Nursing Education and Table of Specifications for Learning Outcomes
Why to Develop Table of Specifications In Nursing Education
The purpose of developing a table of specifications (test map, test grid, test plan, test blueprint) is to ensure that the test serves its intended purpose by representatively sampling the intended learning outcomes and instructional content. The first step in developing a table of specifications is to define the specific learning outcomes to be measured.
Specific learning outcomes, which are derived from more general instructional outcomes (e.g., course and unit objectives), specify tasks that students should be able to perform on completion of instruction (Miller, Linn, & Gronlund, 2012). Bloom's taxonomy (Bloom, Englehart, Furst, Hill, & Krathwhol , 1956) has been used as a guide for developing and leveling general instructional and specific learning outcomes.
Although the cognitive components of the affective and psychomotor domains can be evaluated with structured choice tests, tests have most often been used to determine achievement of outcomes in the six levels of Bloom's cognitive domain (Table 24-2). Anderson and Krathwohl (2001) have revised Bloom's taxonomy, defining knowledge dimensions and cognitive processes.
The knowledge dimensions are
factual, conceptual, procedural, and metacognitive. The cognitive processes are
remembering, understanding, applying, analyzing, evaluating, and creating. Any of the six cognitive processes can be applied to the various
dimensions of knowledge. The licensing exams offered by the National Council of
State Boards of Nursing (NCSBN).
Additional attention is being given to those cognitive processing skills used by nurses, such as critical thinking, clinical judgment, and clinical decision making (Wendt & Harmes, 2009b). Test items should address these processes as well, and a mixture of cognitive processes should be evaluated at each stage of instruction, placing an increasing emphasis (or weight) on higher level skills.
This is vital because higher-level skills are more likely to result in retention and transfer of knowledge. In addition, this will assist in preparing students for the licensing and certification examinations that test primarily at the levels of application and analysis.
The second step in developing a table of
specifications involves determining the instructional content to be evaluated
and the weight to be assigned to each area. This can be accomplished by
developing a content outline and using the amount of time spent teaching the
material as an indicator for weighting.
Finally, a two-way grid is
developed, with content areas being listed down the left side and learning
outcomes being listed across the top of the grid. Each cell is
assigned a number of questions according to the weighting of content and cognitive
processes of learning outcomes.
Some faculty prefer to use a three-way table of specifications. With a three-way grid, the five steps of the nursing process are listed on the left side, outcomes are listed across the top, and the number of items or specific content areas is listed within each cell.
Weighting of the steps of the nursing process again depends on the level of instruction. For example, early in the instructional process, assessment and diagnosis might carry the most weight, whereas all stages may be tested equally by the end of instruction.
Alternatively, a table of
specifications can be created using the test plan of the current licensure or
certification examination (National Council of State Boards of Nursing, 2014).
When developing a test plan based on these examinations, the faculty must also
be using these test plans with appropriate learning outcomes and
teaching learning strategies. Other Considerations in the Planning Stage
Selecting Item Types of Learning Outcomes In Nursing Education
Several types of items can be used to test attainment of learning outcomes. Items may be selection type, providing a set of responses from which to choose, or supply type, a constructed response type requiring the student to provide an answer. Common selection type items include true–false, matching, ordered-response, and multiple-choice questions.
Supply type items include fill-in-the-blank (usually requiring an absolute answer derived from a mathematical calculation), short-answer, multiple-response, hotspot, and essay questions (Wendt & Kenny, 2009). The primary reason for choosing one type of item over another can be determined by answering the question: “Which type of item most directly measures the intended learning outcome?”
Both selection type and supply-type questions can be developed for all levels of the cognitive domain (Su, Osisek, Montgomery, & Pellar, 2009) and to test critical thinking, problem solving, and clinical decision-making skills. Other factors may also influence the item-type selection.
For example, a large class size may prohibit the use of supply-type items
because of the time required for grading. In addition to multiple choice items
with one correct answer, licensing exams use alternative format questions,
which include fill in the blank questions, multiple response questions,
drag and drop or ordered response questions, and picture or graphic questions,
as well as questions that use audio files; using video clips in test questions
is under consideration (Wendt & Harmes, 2009b). Current information on the
examination format can be obtained from the website for the NCSBN.
Selecting Item Difficulty for Table of Specification In Nursing Education
Determining item difficulty, the percentage of students who answered the question correctly, primarily depends on the purpose and type of the test. If the purpose of the test is to evaluate learning in order to assign a grade, the test should be moderately difficult and distinguish the students who have learned the content from those who have not.
If the test is a criterion-referenced test, difficulty should match the
level of the learning that reflects the skills to be mastered. For some
questions, therefore, the item may be an “easy” item. Norm-referenced tests
involve eliminating easy items and using average-difficulty items to maximize
the differences among students.
Determining Number of Items for Table of Specification In Nursing Education
Determining the number of items to include in a test depends on the number of learning outcomes to be evaluated. Although test reliability increases with the number of test items, the number of test items is limited by many practical constraints.
For example, more selection-type items than supply type items can be answered in a given period. Similarly, items that require higher level thinking skills take more time to answer than those that require lower level skills.
A general guide for planning is to allow 1 minute for each moderately difficult multiple-choice item. For tests with greater difficulty and longer questions such as multiple-response type questions, the time allocation may need to be longer, approximately 1.5 minutes per question.
Faculty should also consider the numbers of culturally
and linguistically diverse students in the class and create a supportive test
taking environment by allowing sufficient time for all students to process the
question and respond to the answer options (Fuller, 2013).
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