title: The impact of tutorial strategies on student nurses' accuracy in diagnostic reasoning in different educational settings: a double pragmatic trial in Italy.
abstract: BACKGROUND
  Italian Nursing Faculties use a range of tutorial strategies (laboratory sessions, intensive clinical tutoring, weekly tutoring) aimed to enhance nursing students' diagnostic reasoning: these strategies have different impacts on promoting student critical thinking. By using critical thinking methods, students develop abilities to check, monitor and constantly evaluate the accuracy of the diagnostic reasoning process. However, there is little evidence to show how effective tutorial strategies are on the accuracy of diagnostic reasoning. There is also very little known about the complexity of tutorial strategies because these are made up of several components (e.g. tutor questioning abilities, the value of the setting, the impact of the environment, the expertise of the tutor and the impact of the Faculty's philosophy of learning), tutorial strategies cannot be standardised and depend on multiple factors which are difficult to control.
  
  
  OBJECTIVE
  The objective was to establish a relationship between tutorial strategies orientated to enhance critical thinking and the accuracy of diagnostic reasoning (i.e. the number of correct answers given by students on simulated cases in two different nursing education contexts). It was hypothesised that students who had had one laboratory session using intensive tutorial strategies had less probability of making reasoning errors in diagnosing a simulated case than a control group that had weekly tutorials or routine tutoring.
  
  
  METHODS
  A double pragmatic experimental study was adopted involving two Italian Nursing Faculties at universities in Verona and Udine.
  
  
  METHODS
  A total of 144 students in the first year of their Nursing Science Degree course were involved; in Verona, two random groups of 41 students were taken (an intervention group and a control group). Random selections of 39 students for the intervention group and 29 students for a control group were made from the second campus in Udine. Data analysis was conducted comparing student outcomes in the same faculty (intra-trial analysis) and between the two campuses involved (inter-trial analysis).
  
  
  RESULTS
  The students doing laboratory sessions and intensive clinical tutorials demonstrated fewer errors compared to the control group [OR 3.75; IC 95% 1.77-7.88], although the students who receive routine tutoring, demonstrated higher risk of mistaking the problems of the patient [OR 0.22; IC 0.95% 0.07-0.65].
  
  
  CONCLUSIONS
  From intra- and inter-trial analysis of the results, it can be concluded within limits, that those students who had had intensive tutorial strategies aimed developing critical thinking abilities, formulated fewer wrong hypotheses in the first list they made when confronted with a new nursing case. Faculties should consider these outcomes and develop strategies including intensive tutorial strategies for improving the accuracy of nursing students' clinical reasoning.
authors.affiliation: School of Nursing, University of Udine, Italy. alvisa.palese@uniud.it
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
authors.forename: Anna
authors.initials: A
authors.lastname: Brugnolli
authors.forename: Laura
authors.initials: L
authors.lastname: Regattin
mesh_terms: D006801:Humans; D007558:Italy; D009733:Nursing Diagnosis; D013338:Students, Nursing