Educators, publishers, and, of course, students are abuzz about the much-anticipated Next Generation NCLEX (NGN), which is set to debut in April. Among the changes in this new exam is that 10% will now be in case study format to better evaluate candidates' clinical judgment and decision-making.
Case-based learning, as any educator will tell you, promotes a higher level of cognition and preps the learner for real world scenarios. This continues to be an established approach to nursing education, especially in today's sophisticated simulation laboratories. Specifically, the next generation prelicensure exam uses an unfolding case strategy with a low-fidelity simulation that challenges nurses' critical thinking without the particulars of the actual patient care environment. An ideal unfolding case fosters real-time assessment that requires interpreting, responding, and reflecting on patient situations in a variety of contexts. So why all the fuss about this new exam format?
Despite attempts to introduce case-based teaching strategies in the classroom, nursing education is still primarily driven by classroom lectures. Effective case-based learning encourages dialogue, discussion and group learning and a faculty role that, as many educators have noted, moves from being a "sage on the stage to a guide on the side." Developing effective unfolding cases and learning to be a guide in the classroom is no easy task. The ideal unfolding case study captures all the important approaches to patient care expected of the new nurse: recognizing and analyzing, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. If we want to prepare the next generation of nurses, we must carefully examine the classroom challenges before us.
Several years ago, I was teaching in a business program that contracted with me to help take its undergraduate programs online. As part of this work, I was assigned an instructional designer and technologist who challenged me to think dramatically differently about teaching and learning. Her mentoring was instrumental not only in content development and online teaching strategies, but also in the use of business cases to teach. Cases started early in the curriculum, scaffolded, and grew in complexity as students progressed through the program. To be successful, I had to let go of less effective ways of teaching, such as the lecture-dominated classroom and textbook-guided learning, and learn new and more effective strategies such as gaming, microlearning, and dealing with ambiguity in student responses (polytomous or partial credit scoring). I had to allow myself to be taught to be a better teacher. Although I had always used cases in my classroom, I learned they were simply preparing students to answer fancy multiple-choice questions. Well-developed cases apply standards, encourage discrimination and information seeking, and apply logical reasoning and predication. When done well, they transform learning into a student-centric format.
My own development as an educator has helped me understand the current buzz. I was fortunate to have a one-to-one mentorship in this process. Not every school or program has the wherewithal to invest the time or resources needed to advance faculty learning in this way. My interaction with both faculty and students has convinced me that nurse educators are stepping up to the challenge to ensure that students are prepared to be tested as critical thinkers. I'm also astonished by the advancement in academic-practice partnerships that are breaking barriers by creating relevant clinical experiences for students through such strategies as dedicated education units.
That leads me to think about the role journals play in the professional development and education of nurses. At AJN we are thinking about how to present case studies to better align with the clinical judgment model tested in the NGN. For example, our enormously popular Strip Savvy case series presents an excellent opportunity to introduce the nursing clinical judgment model into each installment. If journals like ours are primary resources for the advancement and dissemination of knowledge for nursing practice and we commit to the development and dissemination of effective case-based learning, perhaps we need to shift our thinking from the academic-practice partnership to an academic-practice-publishing partnership.