Comparing Results of Alternate Format Test Questions to Standard Multiple Choice Test Questions in First, Second and Third Year Baccalaureate Nursing Students

Multiple choice questions are frequently used on examinations within the health disciplines to evaluate student performance. Before 2015, Canadian nursing graduates were required to pass the Canadian Registered Nurse Exam (CRNE) to obtain licensure to practice. This exam consisted of mainly multiple-choice questions. In recent years, Canada (except for its province of Quebec) has adopted the NCLEX-RN exam as the licensure assessment exam for nursing graduates. The NCLEX-RN exam is a computer adaptive test that utilizes not only multiple choice questions, but also question items in a variety of other formats such as multiple responses, fill-in-the-blank calculation, ordered response, and hot spot. To explore if changes in question item formats influenced an individual's ability to answer a test question correctly, we carried out a descriptive, comparative study with first, second, and third-year Baccalaureate nursing students. We compared the students’ performance on NCLEX-RN style alternate format test questions with their performance on standard multiple choice questions in an anatomy and physiology course. We further compared their performance on both types of questions and their final grade in the course. A convenience sample of students enrolled in one Atlantic Canadian Nursing Program was included. Descriptive statistics resulted in significant differences between the various types of questions used. The results of this study provide the basis for recommendations directed toward the inclusion of alternate format test questions on examinations throughout the current nursing curriculum as a means to enhance baccalaureate nursing students' performance on their future licensure exams.