The Impact of Collaborative Testing in Graduate Nursing Education

Background: Collaborative testing (CT) is an educational strategy which allows students to work in teams when completing an examination (Hanna, Roberts, & Hurley, 2016). This active-learning strategy encourages interactions and teamwork among students (Burgess & Medina-Smuck, 2018). In medical student education, themes regarding CT included learning about the content, getting to know other students, and interpersonal interactions (Levine et al., 2018). This approach has been used as an evaluative strategy and as a test review. Undergraduate nursing student perceptions of collaborative testing are overwhelmingly positive (Hanna et al., 2016; Martin, Friesen, & De Pau, 2014). Peer support provided during CT may assist students in learning content, as well as improving test-taking strategies (Eastridge, 2014). In addition to increasing exam scores, CT may improve retention of content (Green, Worthey, & Kerven, 2018). However, there is a lack of data on collaborative testing in graduate nursing education.

Objective: The purpose of this project is to assess the impact of collaborative testing in graduate nursing education in regards to student perception, test performance, and content retention.

Methods: Twenty-eight students were placed into nine groups of either three or four students. All students took the four course examinations individually and collaboratively. Students were randomly assigned to groups for each examination with each group consisting of a student from the top, middle, and bottom third of rankings based on the average individual examination score from the preceding examination. For the first examination, groups were assigned based on the average examination score during the preceding advanced health assessment course. Points were added to individual test grades for those students achieving a grade of A or B on the collaborative examination. To evaluate content retention, five comprehensive questions were included on the fourth examination. To evaluate student perceptions of the collaborative testing experience, a survey was administered at the end of the course, with permission from the authors (Cortright, Collins, Rodenbaugh, & DiCarlo, 2003). Paired t-tests were used to compare performance scores on the traditional individual exams to the collaborative group exams. The mean and standard deviation of each student’s individual test score was compared to the student’s collaborative test score to determine if there was a statistically significant difference in test scores after the collaborative testing experience. Paired t-tests were used to evaluate student performance on cumulative content questions on two tests: 1) tests one, two, or three where content was initially evaluated, and 2) test four, where the question/content was re-evaluated. Students had an opportunity to discuss cumulative questions in the collaborative testing environment after tests one, two, and three. Thus, evaluation of traditional test performance on test four could determine if collaborative testing facilitates content retention.

Results: All collaborative test scores were higher than the traditional test scores [traditional mean range 80.78 (8.53) – 84.07 (7.41), collaborative mean range (93.54 (3.77) – 94.07 (2.80), all p-values <0.001]. Thus, collaborative testing improved overall student test performance for the sample. Students did not demonstrate significant changes in mean scores for cumulative content on test four. Thus, collaborative testing did not improve content retention in this sample. Directed content analysis revealed four themes: enhanced understanding of content, collaboration with classmates, socialization, and improved grades.

Discussion: In graduate nursing education, the use of collaborative testing may be an effective strategy to improve teamwork and communication skills, enrich relationships among peers and between students and faculty, and enhance critical thinking.