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Traditional baccalaureate nursing education has focused on dissemination of information using lecture as a medium. This teaching-learning strategy places students as a passive observer in the classroom experience. Chickering and Gamson (1987) argued that student-faculty interaction, cooperation among students, active learning, prompt feedback, time devoted to academic work, high expectations, and respect for the diverse talents and ways of learning of each student are essential to optimal learning. Achieving these practices in a large classroom environment presents challenges to both the student and faculty. One approach to address several of these practices is the use of formative assessment. Wilson (2014) states that formative assessment is based on the idea that learners should learn to take control of their learning, and that intelligence is a malleable quality.
An extensive literature (see for example Black and Williams, 1998; Koh, 2008) support formative assessment as an approach that promotes motivation and self-esteem and encourages self-regulated learning. Formative assessment is about learning that needs feedback. It cultivates student's capacity to reflect, self-evaluate, and self-correct promoting self-reliance. It allows teachers to access an "untapped reservoir" (Koh, 2008, p.229), helping students to focus on the content at hand rather than on what their final grades will be.
Formative assessment can inform students' perspectives on best practices, quality of their career field, and their own personal identies. A cadre of facts-even interesting facts-is not useful to students; rather it is necessary to build and understand facts within some conceptual scaffold that helps individual students to contextualize facts and put them in perspective as their learning progresses. Linking facts and ideas within a conceptual scaffold enables an individual to identify patterns, reach reasonable conclusions, and adapt their knowledge base according to new information or changing circumstances. (Hagstrom, 2006)
Computerized adaptive testing (CAT) serves as one mechanism for conducting formative assessment. CAT blends computer technology with modern measurement models to increase the effectiveness of the examination procedure. Additionally, it offers immediate feedback to each student, thus integrating learning into the testing process. Computerized adaptive testing requires active participation of the student through reading and responding to the questions. The learner activates through self-regulation through the process of analysis of the stem of the question and review of the response to the choice. Using CAT, provides students a formative assessment to improve learning. Comfort with CAT for nursing students is essential since the National Counsel Licensure Exam (NCLEX) is administered using this technology (NCSBN, 2013).
The purpose of this study was to determine the effectiveness of utilizing a computerized adaptive testing program as a formative assessment strategy to promote active learning and to improve academic success in a medical surgical nursing course. The computerized adaptive testing was a compliment to the teaching strategies currently utilized in the classroom including lecture, muddiest point, case studies, and active discussion. PrepU© by Wolters Kluwer Health was the computerized adaptive testing program that was utilized in this study. This program uses formative assessment in an online quiz format. The adaptive quizzing tool allows the students to study and learn using a mastery approach to topics. The student receives immediate feedback with rationales for the incorrect answers. They are also benchmarked against their peers to place their level of learning in context. While this program initially was created to assist the nursing student in preparation for the NCLEX examination, content specific areas are available to students. With a focus on scaffolding of information, faculty hope that students grasp prerequisite knowledge prior to moving onto more complex information.
Methods:
The study was approved by the University IRB. Subsequently, during the fall semester junior year, students enrolled in the medical-surgical nursing I class, were approached the first week of class. The study was explained to the students and the demographic questionnaire and consent forms were distributed. Out of 156 potential participants, 133 students agreed to participate in the study. A research assistant coded the demographic questionnaire of interested students. All students enrolled in medical-surgical nursing I, whether or not they were part of the study, were required to complete a minimum of 50 PrepU© questions per chapter as assigned in order to receive additional points on their exams. Mastery level was calculated by the PrepU© computerized adaptive program. At 8:00 AM the morning of each exam, the students average mastery level for the chapters assigned and the total number of questions completed per chapter were calculated. If a student obtained an average mastery level of 6.0-6.9, he/she had one additional point added to his or her exam grade. If a student obtained an average mastery level of 7.0-8.0, he/she had 2 additional points added to his or her exam grade. The points added to the exam grade were only for the content that was covered in the exam. Students did not receive additional points for the HESI exam. Students received additional points whether or not they participate in the study. Students were not penalized if they chose not to utilize the PrepU program.
The data from individual exam grades, HESI conversion score, total number of questions per exam, and average mastery level per questions completed within each exam period were analyzed using Pearson's correlation. The final grade, total number of questions completed during the semester and the average mastery level for the semester were also analyzed.
Results:
Preliminary data analysis supported a correlation between the students' achieved mastery level, the number of questions completed, and the exam grades. Qualitative data on the benefits and challenges of using PrepU© as a formative assessment strategy were elicited and will be presented. Additional data analysis will be forthcoming.
Conclusion:
The results of this study supports the benefit of formative assessment using computerized adaptive testing. Student success in courses using CAT as a formative assessment strategy improved through the students increased self-management, desire for learning, and self-control. The use of formative assessment as an active learning strategy in nursing has been supported as a method for improving knowledge retention and problem solving which are critical to the success of nursing students. Determining the relationship between formative assessment strategies with computerized adaptive testing and student outcomes may provide evidence as to the importance of this intervention in nursing. Future research may include a national study to determine the benefit of formative assessment using CAT throughout across a four-year nursing curriculum and to determine student success over time.
Black, P. & William, D. (1998), Assessment and classroom learning. Assessment in Education, 5(1), 7-73.
Chickering, A.W. & Gamson, Z. F. (1987). Seven principles for good practice in undergraduate education. AAHE Bulletin, 39(7), 3-7.
Hagstrom, F. (2006) Formative learning and assessment. Communication Disorders Quarterly, 28, 24-36.
Kim, JunGyu (1992). Three approaches for the integration of teaching, testing and learning. Paper presented at the Annual Meeting of the Mid-South Educational Research Association, Knoxville,, TN.
Koh, L. C. (2008) Refocusing formative feedback to enhance learning in pre-registration nurse education. Nurse Education in Practice, 8, 223-230.
National Council of the State Board of Nursing. (2013, January 1). Computerized adaptive testing. Computerized Adaptive Testing (CAT). Retrieved July 3, 2014, from https://www.ncsbn.org/1216.htm
Wilson, S. (2014). The characteristics of high quality formative assessments. The Innovative Instructor. http://ii.library.jhu.edu/tag/formative-assessment/
Yorke, M. (2001). Formative assessment and its relevance to retention. Higher Education Research and Development. 20(2), 115-126.erences used in the application.