A variety of classroom response systems (CRSs) are available to support interactive learning in the classroom. Simple “clicker” systems, with multiple choice questions only, have evolved to interface with multiple devices including smart phones, tablets and laptops. Different question and response types are now available to enhance classroom interactions. Studies evaluating traditional clicker technology have demonstrated that CRSs can foster learner engagement, participation and satisfaction in the classroom (Collins, 2007; Levesque, 2011). Fewer studies have evaluated mobile CRSs. In a recent study, both computer science and dental students reported that use of the PollEverywhere Audience Response System promoted interactivity, increased participation, focused attention, provided feedback on comprehension, and increased motivation to learn (Meguid & Collins, 2017). Limitations of the use of CRSs include potential for technical problems for the instructor and/or learners, cost to learners, increased time for course planning, and decreased time to deliver lecture content (Collins, 2007). Both students and instructors are diverse and have different levels of experience using technology. Thus a thorough analysis of logistical challenges for instructors and learners should be weighed against perceived and actual benefits of using a particular CRS. As well, there is a lack of good quality evidence of the effectiveness of CRS technology on learning outcomes in health professionals and students (Atlantis & Cheema, 2015; Patterson et al., 2010). Thus further research is needed to support their use in undergraduate nursing education. Specifically, studies evaluating these technologies in undergraduate nursing courses (Welch, 2013) and studies evaluating novel applications of these technologies beyond the classroom are needed. One innovative approach that we are implementing is to use a CRS in the classroom and simulation lab as part of presimulation preparation and postsimulation assessment and debriefing.
Objective
To evaluate instructor and learner perspectives of feasibility, benefits and limitations of using a mobile CRS in the classroom and clinical simulation lab for undergraduate nursing students.
Methods
This descriptive study utilized survey methods to obtain quantitative and qualitative data.
Sample: Participants were instructors (n=4), and second (n=100), third (n=41), and fourth (n=85) year students from a BNSc program; however, only learners enrolled in a second year medical-surgical course used the CRS in both the classroom and the simulation lab, thus, this presentation will focus on data from that cohort.
Use of CRS in the Classroom: The instructor in the year two medical-surgical nursing course used the CRS in about half of the class lectures; the CRS was not used by any of the guest lecturers. This instructor generally used four to five questions per lecture; with two to three questions being multiple choice questions and one or two questions in alternate forms (word answers, matching, sorting, or discussion). In addition, the CRS was used during a lecture focused on management of the unresponsive patient to collect self-assessment data and knowledge of the content before and after the lecture, and again after participation in an unresponsive patient simulation session in the laboratory.
Quantitative Data Collection: Instructor perceptions were measured using the Perceived Usefulness and Perceived Ease of Use Scales and the Overall Degree of Interactivity Scale (Siau et al., 2006).Learner perceptions were measured using the Classroom Response System Perceptions (CRiSP) Questionnaire (Richardson et al., 2015). The CRiSP Questionnaire was also adapted for the simulation lab by including 8 original items, and substituting 4 new items to capture relevance to the simulation lab, demonstrating high internal consistency (Cronbach’s α=0.92).
Qualitative Data Collection: Open-ended questions were included on both the instructor and learner surveys to determine: (1) perceived benefits and limitations of using the CRS in the classroom lecture and the clinical simulation lab setting; and (2) CRS features that were useful or not useful. The purpose of collecting this qualitative data is to inform selection of a CRS in the future and to provide guidance on CRS implementation by faculty members.
Results
Instructor perspectives: Four instructors successfully integrated the CRS into their lecture courses and one instructor was able to include the CRS in one simulation lab component. Results of the instructor survey scales demonstrated that instructors felt the CRS increased classroom interactivity, and that generally instructors found the CRS relatively easy to use, and fairly useful in the classroom; however, interpretation of instructor scores is limited by the small sample size. Qualitative survey results demonstrated that despite some technical challenges, using the CRS helped instructors to identify and address learning gaps in real time.
Learner perspectives: Overall, 2nd year nursing students ratings on the CRiSP Questionnaire were moderately high, with a mean total score of 97.3 (SD=14.0) out of 135, with no significant differences between scores obtained in the classroom and the simulation lab (p=.122). Mean subscale scores were also moderately high for usability (15.7 out of 20; SD=3.4), engagement (38.2 out of 55; SD= 6.7) and learning (43.2 out of 60; SD=6.1). Results of the qualitative questions on the learner surveys suggest learners preferred a mobile CRS to a traditional “clicker” system because it can be used on multiple devices and employs a variety of question styles not limited to multiple choice questions. Most learners who participated in the simulation lab reported CRS questions during the lecture and at the beginning of the lab helped them to better prepare for the simulation. Many learners also felt that repetition of self-assessments via a learning outcomes assessment rubric embedded into the CRS helped them to reflect on their own knowledge and skills prior to and following the simulations. The greatest limitations reported by learners was the cost to purchase the CRS ($24 for the term), and not wanting to be graded in the classroom or simulation lab for using the CRS; they preferred using the CRS for learning purposes only.
Conclusions
Results of this study suggest that a mobile CRS can support learner engagement and learning in undergraduate nursing classrooms, as well as support presimulation preparation and pre/post simulation assessment. Further research is required to evaluate other novel multi-platform mobile CRSs and to further explore use of CRSs in the simulation lab. In particular, “free” versions of CRSs that are available should be evaluated to address financial implications for learners who cannot afford the extra cost to purchase a CRS. This novel study will contribute to the nursing education literature on teaching technologies used in classroom and clinical simulation.