In nurse practitioner education, the delivery of didactic content in traditional face-to-face classrooms has become less common. In many cases, face-to-face classroom instruction has been either partially or wholly replaced by distance learning, with or without computer based learning technologies. Further, as more nurse practitioner courses are delivered in this way, there is a movement to teach diagnostic reasoning and clinical skills with interactive computer based case study simulations. While the use of distance education to deliver didactic content in graduate nursing programs has been shown to be effective in face-to-face delivery, studies that show the effectiveness of computer based case study simulations in graduate nursing programs are sparse. The purpose of this study was to examine the effect of computer based case study simulations on declarative knowledge and clinical performance. Spiro, Feltovich and Coulson's Cognitive Flexibility Theory (1992) served as the theoretical framework for this study.

In order to examine the effect of a computer based case study simulation on nurse practitioner students' declarative knowledge and clinical performance, and experimental design was used. Study participants were drawn from two Midwestern university nurse practitioner programs in the United States. While all participants listened to online lectures with identical content, one group completed an online, text based case study and the other group completed a computer simulated case study. Following completion of the case studies, both groups of students took identical multiple choice posttest items and were observed in clinical performance testing situations with a standardized patient. ANCOVAs, and ANOVAs were used for data analysis.

The results of this study revealed that there was no difference in either declarative knowledge or clinical performance between those students who completed a text based case study and those students who completed a computer simulated case study. Based on the outcome of this study, it was determined that the media used in content presentation is less important than the pedagogy and design used in the presentation. The results of this study can be used to justify the use of computer simulated case studies in the instruction of diagnostic reasoning in nurse practitioner programs.