The Effect of Structured Reflection on Nurse Practitioner Students' Diagnostic Reasoning Within Simulation: Qualitative Outcomes of a Mixed Methods Experiment.

• Structured reflection locates contradictory evidence to challenge initial assessments. • Students noted cognitive bias stemmed from their nursing experience. • Structured reflection used by NP students resulted in diagnostic justification. • Control NP students unknowingly used disconfirming elements of structured reflection. • Structured reflection can be added to current diagnostic reasoning education. Medical learners who use structured reflection demonstrated improved diagnostic accuracy. This has not been explored in nurse practitioner students. The qualitative purpose of the mixed methods intervention study was to understand how nurse practitioner students experience cognitive bias and their perception of structured reflection's utility to explain any diagnostic reasoning competency and accuracy changes within simulation. Qualitative description was used to explore themes. Structured reflection users noted its utility was diagnostic justification. Control participants did not identify using structured reflection but did note using its disconfirming elements for why they changed their initial diagnosis. Structured reflection education and application may build competency. [ABSTRACT FROM AUTHOR]