Reducing Disparities to Transform Practice: Connecting the Dots Between Student Success and Linguistically Modified Exams

Background:   Nursing education programs report increasing numbers of culturally and linguistically diverse students and the call to diversify the nursing workforce continues (Benner, Sutphen, Leonard, and Day, 2010; IOM, 2010; NLN, 2015). Yet educational outcomes, including graduation rates and first-time licensure pass rates, for non-native speakers of English have demonstrated little improvement over the years (NCSBN, 2006). XXX presenting author (2013) and Murray (2015) recommend renewed faculty efforts and greater inclusion of student perspectives for improving educational processes and outcomes.  

One educational intervention, linguistic modification, has shown promise in reducing construct-irrelevant variance in test performance in earlier studies (Bosher & Bowles, 2008; Lujan, 2008). However, more recent examinations of this intervention have not been reported. The primary purpose of this funded nursing education research study was to specifically explore the impact of linguistic modification on multiple-choice exam-type test items for Asian American nursing students who identified as non-native speakers of English.

Methods   The research question asked, “How do non-native speakers of English perceive differences on multiple-choice type exam items that have been linguistically modified?” Teacher-made multiple-choice type exam items were reviewed and revisions were made by a linguistic modification expert. The expert reviewed all questions to verify that the linguistic complexity of test items and semantic complexity of non-content vocabulary had been substantially reduced. Faculty participants served as content experts and validated that the modified question form did not change each question’s nature. The original and modified questions were randomly positioned (a random number set was used) and placed on a written student survey.  Student participants at the sophomore, junior, and senior levels completed a written survey which presented questions about both exam item forms. Students responded to the questions and also indicated their preferences for either the original or linguistically modified form of the exam items.

Study Results:   Twenty-six students from a baccalaureate nursing program in an urban public university participated in this study. Participants reported first learning English at the average age of 10 years and reported speaking and writing English for 15 years on average.  A total of 206 exam items were assessed. Data was analyzed in SPSS. The majority (60%) of participants preferred the linguistically modified exam questions. Additional comments made by student participants will likely be of interest to the audience.

Study Conclusions:  Linguistic modification of exam questions may promote improved student understanding and assist in exam performance among non-native speakers of English who identify as Asian American.

Implications: Strategies to improve student success and educational outcomes and reduce disparities will be addressed. Implications for nursing education policy and future research collaborations and funding opportunities will also be discussed, along with related practice issues for diversifying the nursing workforce, locally and globally.