Publication Date


UMMS Affiliation

Graduate School of Nursing; Department of Surgery; Department of Family Medicine and Community Health

Document Type



Medical Education | Nursing


Objective: Nurse practitioner (NP) students at our graduate school of nursing use WISE-MDTM simulation modules in the curriculum. This prospective randomized controlled pilot study was undertaken to evaluate critical-thinking outcomes associated with adding metacognitive deliberate-reflection guidance to the learning strategy with WISE-MDTM simulation modules.

Methods: Of 33 NP students randomly assigned to intervention and control groups, 16 completed the study. The intervention group received WISE-MDTM learning modules with specific guidance or deliberate reflection. Controls used the modules with instructions for periodic free-thought reflections. Students’ tape-recorded reflections were categorized according to author-developed critical-thinking categories. Data were analyzed using NVIVOTM. Students’ feedback was collected by post-intervention anonymous survey.

Results: Critical thinking outcomes (student responses to exercises after free-thinking or deliberate-reflection guidance) did not differ between groups. However, the intervention group demonstrated a higher level of critical thought after deliberate-reflection guidance. Post-intervention quantitative and qualitative feedback from both groups endorsed the value of the WISE-MDTM modules for NP education.

Conclusions: Despite no difference in unprompted outcomes between groups, the intervention group often verbalized more thoughtful clinical decision-making. We speculate that the deliberate-reflection guidance intervention utilized with students throughout only two modules was insufficient for them to internalize the critical-thinking process. We propose using free-thought reflections with one or two WISE-MDTM modules to identify struggling students’ clinical decision-making process. These students’ remediation plan could include recording their deliberate-reflection process while viewing WISE-MDTM modules. Students would be guided to verbalize and record their critical-thinking processes for faculty review until students sufficiently integrate the process into their clinical decision-making.


WISE-MD, Deliberate reflection, Self-reflection, Think aloud, Critical thinking, Nurse practitioner students, Advanced health assessment

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Copyright the authors. This publication is open access and the publisher PDF is posted as allowed by the publisher's author rights policy at

DOI of Published Version



Terrien, J. M., Hale, J. F., Cahan, M., Quirk, M., Sullivan, K., Lewis, J. (2016). The impact of deliberate reflection with WISE-MDTM modules on critical thinking of nurse practitioner students: A prospective, randomized controlled pilot study. Journal of Nursing Education and Practice, 6(1), 55. DOI: 10.5430/jnep.v6n1p55. Link to article on publisher's website. Copyright the authors. This publication is open access and the publisher PDF is posted as allowed by the publisher's author rights policy at

Journal/Book/Conference Title

Journal of Nursing Education and Practice