The practice of testing is ordinarily thought of as an evaluative process rather than a study tool. Testing has been found to enhance memory recall as the process of actively recalling information stimulates a deeper level of learning than reading material alone (Atabek Yigit, Balkan Kiyici, & Cetinkaya, 2014). Frequent retrieval of information, such as that which occurs with testing, allows individuals to retain knowledge more effectively; therefore, information is more easily retrieved long term (P. C. Brown, Roediger & McDaniel, 2014).
The purpose of this study was to examine the relationship between the frequency of testing within a baccalaureate undergraduate nursing course and students' examination scores. We hypothesized that students who experience frequent assessments in an undergraduate nursing course will be more likely to have higher final examination scores than students who experience only traditional unit exams and that students will see an improvement in course exam scores with an increase in the frequency of assessments. Two research questions were asked: 1) To what extent do frequent assessments in a fundamental-level baccalaureate nursing course improve final examination scores when compared with the use of traditional unit exams alone? 2) What is the relationship between the frequency of assessments in a fundamental-level course and students' exam scores?
BACKGROUND
Nursing students encounter challenges when attempting to retain substantial amounts of course content in a short period of time. This leaves faculty seeking methods that will improve the teaching process and assist students in retention and retrieval of information (Foss & Pirozzolo, 2017). Testing has been shown to benefit college-aged students as a tool to improve long-term memory (Abel & Roediger, 2017).
Knowing one of the greatest difficulties for students is retrieving stored information, the information processing theory was chosen to guide this study. As information is processed, it is either immediately forgotten, moved to short-term memory, or stored in long-term memory. Once in short-term memory, the information must be rehearsed to be moved to long-term memory. When information is properly applied and encoded, it is more easily retrieved and applied when compared to rote memorization. Rehearsal allows an individual to begin to apply associated concepts, which increases the likelihood of being able to retrieve the information when needed. During examinations, students are able to practice retrieval of information, which improves the likelihood of encoding the information to long-term memory (J. L. Brown, 2015). The frequency of testing, as well as its effects on test scores, has been evaluated in many courses, at different levels of (middle school, high school, collegiate); no studies were found evaluating frequent testing in nursing education (McDermott, Agarwal, D'Antonio, Roediger, & McDaniel, 2014).
METHOD
Following institutional review board approval, a quasi-experimental study was conducted within a fundamental-level BSN course over four semesters. This study assessed the frequency of quizzing and its relationship to students' exam scores. All four cohorts of students participated in their coursework as assigned. The first two cohorts of students (fall 2016 and spring 2017) were assigned as the control group and received only unit exams and a comprehensive final. The third and fourth cohorts (fall 2017 and spring 2018) were assigned as the intervention group; they received unit exams, a comprehensive final, and six content-specific quizzes. The quizzes for the intervention group, required as a component of the overall course grade, reviewed major content areas that were covered within the course. After all required coursework was complete, the investigator examined unit and final exam scores for each cohort.
Sample/Setting
A convenience sample from a large public university in the southeastern United States was utilized for this study. The sample consisted of four cohorts of students divided into two groups, with a total sample size of 440. Group 1 (n = 230) was the control (nonquizzing) group; Group 2 (n = 210) was the intervention (quizzing) group. Approximately 95 percent of students were female; students ranged in age from 19 to 50. Most students (approximately 91 percent) were Caucasian; 5 percent were African American, 3 percent were Hispanic/Latino, and 1 percent were of other ethnicities. There were no statistically significant differences when comparing the demographics of the two groups.
Instruments/Measurement
Sixty-question exams were created by course faculty using routine exam creation strategies. Students in the intervention group utilized Learning System RN 3.0, a component of Assessment Technologies Institute (ATI) Pulse(TM) (ATI, 2016) a quiz bank that provides content specific assessments with 20 to 30 questions. Following lecture, students took the quizzes on their own time. They were allowed to take them as many times as desired with a 12-hour lock-out window between attempts prevented students from taking them back-to-back without time to reflect on the content. After completing the assessments, students received a numerical score as well as a written rationale (ATI, 2016).
After completion of all required coursework, exam scores were obtained and analyzed. A univariate analysis of variance was used to perform statistical analysis. The independent variable was the cohort of students; the dependent variable was the students' examination scores.
RESULTS
Positive statistical relationships were found when comparing the implementation of quizzing and students' exam scores. For students in the intervention group, final exam scores were found to increase by 2 points (2.5 percent), with statistical significance noted, F(1, 438) = 21.03, p < .001, [eta]p2 = .046. Comparison of the groups in relationship to unit exam scores also revealed statistical significance, F(1, 438) = 17.89, p < .001, [eta]p2 = .039. Unit exam scores also increased by 2 points (2.5 percent).
DISCUSSION
The information processing theory, which guided this study, is applicable to the implementation of frequent testing as it demonstrates that rehearsal of information helps students transfer information from working to long-term memory. When compared to other study techniques, quizzing stimulates deeper levels of learning, which allows for easier retrieval during unit or comprehensive examinations (J. L. Brown, 2015). The hypotheses for research Questions 1 and 2 were supported. Statistically significant differences were noted for both unit and comprehensive exams when comparing the control and intervention groups.
When quizzing was paired with traditional assessment techniques, improvements were noted in exam scores of BSN students. Nurse educators may use these findings to modify current teaching approaches to include quizzing throughout the course rather than utilizing unit and comprehensive exams alone. Faculty may use the results from the quizzes to determine areas in which the overall group of students struggled, providing additional content to students in areas of weakness. This allows students the opportunity to correct misinformation, decreasing the likelihood of information being stored incorrectly (Rezaei, 2015; Shute & Rahimi, 2017).
Nursing faculty are charged with the task of not only teaching students course content but of teaching students techniques to become successful lifelong learners. Teaching students to use testing as a study tool will allow deeper mental processing, allowing for easier retrieval when required. Faculty should incorporate evidence-based rationales for effective study techniques (P. C. Brown, Roediger, & McDaniel, 2014; Rezaei, 2015).
LIMITATIONS AND FUTURE RESEARCH
The population was a convenience sample with a homogenous demographic make-up, and the study was conducted at a single site, with only one course. The use of multiple sites and multiple courses may yield different results. The same syllabus and textbooks were used for both groups, and the same content areas were covered and tested with each class; however, one faculty member resigned between groups. The addition of a new faculty member to the course may have resulted in slight variations in instructional techniques.
Based on the findings from this study, quizzing has been shown to be beneficial to fundamental-level nursing students. Additional research should be conducted in different geographic locations with multiple sites to obtain a more diverse demographic population. Implementation of the intervention in multiple courses would also expand the generalizability of the findings. The current study could also be expanded to follow the same students to completion of the licensure exam to see if improvements in outcomes were noted.
REFERENCES