This document discusses perspectives on multiple choice question (MCQ) assessment. It provides general thoughts on how MCQs can be used formatively or summatively. It then describes processes for designing, establishing validity and reliability, and providing feedback for MCQs. Specific examples are given from the NCLEX-RN test plan to illustrate steps in writing MCQs, including selecting areas of focus, writing stems and keys/distractors. Case scenarios are also used to demonstrate how to write MCQs assessing different nursing concepts.

1. 1 Some perspectives onMCQ assessment For School of Nursing and Midwifery July 2011 Source: http://www.dreamstime.com/item.php?imageid=7299038

2. 2 Assessment generally “Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer.” Charles Caleb Colton (1780 - 1832)

3. 3 General thoughts MCQs can be a useful element of an overall assessment design Can’t be abstracted from the context No marks / diagnostic / formative / interactive Few marks / semi-formative / assignment High stakes / summative / examination Design and evaluation approach should be appropriate for the context

4. 4 A proposed MCQ process From: Considine, J; Botti, M and Thomas, S. Design, format, validity and reliability of multiple choice questions for use in nursing research and education. Collegian, 2005 Jan; 12 (1): 19-24.

5. 5 An alternative/pragmatic process Design Content/Face validity Use Construct validity Reliability Keep / Replace

6. 6 Design – unit assessment plan

7. 7 Design – MCQ test plan

8. 8 Design – NCLEX-RN MCQ test plan Source: 2010 NCLEX-RN® Detailed Test Plan

9. 9 Face validity A sub-set of content validity Use an ‘expert panel’ to : assess item clarity assess item readability assess consistency of style check for errors

10. 10 Construct validity Key check – do ‘experts’ agree on the correct answer? Item difficulty – the proportion of examinees that get the correct answer Distracter evaluation Item discrimination – the ability of an item to distinguish between knowledgeable students and others

11. 11 BlackBoard Vista item analysis report

12. 12 Review of items Where items have been developed based on a systematic test plan and good content validity, they should only be discarded on the basis of clearly poor construct validity and reliability

13. 13 MCQ Feedback Butler and Roediger (2008) found that: “In comparison with the no-feedback condition, both immediate and delayed feedback increased the proportion of correct responses and reduced the proportion of intrusions (i.e., lure responses from the initial multiple-choice test) on a delayed cued recall test. Educators should provide feedback when using multiple-choice tests.”

14. 14 MCQ Feedback – strategies Provide consolidated feedback after the test has been completed Explanation of why the key is correct Explanation of why a distracter is incorrect Explanation of the general reasoning associated with an item

15. 15 MCQ Feedback – strategies Directing students to associated resources – text chapters/sections/pages, etc. Providing a run-through/de-brief in class after the test Randomisation of MCQ presentation to counter rote learning of ‘saved’ tests

16. 16 A usefulresource? Source: https://www.ncsbn.org/1287.htm

17. 17 Development of the NCLEX-RN Test Plan “A total of 12,000 newly licensed RNs are asked about the frequency and importance of performing 155 nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice that incorporates specific client needs, as well as processes fundamental to the practice of nursing.”

18. 18 NCLEX-RN test plan structure Safe and Effective Care Environment Management of Care Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity Basic Care and Comfort Pharmacological and Parenteral Therapies Reduction of Risk Potential Physiological Adaptation

19. 19 Design – NCLEX-RN MCQ test plan

20. 20 Detailedtest plan

21. 21 Detailedtest plan

22. 22 Sample items – management of care For each of the eight content areas a sample item is provided

23. 23 Steps in item writing Select an area of the test plan for the focus of the item Select a subcategory from the chosen area of the test plan Select an important concept within that subcategory Use the concept selected and write the stem Write a key to represent important information the entry-level nurse should know Identify common errors, misconceptions or irrelevant information Use the previous information and write the distracters Complete the item using the stem, key and distracters

24. 24 Steps in item writing - example Step 1. Select an area of the test plan for the focus of the item Safety and Infection Control Step 2. Select a subcategory from the chosen area of the test plan Standard Precautions/Transmission-Based Precautions/Surgical Asepsis Step 3. Select an important concept within that subcategory Evaluate infection control precautions implemented by staff members

25. 25 Steps in item writing - example Step 4. Use the concept selected and write the stem The nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following activities by the nursing assistant would require immediate follow-up? Step 5. Write a key to represent important information the entry-level nurse should know Contact Isolation: Assisting the client to ambulate in the hallway

26. 26 Steps in item writing - example Step 6. Identify common errors, misconceptions or irrelevant information Lack of understanding of isolation precautions Uncertainty related to specific diagnosis Step 7. Use the previous information and write the distracters Leaving a blood pressure cuff in the client’s room to be used by the client only Putting on a protective gown to assist the client to sit in a chair Taking the gloves off before leaving the client’s room

27. 27 Steps in item writing - example Step 8. Complete the item using the stem, key and distracters The nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following actions performed by the nursing assistant would require immediate follow-up from the nurse? Leaving a blood pressure cuff in the client’s room to be used by that client only Putting on a protective gown to assist the client to sit in a chair Taking the gloves off before leaving the client’s room Assisting the client to ambulate in the hallway (key)

28. 28 Case scenario exercise Reduction of Risk Potential The nurse is caring for client who had a procedure three hours ago. Write an item that includes assessment data the nurse would observe in this client and which data should the nurse respond to first.

29. 29 Reduction of Risk Potential – model The nurse is caring for a client who had a cardiac catherization 3 hours ago. Which of the following findings would be essential for the nurse to follow-up? blood pressure increase from 103/68 to 110/70 over the past one hour blood urea nitrogen (BUN), 22 mg/dL (key) pulse, 101 decrease in respiratory rate from 18 to 16 over the past one hour

30. 30 Case scenario exercise Psychosocial Integrity A nurse on an inpatient psychiatric unit observes a client pacing the hallway, mumbling and occasionally yelling aloud “Stop it!” Write an item describing the action the nurse should take in this situation.

31. 31 Psychosocial Integrity – model MCQ The nurse is caring for a client who is mumbling, pacing in the hallway, and occasionally yelling “Stop it!” Which of the following actions should the nurse take? Remove other clients from the area. Escort the client back to the client’s room. Request that the client be quiet and not disrupt others. Use distraction to re-focus the client to reality. (key)

32. 32 Thank you for your time