justification for your therapeutic choice. You should also include details of safety netting and follow-up arrangements, including actions to be taken by the patient and / or carers in the event of worsening and / or persisting signs.  

Reflective conclusion

This section draws together what you have said in the main body of the assignment. It should reflectively summarise the assessment and analysis you have presented in the main text. In this section you should reflect upon your consultation and the interactions that occurred between yourself and the patient (and their carer if applicable), thinking about events that went well and those where improvements could be made. You may also find it possible to incorporate elements of reflection in the preceding sections of your case study.

Module Learning Outcomes

Remember that the assignment must pass each of the module learning outcomes:

LO1 - Demonstrate the ability to evaluate, apply and critically synthesize a range of theories, concepts and approaches to clinical reasoning and diagnostic decision making:

• Demonstrate knowledge of pathophysiological principles for application to a range of patient presentations.
• Demonstrate a coherent understanding of common acute and long-term health problems for patients across the life span, and the relevance of age to the assessment process.
• Demonstrate an understanding of the concept of evidence-based practice, including using clinical evidence-based resources and terminologies for advanced practice.

LO2- Validate clinical decisions by applying a range of theoretical principles and practical experience informing the generation of multiple hypotheses:

• Analysing, interpreting and synthesising information from focused patient histories, presenting symptoms, clinical findings, investigations, in conjunction with using evidence-based resources, and underpinning relevant pathophysiological principles to develop coherent ranges of appropriate differential diagnoses.
• Critically evaluating own practice and implementing ongoing reflective strategies for development in the transition to being an expert practitioner.

LO3 - Appraise differential diagnoses by exercising clinical judgement to formulate a safe and evidence-based treatment and management plan:

• Critically applying clinical reasoning and problem-solving processes to the assessment and management of patients with undifferentiated presenting health problems.
• Accurately recording the outcomes of the clinical reasoning process and linked management and treatment plans.

LO4 - Contextualize clinical and diagnostic reasoning and decision-making with reference to the underpinning epidemiology, pathophysiology and clinical measurement whilst managing patient safety.

• Critical analysis of theoretical ideas related to clinical reasoning, problem solving, and advanced practice.
• Accessing and using a wide variety of information technology and related evidence-based resources.

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