1<br />Some perspectives onMCQ assessment<br />For School of Nursing and<br />Midwifery July 2011<br />Source: http://www....
2<br />Assessment generally<br />“Examinations are formidable even to the best prepared, for the greatest fool may ask mor...
3<br />General thoughts<br />MCQs can be a useful element of an overall assessment design<br />Can’t be abstracted from th...
4<br />A proposed MCQ process<br />From: Considine, J; Botti, M and Thomas, S. Design, format, validity and reliability of...
5<br />An alternative/pragmatic process<br />Design<br />Content/Face validity<br />Use<br />Construct validity<br />Relia...
6<br />Design – unit assessment plan <br />
7<br />Design – MCQ test plan<br />
8<br />Design – NCLEX-RN MCQ test plan<br />Source: 2010 NCLEX-RN® Detailed Test Plan<br />
9<br />Face validity<br />A sub-set of content validity<br />Use an ‘expert panel’ to :<br />assess item clarity<br />asse...
10<br />Construct validity<br />Key check – do ‘experts’ agree on the correct answer?<br />Item difficulty – the proportio...
11<br />BlackBoard Vista item analysis report<br />
12<br />Review of items<br />Where items have been developed based on a systematic test plan and good content validity, th...
13<br />MCQ Feedback<br />Butler and Roediger (2008) found that:<br />“In comparison with the no-feedback condition, both ...
14<br />MCQ Feedback – strategies<br />Provide consolidated feedback after the test has been completed<br />Explanation of...
15<br />MCQ Feedback – strategies<br />Directing students to associated resources – text chapters/sections/pages, etc.<br ...
16<br />A usefulresource?<br />Source: https://www.ncsbn.org/1287.htm<br />
17<br />Development of the NCLEX-RN Test Plan<br />“A total of 12,000 newly licensed RNs are asked about the frequency and...
18<br />NCLEX-RN test plan structure<br />Safe and Effective Care Environment<br />Management of Care<br />Safety and Infe...
19<br />Design – NCLEX-RN MCQ test plan<br />
20<br />Detailedtest plan<br />
21<br />Detailedtest plan<br />
22<br />Sample items – management of care<br />For each of the eight content areas a sample item is provided<br />
23<br />Steps in item writing<br />Select an area of the test plan for the focus of the item<br />Select a subcategory fro...
24<br />Steps in item writing - example<br />Step 1. Select an area of the test plan for the focus of the item<br />Safety...
25<br />Steps in item writing - example<br />Step 4. Use the concept selected and write the stem<br />The nurse and nursin...
26<br />Steps in item writing - example<br />Step 6. Identify common errors, misconceptions or irrelevant information<br /...
27<br />Steps in item writing - example<br />Step 8. Complete the item using the stem, key and distracters<br />The nurse ...
28<br />Case scenario exercise<br />Reduction of Risk Potential<br />The nurse is caring for client who had a procedure th...
29<br />Reduction of Risk Potential – model<br />The nurse is caring for a client who had a cardiac catherization 3 hours ...
30<br />Case scenario exercise<br />Psychosocial Integrity<br />A nurse on an inpatient psychiatric unit observes a client...
31<br />Psychosocial Integrity – model MCQ<br />The nurse is caring for a client who is mumbling, pacing in the hallway, a...
32<br />			Thank you for your time<br />
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Nursing MCQ session

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  1. 1. 1<br />Some perspectives onMCQ assessment<br />For School of Nursing and<br />Midwifery July 2011<br />Source: http://www.dreamstime.com/item.php?imageid=7299038<br />
  2. 2. 2<br />Assessment generally<br />“Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer.”<br /> Charles Caleb Colton (1780 - 1832)<br />
  3. 3. 3<br />General thoughts<br />MCQs can be a useful element of an overall assessment design<br />Can’t be abstracted from the context<br />No marks / diagnostic / formative / interactive<br />Few marks / semi-formative / assignment<br />High stakes / summative / examination<br />Design and evaluation approach should be appropriate for the context<br />
  4. 4. 4<br />A proposed MCQ process<br />From: Considine, J; Botti, M and Thomas, S. Design, format, validity and reliability of multiple choice questions<br />for use in nursing research and education. Collegian, 2005 Jan; 12 (1): 19-24.<br />
  5. 5. 5<br />An alternative/pragmatic process<br />Design<br />Content/Face validity<br />Use<br />Construct validity<br />Reliability<br />Keep / Replace<br />
  6. 6. 6<br />Design – unit assessment plan <br />
  7. 7. 7<br />Design – MCQ test plan<br />
  8. 8. 8<br />Design – NCLEX-RN MCQ test plan<br />Source: 2010 NCLEX-RN® Detailed Test Plan<br />
  9. 9. 9<br />Face validity<br />A sub-set of content validity<br />Use an ‘expert panel’ to :<br />assess item clarity<br />assess item readability<br />assess consistency of style<br />check for errors<br />
  10. 10. 10<br />Construct validity<br />Key check – do ‘experts’ agree on the correct answer?<br />Item difficulty – the proportion of examinees that get the correct answer<br />Distracter evaluation<br />Item discrimination – the ability of an item to distinguish between knowledgeable students and others<br />
  11. 11. 11<br />BlackBoard Vista item analysis report<br />
  12. 12. 12<br />Review of items<br />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<br />
  13. 13. 13<br />MCQ Feedback<br />Butler and Roediger (2008) found that:<br />“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.<br />Educators should provide feedback when using multiple-choice tests.”<br />
  14. 14. 14<br />MCQ Feedback – strategies<br />Provide consolidated feedback after the test has been completed<br />Explanation of why the key is correct<br />Explanation of why a distracter is incorrect<br />Explanation of the general reasoning associated with an item<br />
  15. 15. 15<br />MCQ Feedback – strategies<br />Directing students to associated resources – text chapters/sections/pages, etc.<br />Providing a run-through/de-brief in class after the test<br />Randomisation of MCQ presentation to counter rote learning of ‘saved’ tests<br />
  16. 16. 16<br />A usefulresource?<br />Source: https://www.ncsbn.org/1287.htm<br />
  17. 17. 17<br />Development of the NCLEX-RN Test Plan<br />“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.”<br />
  18. 18. 18<br />NCLEX-RN test plan structure<br />Safe and Effective Care Environment<br />Management of Care<br />Safety and Infection Control<br />Health Promotion and Maintenance<br />Psychosocial Integrity<br />Physiological Integrity<br />Basic Care and Comfort<br />Pharmacological and Parenteral Therapies<br />Reduction of Risk Potential<br />Physiological Adaptation<br />
  19. 19. 19<br />Design – NCLEX-RN MCQ test plan<br />
  20. 20. 20<br />Detailedtest plan<br />
  21. 21. 21<br />Detailedtest plan<br />
  22. 22. 22<br />Sample items – management of care<br />For each of the eight content areas a sample item is provided<br />
  23. 23. 23<br />Steps in item writing<br />Select an area of the test plan for the focus of the item<br />Select a subcategory from the chosen area of the test plan<br />Select an important concept within that subcategory<br />Use the concept selected and write the stem<br />Write a key to represent important information the entry-level nurse should know<br />Identify common errors, misconceptions or irrelevant information<br />Use the previous information and write the distracters<br />Complete the item using the stem, key and distracters<br />
  24. 24. 24<br />Steps in item writing - example<br />Step 1. Select an area of the test plan for the focus of the item<br />Safety and Infection Control<br />Step 2. Select a subcategory from the chosen area of the test plan<br />Standard Precautions/Transmission-Based Precautions/Surgical Asepsis<br />Step 3. Select an important concept within that subcategory<br />Evaluate infection control precautions implemented by staff members<br />
  25. 25. 25<br />Steps in item writing - example<br />Step 4. Use the concept selected and write the stem<br />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?<br />Step 5. Write a key to represent important information the entry-level nurse should know<br />Contact Isolation: Assisting the client to ambulate in the hallway<br />
  26. 26. 26<br />Steps in item writing - example<br />Step 6. Identify common errors, misconceptions or irrelevant information<br />Lack of understanding of isolation precautions<br />Uncertainty related to specific diagnosis<br />Step 7. Use the previous information and write the distracters<br />Leaving a blood pressure cuff in the client’s room to be used by the client only<br />Putting on a protective gown to assist the client to sit in a chair<br />Taking the gloves off before leaving the client’s room<br />
  27. 27. 27<br />Steps in item writing - example<br />Step 8. Complete the item using the stem, key and distracters<br />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?<br />Leaving a blood pressure cuff in the client’s room to be used by that client only<br />Putting on a protective gown to assist the client to sit in a chair<br />Taking the gloves off before leaving the client’s room<br />Assisting the client to ambulate in the hallway (key)<br />
  28. 28. 28<br />Case scenario exercise<br />Reduction of Risk Potential<br />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.<br />
  29. 29. 29<br />Reduction of Risk Potential – model<br />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?<br />blood pressure increase from 103/68 to 110/70 over the past one hour<br />blood urea nitrogen (BUN), 22 mg/dL (key)<br />pulse, 101<br />decrease in respiratory rate from 18 to 16 over the past one hour<br />
  30. 30. 30<br />Case scenario exercise<br />Psychosocial Integrity<br />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.<br />
  31. 31. 31<br />Psychosocial Integrity – model MCQ<br />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?<br />Remove other clients from the area.<br />Escort the client back to the client’s room.<br />Request that the client be quiet and not disrupt others.<br />Use distraction to re-focus the client to reality. (key)<br />
  32. 32. 32<br /> Thank you for your time<br />

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