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Assessment of learning with multiple-choice questions

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Summary

Nurse educators aspire to learning outcomes that will produce competent practitioners. Assessment strategies should be consistent with desired learning outcomes [Manogue, M., Kelly, M., Bartakova Masaryk, S., Brown, G., Catalanotto, F., Choo-Soo, T., Delap, E., Godoroja, P., Murio, I., Rotgans, J., Saag, M., 2002. Evolving methods of assessment. European Journal of Dental Education 6 (3) 53–66] and there is a requirement to diversify approaches. Objective testing, specifically multiple-choice questions (MCQ’s) are one of the approaches that may diversify the assessment approach in Irish undergraduate nursing education. In this paper, Quinn’s [Quinn, F.M., 2000. The Principles and Practice of Nurse Education, fourth ed., Stanley Thorne (Publishers) Ltd, Cheltenham] cardinal criteria of assessment, practicality, reliability, validity and discrimination provide a useful framework to discuss the issues associated with the implementation of this type of assessment strategy. MCQ examinations that are consistent with educational outcomes can be used to effectively assess aspects of student performance and can facilitate timely feedback and contribute to the process of self-learning. Significant commitment is required to prepare MCQ test items and examination formats that are reliable and consistent with curriculum objectives. Appropriately constructed MCQ examinations are efficient, objective, capable of discrimination and can be combined with other assessment strategies to contribute to a comprehensive student assessment strategy for use in nursing education.

Introduction

A diverse range of formative and summative assessment strategies are at the disposal of nurse educators (Milligan, 1996, Quinn, 2000, Race and Brown, 2001; Manogue et al., 2002). Assessment is critical to the success of any educational program and is essentially a gate keeping mechanism through which people do or do not make progress in their chosen profession or occupation (Jarvis, 1985, Manogue et al., 2002). Critical thinking is one of the hallmarks of higher education and aspects of performance such as analysis, reasoning, and decision making are just some of the critical indicators by which we can evaluate graduating nurses (Vaughan-Wrobel et al., 1997). The measurement of a student’s ability to think critically is a consistent challenge for nurse educators and there is considerable debate on the best assessment methods to assess critical thinking skills (Morrission and Free, 2001, Staib, 2003, Manogue et al., 2002). “Assessment can take many forms and it can be argued that the greater the diversity in the methods of assessment, the fairer the assessment is to the students” (Race and Brown, 2001, p. 41). Over use of one assessment strategy can favor particular students and result in one-dimensional or limited evaluation of student performance. Current approaches to class assessment of undergraduate nursing students in the Irish Republic appear to focus on a variety of seen and unseen examination essay formats. Essays items are well suited to assessing learning outcomes in nursing as they require students to develop a rational to support their thinking and position, to consider multiple perspectives and present ideas logically (Oermann, 1999), but as Holsgrove (1992) highlights can be limited in terms of reliability and objectivity. At present, there exists a will in the Irish Nursing education circles to develop some diversity in the current approach. This paper will explore objective testing, specifically multiple-choice questions (MCQs), and analyze its effectiveness as an assessment strategy. Quinn (2000) outlines the following, as the cardinal criteria of assessment, practicality, reliability, validity, and discrimination, and these will be used as a framework to facilitate analysis.

Section snippets

Practicality/usability

The forthcoming changes in nursing education in the Irish republic will result in increasing numbers of students, with diverse needs, causing greater workload in terms of assessment for nursing faculty. Students require feedback in a timely fashion so that assessment is actively incorporated into the learning process. Pamplett and Farnill (1995), state that the importance of MCQs lies is in their ability for testing large numbers of students in a short time and for testing different aspects of

Reliability and validity

Educators need to take steps to ensure their assessment practices and instruments are well-designed and valid (Race and Brown, 2001). The challenge for examiners, in designing objective tests, is to produce assessments that are suitable and consistent in measuring, what they are supposed to measure. Masters et al. (2001) suggest that questions should be written to reflect the level of sophistication that students are expected to perform in practice. MCQs appear to lend themselves to objective

Discrimation

The multiple-choice examination has been criticized for being artificial and not reflective of real life clinical situations. The potential for cueing effect in multiple-choice question instruments is highlighted by Veloski et al. (1993). The undesirable effect of cueing and the short list of potential options, furnishes hints to examinees that could not be there in clinical practice. They argue that the cueing effect of five choices makes it impossible for examiners to find out about specific

Conclusion

Over the coming years in the Irish Republic, we will see the amalgamation of schools of nursing in the third level settings with a dramatic increase in the size of groups involved in classroom teaching. It can appear that the most significant product of higher education is the qualifications that students gain, rather than the quality of the learning experience. A balance is necessary between enhancing the students learning experience and determining qualifications that are valid, and

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