Examination wrappers are short reflective surveys completed by students in connection with their course examinations. Although they may serve multiple purposes, 2 key benefits of using examination wrappers are to increase student metacognition/reflection skills and elucidate prevalent study techniques so faculty can more effectively remediate and analyze course performance. Many examples have appeared in nursing education journals, and the strategy has been described as a low-cost, low-effort methodology with the potential for impressive returns.1-3

Typically, examination wrapper surveys query students both before and after examination administration (Supplemental Digital Content, http://links.lww.com/NE/A949, provides an example of an examination wrapper). Before the examination begins, students predict their scores and identify their study methods, including the amount of time and effort invested in preparation. After the examination, students identify their test-taking errors and, most importantly, determine the changes they plan to make before the next examination. Essentially, examination wrappers provide a format for students to calibrate their study methods with their earned scores and synthesize methods for improvement. The strategy has clear potential for increasing student success, with Butzlaff et al4 citing greater than 10% improvement in examination scores over 1 semester.

Examination wrapper surveys benefit faculty by revealing students' predominant study methods and testing strategies and by providing data to compare the methods favored by higher- versus lower-scoring students. When examination wrappers are used over a semester, faculty may identify changes in study strategies as students become experienced with course concepts and develop skill in metacognition and self-regulated learning. Such information is helpful when remediating with struggling students.

Examination Wrapper Project

Attracted by the low-cost, low-risk possibilities, faculty in our program who teach the first-semester nursing foundations course designed a project using examination wrappers with each of 4 examinations over the course of a semester. Despite providing no incentive for students to participate, 196 of 200 of students completed the first survey. Moving all examinations online in response to the COVID-19 pandemic necessitated a change in examination wrapper formatting. We modified our original wrapper into the format of an online survey, but because of the possibility of student confusion and stress, faculty did not administer wrappers with the next 2 examinations. A link to the wrapper for the final examination was posted on the course announcement board with slightly more than 100 of the students completing it.

Results

Although disappointed with the drop in participation, we analyzed the data to learn what we could. Several helpful findings emerged.

Confidence

From the first to the final examination, the percentage of students reporting that they were not confident in their recall and test-taking abilities decreased from 25% initially to 3% by the end of the semester.

Reviews by Nursing Faculty

In our program, nursing faculty with workload assigned for remediation (termed "Student Success faculty") hold weekly online group test-taking practice sessions, with emphasis on study and test-taking skills. In individual sessions, students with less-than-passing scores meet with Student Success faculty to review examinations. Data from the examination wrappers indicated that the usage of the Student Success individual and group meetings increased from 40% to about 65% by the end of the semester. Among the lowest-scoring students (earning a grade of C or below on the first examination), meeting with Student Success faculty was significantly associated with attaining a high score (A or B) on the final examination.

Supplemental Study Aids

Several textbook-associated online resources were available to students. Practice test questions were popular and were used by about 75% of students, but use declined to just greater than 60% by the end of the semester.

Study Time

By the end of the semester, the percentage of students who began preparing for examinations more than 1 week before they were scheduled had nearly doubled. Students who reported after the first examination that they planned to begin studying sooner next time showed by the final examination wrapper that they had implemented this.

Group Study as a Strategy

We had initially expected the use of group study to increase, as shown by Butzlaff et al.4 Social distancing, required during the spring 2020, made this concept impossible to test. Group study as a strategy decreased sharply, except in the form of an online group study, which increased from 5% to 11% of students by the end of the semester. When questioned about this, students revealed that they started a video conference session with a group of other students (often a clinical group) and would spend a couple of hours studying concepts together. They reported that often they studied with minimal verbal interaction, each student silently reading a textbook-yet being able to see one another over video made them feel less isolated.

Although individual students seeking to improve did so dramatically, overall class examination averages remained in the 85% range between the first and final examinations. There were no significant differences between examination scores in spring 2020 when the wrapper project was conducted to those from those the year before. Circumstances related to the pandemic interfered with the original plan, resulting in a loss of data points. Evidence pointing to increased metacognitive skills was sparse and inconclusive.

Although examination wrappers were collected only twice, comparing the changes in student responses from the beginning to the end of the semester allowed us to discover improvement in students' test-taking confidence and changes in study techniques. We shared with new incoming students the information we had gained about the effectiveness of Student Success faculty reviews and the innovative technique students had used of studying with their peers using conferencing software. The experience has been valuable and will inform our future examination wrappers initiatives.

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