Impact of Using Commercially Prepared Specialty Exams as Clinical Course Final Exams

Monday, 30 October 2017: 9:30 AM

Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE
School of Nursing, University of St. Thomas Carol and Otis Peavy School of Nursing, Houston, TX, USA
Kristina L. Leyden, PhD
Peavy School of Nursing, University of St. Thomas, Houston, TX, USA
Christen D. Sader, MSN
Peavy School of Nursing, University of St. Thomas Peavy School of Nursing, Houston, TX, USA


One baccalaureate-nursing program at a private, faith-based university in the southern United States used commercially prepared, standardized specialty exams in some clinical courses and used an exit exam to determine NCLEX-RN readiness. Diversity is the hallmark of the student population at the university. The current senior class in the nursing program is Caucasian (11%), African American (17%), Asian (25%), and Hispanic (47%). When first implemented in 2012, the specialty exams were not consistently used in courses throughout the program. Initially most students, as well as some faculty, did not perceive the value of specialty exams as preparation for the NCLEX-RN Exam. When the specialty exams were used, they were weighted between 5% and 10% of the course grade for Junior and Senior level courses, respectively. In this context, students generally scored poorly on the commercially prepared tests and reported not utilizing accompanying remediation tools. Students reported a lack of emphasis in studying for exams due to low weighting for overall grade. These low scores demanded that faculty consider other options to promote test preparation and improved performance on specialty, exit and ultimately NCLEX-RN exams.


In the fall semester of 2015, baccalaureate faculty approved changes geared toward improving test scores. All weighted value of exams within all courses would increase to 25%. This change was effective immediately. Additionally, the specialty exams were approved for use as final exams. As finals, the specialty exams would be given twice at the semester’s end, with at least two weeks between administration to allow adequate time for student remediation between exams. The higher of the two exam scores would be recorded as the final exam grade. This change would be be implemented across all courses beginning summer semester of 2016. A pilot on using the specialty exams on two courses was approved for spring semester of 2016. In the spring of 2016, faculty in two specialty courses, Obstetrics and Pediatrics, implemented the approved pilot. The first version of each exam was administered a minimum of two weeks before “Finals” week so that students could have the opportunity to complete online remediation to prepare for the second version of the exam.


Class means for each course were higher than the national average for the first time since using the specialty exams. Mean raw scores for Obstetrics increased by 14.8% from the previous year. The percent of students achieving at or above the recommended minimum score on one of the exams increased to 54% of the class compared to 27% the previous year. Mean raw scores for Pediatrics increased by 11.5% from the previous year. The percent of students achieving at or above the recommended minimum score on one of the exams increased to 54% from 21% the previous year. The use of the specialty exams as final exams with a higher percentage had no negative impact on students’ ability to successfully complete the courses.


The success of the spring pilot prompted a School of Nursing policy change effective the following semester. Specialty exam utilization changes implemented in the pilot became standard for all clinical courses as of summer, 2016. Data collected and evaluated on courses taught during the summer of 2016 supported the educational benefit of specialty exams as final exams.