DNP Scholarly Project

My project aimed to evaluate how this clinical reasoning workbook would impact the following outcome measures in new graduate APPs:

• Self-confidence in their clinical reasoning skills
• Practice efficiency
• Diagnostic competency

The organization that initiated this project is UCHealth, a top-ranking hospital system located on the Anschutz Medical Campus in Denver, Colorado.

UCHealth’s APP fellowship program is made up of three separate tracks consisting of surgery, surgical-critical care, and medical-critical care. The program is designed to assist the transition-to-practice of new graduate APPs and supports practicing APPs seeking to change their career focus. The fellowship provides specialized clinical rotations, didactic curriculum, and hands-on patient care experiences. Their mission is to prepare, educate, and integrate APPs that will be able to operate at a high level of autonomy within their chosen specialty.

This project addressed gaps in clinical reasoning skills that were identified among novice APPs entering UCHealth’s fellowship program. Notable deficits in novice APP capabilities included:

• Limited ability to generate comprehensive differential diagnoses
• Obtain pertinent clinical data
• Synthesize succinct and accurate problem representations
• Refine differentials
• Prioritize necessary vs unnecessary diagnostics 

A root‑cause analysis revealed contributing factors such as limited prior training, high‑acuity clinical environments, and lack of educational resources and evaluation tools.

A SWOT analysis highlighted strong preceptor support and motivated APP fellows, but also noted challenges related to clinical workload and variable teaching styles. 

Based on this needs assessment, a paper‑based clinical reasoning workbook was developed using evidence‑based strategies that included case‑based learning, reflective practice, illness scripts, and diagnostic schemas to build foundational clinical reasoning skills (Corrao & Argano, 2022; Dekhtyar et al., 2021; Griffith et al., 2023; Moghadami et al., 2021; Yamada et al., 2024).  

The workbook was distributed to two cohorts of APP fellows that included the Spring 2024 and Fall 2025 cohorts which allowed for a total of 11 APP fellows to be evaluated. All APP fellows participated in pre and post surveys that evaluated their self-confidence in clincial reasoning and practice efficiency while their diagnostic performance was assessed by their preceptors.