Reflecting on diagnosis: The Metacognitive Diagnostic Reasoning Model©

Document Type

Journal Article

Publication Date



Journal of the American Association of Nurse Practitioners




BACKGROUND: Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research. PURPOSE: To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model©. METHODOLOGY: A review of the literature through systematic database search, historical articles, texts, and documents was conducted from inception through August 2023 (N = 41). RESULTS: The MDR model depicts the following concepts: (1) metacognition is viewed as the driving force of diagnostic reasoning; (2) dual cognitive processing and knowledge representations are used; (3) once a diagnosis, treatment plan, and evaluation are complete, APRNs use metacognition for the next patient encounter, using repetition for improvement of the process. CONCLUSIONS: The model combines key concepts of diagnostic reasoning, providing a framework for researchers to develop and test, and faculty to teach and evaluate this complex process in learners. IMPLICATIONS: The MDR model provides research opportunities to validate its usefulness and effectiveness and a framework to guide educational research, contributing to the body of evidence-based practice in nursing. In addition, it may foster ongoing education and training that could lead to more accurate diagnoses and treatment plans, ultimately improving patient care by reducing diagnostic errors.


Nursing Faculty Publications