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Nursing MCQ session

Nursing MCQ session

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  • 1. 1
    Some perspectives onMCQ assessment
    For School of Nursing and
    Midwifery July 2011
    Source: http://www.dreamstime.com/item.php?imageid=7299038
  • 2. 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. 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. 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. 5
    An alternative/pragmatic process
    Design
    Content/Face validity
    Use
    Construct validity
    Reliability
    Keep / Replace
  • 6. 6
    Design – unit assessment plan
  • 7. 7
    Design – MCQ test plan
  • 8. 8
    Design – NCLEX-RN MCQ test plan
    Source: 2010 NCLEX-RN® Detailed Test Plan
  • 9. 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. 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. 11
    BlackBoard Vista item analysis report
  • 12. 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. 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. 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. 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. 16
    A usefulresource?
    Source: https://www.ncsbn.org/1287.htm
  • 17. 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. 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. 19
    Design – NCLEX-RN MCQ test plan
  • 20. 20
    Detailedtest plan
  • 21. 21
    Detailedtest plan
  • 22. 22
    Sample items – management of care
    For each of the eight content areas a sample item is provided
  • 23. 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. 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. 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. 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. 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. 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. 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. 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. 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. 32
    Thank you for your time