test writing strategies
Alexandra Kaduc RN, BSN, CCRN
TinaMarie Cieri, RN, BSN
Kelly McCabe RN, BSN
Norvella Hill RN, BSN
Jennifer Austin RN, BSN
Norm-referenced tests (NRTs) are tests that rank a student’s performance on a the test in relation to other students that have taken the same test, and are based on a measurement of content according to certain specifications that have been predetermined (Billings & Halstead, 2012; Ebert & Scott, 2014; Ricketts, 2009). An example of an NRT is the Test of Essential Academic Skills (TEAS) used as an entrance examination into many schools of practical nursing. The Scholastic Aptitude Test (SAT) is another example of an NRT and is used by many colleges to determine the possible success of the admitted student in college. Generally the results of these tests are shown in percentages and are useful in determining a student’s performance among other students and can be used for grading purposes (Billings & Halstead, 2012).
Criterion-referenced test (CRTs) determine the individual students performance compared to set criteria or learning outcome and measures or determines if the tester has met a certain skill set (Billings & Halstead, 2012; Ebert & Scott, 2014; Ricketts, 2009). An example of CRT is the National Council Licensure Examination (NCLEX) for nursing. This examination is a pass or fail based on the examiner meeting certain predetermined criteria based on a mastery of skills or content. A CRT is a beneficial way to measure and determine a student’s master of certain skills or subject matter (Billings & Halstead, 2012). According to Billings & Halstead (2012) CRTs are often used to determine a level of safety in nursing education for example calculation drug dosages.
This link provides access to a test writing guide that can serve as a rich resource to the nurse educator as it provides detailed information on how to properly and effectively plan a test, details related to multiple-choice test item development, true-false test item information, matching test item components, fill-in-the-blank test item information, and essay test item instructions. It also provides valuable tips and information related to the construction of an exam in addition to information on authentic assessments and the development of grading rubrics. Additionally, it incorporates charts containing information on both the cognitive and affective domains to help educators select the key words to utilize when creating objectives, assignments, and evaluations to ensure that the proper level of bloom's taxonomy is reflected in the testing strategy chosen.
For more information on how to write effective multiple choice test questions, this link provides insight on how to formulate effective stems to multiple choice test question as well as information regarding inclusion of effective alternatives and additional guidelines for the development of multiple choice test questions. There is also information on how to write multiple choice test questions and tips that help educators ensure that the test questions reflect the student learning objectives of the course.
Lastly, as a resource to utilize when comparing and contrasting the advantages/disadvantages of various testing formats, this link provides access to a quick reference for descriptions of the various formats and includes tips to utilize when creating each type.
Bloom’s taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom, et al., 1956; Anderson & Krathwohl, 2001). Since the practice of nursing requires application of knowledge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing (NCSBN, 2013).
Test Plan Structure:
The framework of Client Needs was selected for the examination because it provides a universal structure for e. nursing actions and competencies, and focuses on clients in all settings (NCSBN, 2013).
Client Needs:
The content of the NCLEX-RN Test Plan is organized into four major client needs categories. Two of the four categories are divided into subcategories: (NCSBN, 2013).
1.Safe and Effective Care Environment
a. Management of care
b. Safety and Infection control
2. Health Promotion and Maintenance
3. Psychosocial Integrity
4. Physiological Integrity
a. Basic care and comfort
b. Pharmacological and parenteral therapies
c. Reduction of risk potential
d. Physiological adaptation
Types of test questions utilized in the NCLEX:
All registered nurse candidates must answer a minimum of 75 items. The maximum number of items that a registered nurse candidate may answer is 265 during the allotted six-hour time period. Candidates may be administered multiple choice items as well as items written in alternate formats (NCSBN, 2013).These formats may include but are not limited to multiple response, fill-in-the-blank calculation, ordered response, and/or hot spots. All item types may include multimedia such as charts, tables, graphics, sound and video (NCSBN, 2013). All items go through an extensive review process before being used as items on the examination (NCSBN, 2013).
A recent and relevant article on testing in pre-licensure nursing education:
Spurlock, D. J. (2006). Do no harm: progression policies and high-stakes testing in nursing education. The Journal Of Nursing Education, 45(8), 297-302.
This article discusses the use of progression policies by many educational institutions where nursing students are given a predictive exit examination (an exam which evaluates the likelihood of a nursing student to pass the NCLEX exam), and based on that outcome, the nursing student is either A-permitted to complete the program, or B-hindered from completing the program and thereby prevented from taking the NCLEX. This ensures that the schools licensure pass rates remain favorable. A study was done and outcomes were evaluated to determine whether or not high-stakes testing was of a benefit or did it prove to have negative consequences. It was determined that a students progression and graduation from a program should not solely be determined by the examination alone but other factors should be considered such as other evidence which adds to the overall picture of the student. It was determined that nursing programs responsibilities includes providing a solid nursing educational foundation which prepares the student to practice nursing, and the preparation for the NCLEX should be a part of the nursing assessment within the program but not the deciding factor. It was also determined that a greater focus should be placed on providing the students with the best educational background as possible with ongoing evaluation at the teaching and learning process at all stages throughout the curriculum, this will greatly decrease the need for and use of progression policies in nursing programs.
A second recent and relevant article on testing in pre-licensure nursing education and the connection between testing and preparation for success with the NCLEX examination:
Carr, S.M. (2011). Nclex-rn pass rate peril: One school’s journey through curriculum revision, standardized testing, and attitudinal change. Nursing Education Perspectives, 32(6), 384-388.
This article describes one nursing school’s journey of improving their nursing graduate’s NCLEX-RN pass rates. This process involved curriculum revision, changes in testing/remediation requirements, and development of NCLEX review courses. Curriculum Assessment Tools (CAT) were used to identify weaknesses in the existing curriculum, and then changes were made courses in order to improve areas such as infection control, psychosocial integrity, physiologic integrity, basic care and comfort, pharmacological and parenteral therapies, cultural implications, and the nursing process. Faculty members were trained in NCLEX-RN requirements and test-question writing strategies. The school also developed and modified their NCLEX review course for senior-level nursing students. These various changes in curriculum and testing modifications (over the course of approximately four years) increased the school’s NLCLEX pass-rates from 73.2 percent to 95 percent.
References
Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis, MO: Elsevier.
Carr, S.M. (2011). Nclex-rn pass rate peril: One school’s journey through curriculum revision, standardized testing, and attitudinal change. Nursing Education Perspectives, 32(6), 384-388.
Ebert, K. D., & Scott, C. M. (2014). Relationships between narrative language samples and norm-referenced test scores in language assessments of school-age children. Language, Speech, and Hearing Services in Schools, 45,337-350.
National Council of State Boards of Nursing, (2013). NCLEX-RN Test Plan. Retrieved from:https://www.ncsbn.org/nclex.htm
Ricketts, C. (2009). A plea for the proper use of criterion-referenced tests in medical assessment. Medical Education, 43, 1141-1146. http://dx.doi.org/10.1111/j.1365-2923.2009.03541.x
Spurlock, D. J. (2006). Do no harm: progression policies and high-stakes testing in nursing education. The Journal Of Nursing Education, 45(8), 297-302.
Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis, MO: Elsevier.
Carr, S.M. (2011). Nclex-rn pass rate peril: One school’s journey through curriculum revision, standardized testing, and attitudinal change. Nursing Education Perspectives, 32(6), 384-388.
Ebert, K. D., & Scott, C. M. (2014). Relationships between narrative language samples and norm-referenced test scores in language assessments of school-age children. Language, Speech, and Hearing Services in Schools, 45,337-350.
National Council of State Boards of Nursing, (2013). NCLEX-RN Test Plan. Retrieved from:https://www.ncsbn.org/nclex.htm
Ricketts, C. (2009). A plea for the proper use of criterion-referenced tests in medical assessment. Medical Education, 43, 1141-1146. http://dx.doi.org/10.1111/j.1365-2923.2009.03541.x
Spurlock, D. J. (2006). Do no harm: progression policies and high-stakes testing in nursing education. The Journal Of Nursing Education, 45(8), 297-302.