Presented by Ainslie Nibert, Associate Dean/Associate Professor, College of Nursing, Texas Woman's University - Houston Center Now that your spring semester has started, now is the time to act on your new year’s resolution to improve your item writing skills and build sound assessments. This webinar will help your create critically-thinking test items for this semester’s exams. You’ll obtain valuable student response data from these new questions that can guide future editing, and help you obtain the greatest benefit from your authoring efforts. By performing a systematic item analysis after each exam, you can pinpoint students’ knowledge gaps, which will help you focus your item writing on those course objectives that are globally misunderstood or ignored. In addition to reviewing item writing techniques, we’ll also cover the advantages of using electronic test blueprints to establish test validity and tie your assessments to your overall program objectives. You may not lose 10 pounds by February 14th, but you can develop 10 new (or newly-edited) test items instead of polishing off that box of Valentine’s chocolates – what a great way to make a productive start to 2017, and to your new semester!

1. Achieve Your 2017
Resolution to Improve
Your Test Item Writing
Skills and Create
Better Exams
Ainslie T. Nibert, PhD, RN, FAAN
Consultant
Email – anibert@comcast.net

2. Objectives
Create/Edit test items that assess for application and analysis.
Critique exams for alignment with the NCLEX-RN®
Test Plan.
Evaluate the relevance and effectiveness of current testing policies.

3. Resources for Developing Critical Thinking
Test Items and Alternate Format Items:
National Council Website
www.nscbn.org
◦NCLEX Test Plans
◦2016 RN
◦Candidate FAQ
◦Alternate item formats FAQ
◦Exam Development FAQ
Source: https://www.ncsbn.org/9010.htm

4. Relationship between
Testing & the Curriculum
Focus today:
INTERNAL Curriculum
Evaluation
(Teacher-made Tests)

5.  Writing Critical Thinking Test Items
 Item Analysis Software & Blueprinting
 Test Item Banking & Exam Delivery
Internal Evaluation
Evaluation of course objectives (faculty designed)

6. Five Guidelines to
Developing Effective Critical
Thinking Exams
 Assemble the “basics.”
 Write critical thinking test
items.
 Pay attention to housekeeping
duties.
 Develop a test blueprint.
 Scientifically analyze all exams.

7. Critical Thinking Test Items
 Contain Rationale
 Written at the Application Level or Above
 Require Multilogical Thinking to Answer
 Ask for High Level of Discrimination
Source: Morrison, Nibert, & Flick (2006)

8. Housekeeping Tips

9. Rules
 Get rid of names
 Get rid of ‘multiple’ multiples
 Use non-sexist writing style
 Develop parsimonious writing style
Eliminate
Delete scenarios
 Write items independent of each other
“of the following…”X

10. … and More Rules
 Use a question format when possible
 Make distracters plausible and
homogeneous
 Include in stem words repeated in
responses

11. … and More Rules
 Eliminate “all of the above” and “none of the
above”
 Rewrite any “all except” questions
 Ensure that alternatives do not overlap
 Present choices in a logical order
 Vary correct answer

12. … and the MOST IMPORTANT Rule
Develop written testing policy
 Writing style
 Format

13. Does the test measure
what it claims to measure?
Content ValidityContent Validity

14. Use a Blueprint to Assess a
Test’s Validity
 Test Blueprint
 Reflects Course Objectives
 Rational/Logical Tool
 Testing Software Program
 Storage of item analysis data (Last & Cumulative)
 Storage of test item categories

18. Consistency of Scores

19. Reliability
Tools
 Kuder-Richardson Formula 20
(KR20)—EXAM
Range from –1 to + 1
 Point Biserial Correlation Coefficient
(PBCC)—TEST ITEMS
Range from – 1 to + 1

20.  Item difficulty 30% - 90%
 Item Discrimination Ratio 25% and
Above
 PBCC 0.20 and Above
 KR20 0.70 and Above
Standards of
Acceptance

21. one “absolute” rule
about item difficulty
TEST ITEMS ANSWERED CORRECTLY BY 30% or LESS of the
examinees should always be considered too difficult, and
the instructor must take action.

22. …but what about high
difficulty levels?
Test items with high difficulty levels (>90%) often
yield poor discrimination values.
Is there a situation where faculty can legitimately
expect that 100% of the class will answer a test
item correctly, and be pleased when this happens?
RULE OF THUMB ABOUT MASTERY ITEMS: Due to
their negative impact on test discrimination and
reliability, they should comprise no more than 10%
of the test.

23.  Item difficulty 30% - 90%
 Item Discrimination Ratio 25% and
Above
 PBCC 0.20 and Above
 KR20 0.70 and Above
Standards of
Acceptance

24. Thinking more about item
discrimination statistics on teacher-
made tests…
IDR can be calculated quickly, but doesn’t effectively
consider variance of the entire group. Use it to quickly
identify items that have zero/negative discrimination
values, since these need to be edited before using again.
PBCC is a more powerful measure discrimination.
Correlates the correct answer to a single test items with the total
test score of the student.
Considers the variance of the entire student group, not just the
lower and upper 27% groups.
For a small ‘n,’ consider referencing the cumulative value.

25. … what decisions need to be
made about Test items?
When a test item has poor difficulty and/or
discrimination values, action is needed.
All of these actions require that the exam be
rescored.
Credit can be given for more than one choice.
Test item can be nullified.
Test item can be deleted.
REMEMBER: Each of these actions has a consequence,
so faculty need to carefully consider these when choosing
an action. Faculty judgment is crucial when determining
actions affecting test scores.

26. Standards of
Acceptance Nursing
Nursing-PBCC 0.15 and Above
Nursing-KR20 0.60 - 0.65 and
Above

27. 3-Step Method for
Item Analysis
1. Review Difficulty Level
2. Review Discrimination Data
 Item Discrimination Ratio (IDR)
 Point Biserial Correlation Coefficient
(PBCC)
3. Review Effectiveness of Alternatives
 Response Frequencies
 Non-distracters

28. ..and a word about
using Response
Frequencies
A review of the response frequency data can focus your editing.
For items where 100% of students answer correctly, and no
other options were chosen, make sure that this is indeed
intentional (MASTERY ITEM), and not just reflective of an item
that is too easy (>90% DIFFICULTY.)
Target re-writing the “zero” distracters – those options that
are ignored by students. Replacing “zeros” with plausible
options will immediately improve item DISCRIMINATION.

32. Critically-thinking
Questions
Which intervention is most important?
Which intervention, plan, assessment data is/are most
critical to developing a plan of care?
Which intervention should be done first?
What action should the nurse take first?
Which intervention, plan, nursing action has the highest
priority?
What response is best?

33. 33

34. Fair/Common Universal
Language
The client is running late for an appointment.
The client understands Buddhist practices are peaceful.
The client is on five different medications.
The client ate a submarine sandwich.
The alcoholic client with delirium tremens is agitated.
After the client sneezed, the nurse said “bless you.”
The nurse is giving a report on the client.
The nursing unit is working shorthanded.
Source: Bristol, T. 2016) NCLEX®
Updates (webinar series) Available: http://nursetim.com/webinars/nclex

36. Latest NCLEX®
Test Item
Format Considerations
Units of Measure
•International Systems of Units (SI)
•Metric
•Imperial Measurement
Generic vs. Trade Names for Medications
•Generic names only in most cases
•References to general classifications of medications

37. Item Writing Tools for
Success …
Knowledge
Test Blueprint
Testing Software

38. References
Morrison, S., Nibert, A., & Flick, J. (2006). Critical thinking and test item
writing (2nd ed.). Houston, TX: Health Education Systems, Inc.
National Council of State Boards of Nursing. (2016) 2016 NCLEX-RN test
plan. Chicago, IL: National Council of State Boards of Nursing.
https://www.ncsbn.org/RN_Test_Plan_2016_Final.pdf
Nibert, A. (2010) Benchmarking for student progression throughout a
nursing program: Implications for students, faculty, and administrators. In
Caputi, L. (Ed.), Teaching nursing: The art and science, 2nd ed. (Vol. 3).
(pp.45-64). Chicago: College of DuPage Press.