How one online NP program uses AI simulation for clinical reasoning
There's a problem keeping many NP program directors up at night and it's not the one you might expect.
At Missouri Baptist University's fully online, asynchronous MSN program, Dr. Bryanna Scherer, Assistant Professor of Nursing and Simulation Coordinator (DNP, APRN, AGNP-C, CHSE), watched it unfold in real time. Watch her full testimonial and read the transcript here. As generative AI tools became embedded in everyday academic life, a troubling pattern emerged: students completing assignments without deeply engaging with the clinical reasoning those assignments were designed to build. “In the age of AI, we saw a lot of challenges…with students maybe not being as engaged in that learning and maybe becoming reliant on AI use to approach that case.”
For NP education, clinical reasoning is a core competency. Missouri Baptist's response wasn't to try to wall AI out. It was to fight fire with fire.
The structural challenge: Why online NP programs struggle to assess clinical reasoning
In a fully online NP program, faculty face a fundamental visibility gap. Students complete their clinical practicum with local preceptors who observe patient interactions and coach clinical judgment, but the institution's faculty are largely working from secondhand reports.
Simulation changes that. Done well, it gives faculty a direct window into how a student reasons through a patient encounter: how they gather a history, what they look for on a physical exam, how they build and refine a differential. It's why AI simulation for clinical reasoning in NP education is gaining traction; it surfaces clinical judgment in a way traditional written assignments simply can't.
From static case studies to interactive clinical reasoning: what changed
Before adopting DDx, Missouri Baptist used written case study discussions. The problem wasn't the concept; it was the execution.
Static assignments create static engagement:
- Students work through a scenario at their own pace
- They submit a polished answer with no visibility into how they got there
- In the age of generative AI, there's no guarantee the reasoning happened at all
DDx changed the dynamic. Rather than asking for a response to a scenario, it walks students through a patient encounter step by step — history, physical exam, differential diagnosis, management decisions — requiring active engagement at each stage before moving to the next.
“Each step is set up very sequentially. Students reevaluate their differential diagnoses throughout the whole process.” - Scherer
Instead of producing a finished answer, students have to think out loud. The platform captures every step.
A two-track approach: How DDx by Sketchy supports both learning and clinical assessment
Missouri Baptist uses DDx in two distinct ways:
In didactic courses — low-stakes learning
- One case per week, aligned to course learning objectives
- Hint features enabled, adaptive feedback on
- Goal is exploration: build diagnostic reasoning in a supported environment
"Those are designed to be low stakes activities. So students have full access to the hint features." - Scherer
In practicum courses — high-stakes assessment
- DDx powers both the midterm and final (the "exit ticket" for practicum)
- Test mode: hints off, no guidance, students rely entirely on what they know
"It is truly set up to be in test mode where it is a direct reflection of their application of their knowledge." - Scherer
The result is a coherent progression: supported exploration early, authentic demonstration later. Assessments reflect actual clinical readiness not the ability to produce a convincing written response.
What DDx delivers: For students and faculty
For students: engagement that goes beyond compliance
- Adaptive feedback creates an immediate loop; students don't wait days for a grade; they get feedback while the patient encounter is still unfolding
- A built-in gamification element (working toward visible key findings) creates momentum and progress
- Many students voluntarily replay cases after completion
One student's verdict: "Sketchy is 10 out of 10." - Scherer
For faculty: visibility into how students actually think
- Cohort-level analytics show exactly where clinical reasoning breaks down (history-taking, physical exam, differential) not just who passed or failed
- Individual performance breakdowns and downloadable case transcripts create an evidence trail
- When a preceptor raises concerns, faculty can cross-reference simulation data to build a targeted remediation plan
"I can see if my students all overwhelmingly struggled with the history portion… that gives me really great data to know this is a spot where I need to tailor some additional education." - Scherer
How Missouri Baptist integrated DDx into the curriculum
Faculty adoption is often the hardest part of any curriculum change, and the Missouri Baptist team benefited from direct support in mapping DDx to their existing curriculum. The DDx team helped with integration planning, case selection, and platform setup, including providing a sample curriculum integration map that gave faculty a concrete starting point.
The platform's case library is filterable by system and clinical setting, and faculty can preview case objectives, key findings, and differentials before assigning them. Cases can also be calibrated to learner level — truncated for students earlier in the program, more expansive as their knowledge deepens — creating what amounts to an unfolding case experience across the curriculum.
What this means for your online NP program
That's the core case for AI simulation in NP education — not replacing clinical judgment, but making it visible. The question isn't whether students will use AI. It's whether educators can create learning experiences where the reasoning process matters too much to outsource.
As Scherer frames it: “Sketchy leverages AI in a way that makes the learning engaging… it almost combats AI use by using AI.”
For online NP programs navigating this moment, the takeaway is practical: the challenge isn't just delivering content. It's making student thinking visible. And NP programs finding their footing are the ones investing in tools that let them see how their students reason, not just what they produce.
“We're able to see the growth in their clinical reasoning and their clinical judgment as they work through these cases.”
See how Sketchy DDx uses AI simulation to strengthen clinical reasoning across your NP curriculum.
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Dr. Bryanna Scherer, DNP, APRN, AGNP-C, CHSE | Assistant Professor of Graduate Nursing & Simulation Coordinator | Missouri Baptist University
Dr. Scherer leads simulation integration across MBU's fully online MSN program, with a focus on using AI-powered tools to strengthen clinical reasoning in NP education.
