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Nursing MCQ session

Nursing MCQ session

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    Sp110623 Sp110623 Presentation Transcript

    • 1
      Some perspectives onMCQ assessment
      For School of Nursing and
      Midwifery July 2011
      Source: http://www.dreamstime.com/item.php?imageid=7299038
    • 2
      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)
    • 3
      General thoughts
      MCQs can be a useful element of an overall assessment design
      Can’t be abstracted from the context
      No marks / diagnostic / formative / interactive
      Few marks / semi-formative / assignment
      High stakes / summative / examination
      Design and evaluation approach should be appropriate for the context
    • 4
      A proposed MCQ process
      From: Considine, J; Botti, M and Thomas, S. Design, format, validity and reliability of multiple choice questions
      for use in nursing research and education. Collegian, 2005 Jan; 12 (1): 19-24.
    • 5
      An alternative/pragmatic process
      Design
      Content/Face validity
      Use
      Construct validity
      Reliability
      Keep / Replace
    • 6
      Design – unit assessment plan
    • 7
      Design – MCQ test plan
    • 8
      Design – NCLEX-RN MCQ test plan
      Source: 2010 NCLEX-RN® Detailed Test Plan
    • 9
      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
    • 10
      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
    • 11
      BlackBoard Vista item analysis report
    • 12
      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
    • 13
      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.”
    • 14
      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
    • 15
      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
    • 16
      A usefulresource?
      Source: https://www.ncsbn.org/1287.htm
    • 17
      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.”
    • 18
      NCLEX-RN test plan structure
      Safe and Effective Care Environment
      Management of Care
      Safety and Infection Control
      Health Promotion and Maintenance
      Psychosocial Integrity
      Physiological Integrity
      Basic Care and Comfort
      Pharmacological and Parenteral Therapies
      Reduction of Risk Potential
      Physiological Adaptation
    • 19
      Design – NCLEX-RN MCQ test plan
    • 20
      Detailedtest plan
    • 21
      Detailedtest plan
    • 22
      Sample items – management of care
      For each of the eight content areas a sample item is provided
    • 23
      Steps in item writing
      Select an area of the test plan for the focus of the item
      Select a subcategory from the chosen area of the test plan
      Select an important concept within that subcategory
      Use the concept selected and write the stem
      Write a key to represent important information the entry-level nurse should know
      Identify common errors, misconceptions or irrelevant information
      Use the previous information and write the distracters
      Complete the item using the stem, key and distracters
    • 24
      Steps in item writing - example
      Step 1. Select an area of the test plan for the focus of the item
      Safety and Infection Control
      Step 2. Select a subcategory from the chosen area of the test plan
      Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
      Step 3. Select an important concept within that subcategory
      Evaluate infection control precautions implemented by staff members
    • 25
      Steps in item writing - example
      Step 4. Use the concept selected and write the stem
      The 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 know
      Contact Isolation: Assisting the client to ambulate in the hallway
    • 26
      Steps in item writing - example
      Step 6. Identify common errors, misconceptions or irrelevant information
      Lack of understanding of isolation precautions
      Uncertainty related to specific diagnosis
      Step 7. Use the previous information and write the distracters
      Leaving a blood pressure cuff in the client’s room to be used by the client only
      Putting on a protective gown to assist the client to sit in a chair
      Taking the gloves off before leaving the client’s room
    • 27
      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?
      Leaving a blood pressure cuff in the client’s room to be used by that client only
      Putting on a protective gown to assist the client to sit in a chair
      Taking the gloves off before leaving the client’s room
      Assisting the client to ambulate in the hallway (key)
    • 28
      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.
    • 29
      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?
      blood pressure increase from 103/68 to 110/70 over the past one hour
      blood urea nitrogen (BUN), 22 mg/dL (key)
      pulse, 101
      decrease in respiratory rate from 18 to 16 over the past one hour
    • 30
      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.
    • 31
      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?
      Remove other clients from the area.
      Escort the client back to the client’s room.
      Request that the client be quiet and not disrupt others.
      Use distraction to re-focus the client to reality. (key)
    • 32
      Thank you for your time