The Journal of Continuing Education in Nursing

Teaching Tips 

Using Structured-Option Test Questions to Assess Competency Attainment: Part I

Diane M. Billings, EdD, RN, FAAN, ANEF

Abstract

Nursing is a practice profession, and nurse educators have the responsibility to ensure learner attainment of competency at all levels of nursing education. This two-part article provides basic information about designing structured-option test questions to assess and evaluate competency attainment. Part one discusses the uses, advantages, and limits of using structured-option test questions and explains how to develop a structured-option test question. Part two provides information about developing a test blueprint, administering the test, interpreting test results, and revising the test questions.

J Contin Educ Nurs. 2017;48(5):207–208.

Abstract

Nursing is a practice profession, and nurse educators have the responsibility to ensure learner attainment of competency at all levels of nursing education. This two-part article provides basic information about designing structured-option test questions to assess and evaluate competency attainment. Part one discusses the uses, advantages, and limits of using structured-option test questions and explains how to develop a structured-option test question. Part two provides information about developing a test blueprint, administering the test, interpreting test results, and revising the test questions.

J Contin Educ Nurs. 2017;48(5):207–208.

Structured-option test questions present a clinical scenario (i.e., a clinical situation), a stem (i.e., the question), and correct and incorrect answers; the test taker must choose the correct answer from those provided. Unlike other types of evaluation strategies, such as essay tests, written papers, or reflection, for which the learner provides a response, answers in this type of test question are structured by the test item writer. Commonly used types of structured-option test questions include multiple choice (i.e., one correct answer); multiple response (i.e., one or more correct answers); ordered response (i.e., answers placed in an order of priority); chart (i.e., interpret data from health records to plan nursing care); or fill in the blank (i.e., correct answer has a numerical value). Although time consuming to develop, structured-option test questions can easily determine the learners' attainment of the competency in the cognitive domain and the cognitive aspects of the affective and psychomotor domain (Anderson & Krathwhol, 2001; McDonald, 2013; Miller, Linn, & Gronlund, 2012). Structured-option questions are easy to administer and score but do not replace evaluating competency attainment in actual clinical practice.

Using Structured-Option Test Questions

Structured-option test questions can be used to assess or evaluate attainment of competency statements and learning outcomes. In assessment mode, the questions are used by the learner and educator to gauge understanding of the content and progress toward attaining the competency. Here, questions can be administered prior to the instructional session to determine readiness to participate in the lesson; embedded in interactive PowerPoint® lectures to ensure all learners have grasped the concepts just presented; distributed as a practice test at the end of class, lesson, or module; or administered via a learning management system to assess mastery of the competency. Assessment is an opportunity for practice with feedback, and both the learner and the educator can readjust the teaching or learning required for competency attainment. In evaluation mode, structured-option test questions are administered as an examination, and learner competency attainment is judged and graded or noted as a pass or fail.

Developing Structured-Option Test Questions

Structured-option test question are used to determine competency attainment and must align with a competency statement (i.e., learning outcome or objective) at the appropriate level of the cognitive domain (Table 1). Because nursing is an applied science, competency statements must be written at application levels of the cognitive domain and above, and the test question must be designed to ascertain competency attainment at this level, as well. It is tempting to write competency statements at knowledge and comprehension levels of the domain and then to also write test questions at this level, but clinical competency requires nurses to apply information, analyze data and diagnose problems, synthesize information from a variety of sources, evaluate patient and organizational outcomes, as well as create care plans and reports. The challenge in testing competency at the higher levels of the cognitive domain is to write higher level competency statements and match the test question to test at these higher levels of the cognitive domain.


Levels of the Cognitive Domain

Table 1:

Levels of the Cognitive Domain

All types of structured-option questions are written to include a scenario, a stem, and the structured options, one of which must be correct and the others plausible but incorrect (Table 2). Tips for writing structured-option test questions are provided in Table 2. Table 3 shows an example of a multiple choice type of a structured-option question, written at the synthesis level of the cognitive domain.


Tips for Writing Structured-Option Test Questions

Table 2:

Tips for Writing Structured-Option Test Questions


Example of a Multiple Choice Test Question Written at the Synthesis Level of the Cognitive Domain

Table 3:

Example of a Multiple Choice Test Question Written at the Synthesis Level of the Cognitive Domain

This article has introduced the basics of writing structured-option test questions, discussed the advantages and limits to using these questions in the teaching–learning process, and emphasized the importance of writing competency statements at higher levels of the cognitive domain and developing test questions that align with the competency being assessed or evaluated. Part two of this article discusses how to prepare a test plan, administer the test, interpret test results, and revise the test items.

References

  • Anderson, L.W. & Krathwohl, D.R. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. New York, NY: Longman.
  • McDonald, M.E. (2013). The nurse educators' guide to assessing learning outcomes. Burlington, MA: Jones & Bartlett.
  • Miller, M.P., Linn, R.L. & Grondlund, N.E. (2012). Measurement and assessment in teaching Upper Saddle River, NJ: Pearson Education.

Levels of the Cognitive Domain

Level of DomainCognitive Ability
KnowledgeRemember; recall facts
ComprehensionUnderstand meaning of facts; describe; explain
ApplicationaApply information to clinical situation
AnalysisaAnalyze patient or organizational data to make a diagnosis or set priorities
SynthesisaUse information from observation, health records, and patient, to determine nursing action
EvaluationaEvaluate patient outcomes after implementing a plan of care
CreateaDevelop a care plan, shift report, staffing schedule

Tips for Writing Structured-Option Test Questions

Part of the QuestionTips for Writing
ScenarioIntroduce a clinical encounter that requires implementing a nursing action, making a clinical decision, interpreting data, making a nursing diagnosis, setting a priority, developing a care plan, or giving a shift report. Can include relevant and irrelevant information. Do not use names, gender, ethnicity, or age unless needed to answer the question.
Stem/questionAsk a question that is based on information in the scenario. Write questions at cognitive levels of application and above. Scenarios can include data from health records, such as laboratory reports or nurses' notes; to save reading time, include as much information in the stem as possible rather than repeating it in the answers.
Options/answersIncludes correct and plausible incorrect answers to the question. Write the correct answer first. Answers should be of similar length; vary the location of the correct answer in the list of possible answers.

Multiple choice: one correct and three incorrect answers.

Multiple response: five to seven answers; one to six of which may be correct.

Chart: can be multiple choice or multiple response.

Fill-in-the blank: only one correct answer expressed numerically (unit of measure [e.g., drops per minute, mg, tablet, mL] provided by item writer).

Example of a Multiple Choice Test Question Written at the Synthesis Level of the Cognitive Domain

A patient is receiving 1,000 mL normal saline with 40mEq KCL, which is to infuse at 125 mL/h. The patient tells the nurse “My IV hurts.” The nurse should first:

Notify the health care provider.

Slow the infusion to a keep-open rate of 20 to 50 mL/h.

Assess the IV insertion site for signs of extravasation.

Check the solution and administration set for date when mixed.

Authors

Dr. Billings is Chancellor's Professor Emeritus, Indiana University School of Nursing, Indianapolis, Indiana.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Diane M. Billings, EdD, RN, FAAN, ANEF, Chancellor's Professor Emeritus, Indiana University School of Nursing; e-mail: dbillin@iu.edu.

10.3928/00220124-20170418-04

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