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Some perspectives onMCQ assessment

For School of Nursing and

Midwifery July 2011

Source: http://www.dreamstime.com/item.php?imageid=7299038

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Assessment generally

“Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer.”

Charles Caleb Colton (1780 - 1832)

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General thoughts

MCQs can be a useful element of an overall assessment design

Can’t be abstracted from the contextNo marks / diagnostic / formative / interactive

Few marks / semi-formative / assignment

High stakes / summative / examination

Design and evaluation approach should be appropriate for the context

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A proposed MCQ process

From: Considine, J; Botti, M and Thomas, S. Design, format, validity and reliability of multiple choice questionsfor use in nursing research and education. Collegian, 2005 Jan; 12 (1): 19-24.

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An alternative/pragmatic processDesign

Content/Face validity

Use

Construct validity

Reliability

Keep / Replace

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Design – unit assessment plan

Assignment No. Assignment details Marks

1 Introduction to DSO 3 %

2 Information literacy & the Library 5 %

3 Referencing 10 %

4 Professional ethics report 15 %

5 Multi-choice test 1 6 %

6 Multi-choice test 2 6 %

7 Major report and presentation 25 %

Exam Must pass! 30 %

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Design – MCQ test plan

ContentAreas

Processes

1. Knowledge 2. Comprehension 3. Application %

A 3.75% 5.25% 6% 15

B 6.25% 8.75% 10% 25

C 3.75% 5.25% 6% 15

D 7.5% 10.5% 12% 30

E 3.75% 5.25% 6% 15

% 25 35 40 100

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Design – NCLEX-RN MCQ test plan

Source: 2010 NCLEX-RN® Detailed Test Plan

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Face validity

A sub-set of content validity

Use an ‘expert panel’ to : assess item clarity assess item readability assess consistency of style check for errors

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Construct validity

Key check – do ‘experts’ agree on the correct answer?

Item difficulty – the proportion of examinees that get the correct answer

Distracter evaluation

Item discrimination – the ability of an item to distinguish between knowledgeable students and others

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BlackBoard Vista item analysis report

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Review of items

Where items have been developed based on a systematic test plan and good content validity, they should only be discarded on the basis of clearly poor construct validity and reliability

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MCQ Feedback

Butler and Roediger (2008) found that:

“In comparison with the no-feedback condition, both immediate and delayed feedback increased the proportion of correct responses and reduced the proportion of intrusions (i.e., lure responses from the initial multiple-choice test) on a delayed cued recall test.

Educators should provide feedback when using multiple-choice tests.”

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MCQ Feedback – strategies

Provide consolidated feedback after the test has been completed

Explanation of why the key is correct

Explanation of why a distracter is incorrect

Explanation of the general reasoning associated with an item

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MCQ Feedback – strategies

Directing students to associated resources – text chapters/sections/pages, etc.

Providing a run-through/de-brief in class after the test

Randomisation of MCQ presentation to counter rote learning of ‘saved’ tests

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A usefulresource?

Source: https://www.ncsbn.org/1287.htm

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Development of the NCLEX-RN Test Plan

“A total of 12,000 newly licensed RNs are asked about the frequency and importance of performing 155 nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice that incorporates specific client needs, as well as processes fundamental to the practice of nursing.”

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NCLEX-RN test plan structure

Safe and Effective Care EnvironmentManagement of CareSafety and Infection Control

Health Promotion and Maintenance

Psychosocial Integrity

Physiological IntegrityBasic Care and ComfortPharmacological and Parenteral TherapiesReduction of Risk PotentialPhysiological Adaptation

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Design – NCLEX-RN MCQ test plan

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Detailedtest plan

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Detailedtest plan

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Sample items – management of care

For each of the eight content areas a sample item is provided

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Steps in item writing

1. Select an area of the test plan for the focus of the item

2. Select a subcategory from the chosen area of the test plan

3. Select an important concept within that subcategory

4. Use the concept selected and write the stem

5. Write a key to represent important information the entry-level nurse should know

6. Identify common errors, misconceptions or irrelevant information

7. Use the previous information and write the distracters

8. Complete the item using the stem, key and distracters

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Steps in item writing - example

Step 1. Select an area of the test plan for the focus of the itemSafety and Infection Control

Step 2. Select a subcategory from the chosen area of the test planStandard Precautions/Transmission-Based Precautions/Surgical Asepsis

Step 3. Select an important concept within that subcategoryEvaluate infection control precautions implemented by staff members

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Steps in item writing - example

Step 4. Use the concept selected and write the stemThe nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following activities by the nursing assistant would require immediate follow-up?

Step 5. Write a key to represent important information the entry-level nurse should knowContact Isolation: Assisting the client to ambulate in the hallway

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Steps in item writing - example

Step 6. Identify common errors, misconceptions or irrelevant informationLack of understanding of isolation precautionsUncertainty related to specific diagnosis

Step 7. Use the previous information and write the distractersLeaving a blood pressure cuff in the client’s room to be used by the client onlyPutting on a protective gown to assist the client to sit in a chairTaking the gloves off before leaving the client’s room

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Steps in item writing - example

Step 8. Complete the item using the stem, key and distracters

The nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following actions performed by the nursing assistant would require immediate follow-up from the nurse?

a. Leaving a blood pressure cuff in the client’s room to be used by that client only

b. Putting on a protective gown to assist the client to sit in a chair

c. Taking the gloves off before leaving the client’s room

d. Assisting the client to ambulate in the hallway (key)

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Case scenario exercise

Reduction of Risk Potential

The nurse is caring for client who had a procedure three hours ago. Write an item that includes assessment data the nurse would observe in this client and which data should the nurse respond to first.

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Reduction of Risk Potential – model

The nurse is caring for a client who had a cardiac catherization 3 hours ago. Which of the following findings would be essential for the nurse to follow-up?

a. blood pressure increase from 103/68 to 110/70 over the past one hour

b. blood urea nitrogen (BUN), 22 mg/dL (key)

c. pulse, 101

d. decrease in respiratory rate from 18 to 16 over the past one hour

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Case scenario exercise

Psychosocial Integrity

A nurse on an inpatient psychiatric unit observes a client pacing the hallway, mumbling and occasionally yelling aloud “Stop it!” Write an item describing the action the nurse should take in this situation.

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Psychosocial Integrity – model MCQ

The nurse is caring for a client who is mumbling, pacing in the hallway, and occasionally yelling “Stop it!” Which of the following actions should the nurse take?

a. Remove other clients from the area.

b. Escort the client back to the client’s room.

c. Request that the client be quiet and not disrupt others.

d. Use distraction to re-focus the client to reality. (key)

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Thank you for your time