Impact of Adaptive Quizzing as a Practice and Remediation Strategy to Prepare for the NCLEX-RN

Abstract

National Council Licensure Examination-Registered Nurse (NCLEX-RN) outcomes are extremely important to nursing institutions and students for myriad reasons. For students, the NCLEX-RN represents one of the final milestones to conquer before entering a nursing career. Nursing programs monitor NCLEX-RN pass rates as an important gauge of program quality and minimum levels frequently must be met. This study explored the implementation of an adaptive quizzing and learning system as part of an NCLEX-RN preparation strategy designed to increase student engagement and subsequent success on the NCLEX-RN. The adaptive quizzing system was used as part of an ongoing, proactive strategy to student preparation. This strategy is in contrast to the practice of using high-stakes exams scores to try and predict student NCLEX-RN outcomes. In the latter case there is mixed evidence on how scores relate to remediation and moving students toward success based on evidence of need. The study school required students (N = 54) to take regular, adaptive practice quizzes throughout their final year in the nursing program. Students were also given the HESI E 2 in their final semester and all but one student achieved the target threshold with a range of scores (772 to 1028). Despite this variability, 90.7% of the students in the study group passed the NCLEX-RN on their first attempt, with a pass rate of 98% when considering those who passed on the second attempt. NCLEX-RN pass rates at the study school increased by 11.55% following the implementation of the system and in the second year of implementation (the data analyzed for this study) increased an additional 3.95% from the previous year. With many factors to consider, we cannot say, unequivocally, that using the AQS resulted in an increase in NCLEX-RN pass rates at the study school. Findings from this retrospective study do, however, support the use of an adaptive quizzing system

Evaluating the Effect of Pre-Exam Adaptive Quizzing on Nursing Student Exam Scores

“…House et al (2016) found most students were satisfied using an adaptive quizzing program and felt its use improved their ability to learn. Most studies evaluated the predictive ability of adaptive quizzing programs on NCLEX pass rates (Cox-Davenport & Phelan, 2015;Malkemes & Phelan, 2017;Pence & Wood, 2018). Presti and Sanko (2019) focused on the relationship between adaptive quizzing programs and end-of-program exit exam scores; they evaluated four cohorts in an accelerated bachelor of science in nursing program.…”

Blending Adaptive Learning Technology Into Nursing Education: A Scoping Review

“…However, two motives are most prominent Firstly, a desire to determine whether ALT improves the learning outcomes compared to traditional teaching methods or not (Hinkle et al, 2020;Morente et al, 2014). Secondly to enhance the likelihood that students pass final license exams (Malkemes & Phelan, 2017;Presti & Sanko, 2019;Simon-Campbell & Phelan, 2016). A single study is pedagogically motivated by a hypothesis that adaptive technologies may provide an enhancement of case-based learning by personalizing cases to the students' abilities (Hinkle & Moskal, 2018).…”

“…As students improve, they are given harder questions. Some of the technologies used allow students to design quizzes themselves and provide the students with an overall mastery score (Malkemes & Phelan, 2017;Presti & Sanko, 2019;Simon-Campbell & Phelan, 2016).…”

“…The duration of the interventions is one of the most commonly described parameters of the learning design. The duration varies greatly, ranging from a four hour session (Morente et al, 2014) to an experiment that stretches over two semesters (Malkemes & Phelan, 2017). The remaining studies are somewhere in between and of a length similar to a semester.…”

“…Four of the studies described how they encouraged the students to engage with the ALT. The degree of formalization varies greatly, ranging from Hinkle and Moskal (2018), which had no requirements from the students, and their interactions and achievements were not taken into account to Malkemes and Phelan (2017), who had set criteria for engagement in terms of number of questions to be answered each week, a certain mastery level to be reached and students' performance were taken into account in their final grade. In Hinkle (2018), the instructors continuously encouraged students to use the technology, and in Simon-Campbell and Phelan (2016), it is mentioned that the visualization of progress within the interface was a motivational factor for engagement for students.…”