Academic journal article Nursing Education Perspectives

Improved Class Preparation and Learning through Immediate Feedback in Group Testing for Undergraduate Nursing Students

Academic journal article Nursing Education Perspectives

Improved Class Preparation and Learning through Immediate Feedback in Group Testing for Undergraduate Nursing Students

Article excerpt


PURPOSE A mixed-method educational evaluation project to increase learning through testing was conducted in a required senior nursing course.

METHOD The Immediate Feedback Assessment Technique (IF-AT) was used to motivate preparation for optimal final examination performance. Students took multiple-choice final exams in small groups, used critical thinking and collaboration to select best answers, and then used scratch-off answer sheets indicating correct answers. A causal-comparative evaluation design was used to assess effectiveness of the IF-AT technique in improving learning as measured by final exam scores compared with results of traditional individual multiple-choice final exams.

FINDINGS Results indicated that the IF-AT format was significantly more effective than traditional testing in enhancing learning.

CONCLUSION Descriptive and qualitative evaluation data from students indicated students increased their learning, engaged in critical thinking, and prepared adequately for the exam. Students evaluated the test method as superior to standard testing. Implementation information is included.


Collaborative Testing--Group Testing --Learning While Testing--Education Evaluation Research


Changes in classroom methodology frequently stem from the instructor's desire for improved student learning (Fink, 2003). For the senior nursing course "Nursing: Health Enhancement," one aspect targeted for improvement was preparation for the final examination. This four-credit course focuses on adult health theory and research for the management of chronic illness, topics that require a heavy student reading load. However, individual faculty-student conversations, class discussions, final exam results, and final course grades suggested that students were not preparing enough nor studying in ways that proved successful. Faculty, therefore, focused on their final examination methodology in an effort to improve student course performance and learning.


After attending a workshop facilitated by L. Dee Fink (, who modeled the Immediate Feedback Assessment Technique (IF-AT) (Epstein Educational Enterprises, Cincinnati, OH), the four course instructors decided to implement IF-AT collaborative testing in their classroom. The IF-AT (Epstein, Epstein, & Brosvic, 2001) consists of a scratch-off answer form for use with either 25 or 50 multiple-choice questions, each of which can have four or five answer choices. When using the forms, students follow a typical collaborative testing method; they discuss each question in a small-group setting and choose their answer through consensus building, often teaching each other and employing critical thinking skills as they negotiate for the correct response. They then scratch off the film for their choice. If they are correct, they see a star and receive maximum points. If incorrect, they discuss again and make a second or third choice, with the points decreasing with each incorrect answer. Stars are placed randomly in different positions within each answer choice rectangle to prevent cheating. This collaborative approach leads to lively discussion, debate, and audible cheers for successful choices. More detailed testing and analysis of this process indicates that it has significant benefits for both student preparedness (Mitchell & Melton, 2003; Slusser & Erickson, 2006) and student learning (Epstein et al., 2001, 2002; Giuliodori, Lujan, & DiCarlo, 2008; Kapitanoff, 2009; Skidmore & Aagaard, 2004; Wiggs, 2011).

The purposes of the project reported in this article are to describe and explain the implementation of the collaborative testing technique in the Nursing: Health Enhancement course; to assess its effectiveness in improving final exam scores by comparing scores from courses using the testing technique with scores from courses not using this method; and to evaluate the testing technique as implemented, as well as student perceptions of outcomes after using this method. …

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