Multiple-choice testing procedures that do not provide corrective feedback facilitate neither learning nor retention. In Studies 1 and 2, the performance of participants evaluated with the Immediate Feedback Assessment Technique (IF AT) , a testing method providing immediate feedback and enabling participants to answer until correct, was compared to that of participants responding to identical tests with Scantron answer sheets. Performance on initial tests did not differ, but when retested after delays of 1 day or 1 week, participants evaluated with the IF AT demonstrated higher scores and correctly answered more questions that had been initially answered incorrectly than did participants evaluated with Scantron forms. In Study 3, immediate feedback and answering until correct was available to all participants using either the IF AT or a computerized testing system on initial tests, with the final test completed by all participants using Scantron forms. Participants initially evaluated with the IF AT demonstrated increased retention and correctly responded to more items that had initially been answered incorrectly. Active involvement in the assessment process plays a crucial role in the acquisition of information, the incorporation of accurate information into cognitive processing mechanisms, and the retrieval of correct answers during retention tests. Results of Studies 1-3 converge to indicate that the IF AT method actively engages learners in the discovery process and that this engagement promotes retention and the correction of initially inaccurate response strategies.Testing and assessment are integral to the educational process. When university or college education takes place as tutorials or in classrooms with a small number of participants, essay examinations are preferred, as they are relatively easy to construct, they allow the instructor to assess the depth and breadth of participant understanding, and they

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.