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The Enhanced Multiple-Response Item: An Option for Next Generation NCLEX

Oct 17, 2018, 11:52 AM
<4-min. read> The National Council of the State Boards of Nursing (NCSBN) is considering changes to the NCLEX. While NCSBN has identified a variety of reasons for updating the exam, a primary one is that testing today no longer needs to measure students’ ability to memorize long lists of facts.
“Students don't memorize — don’t need to memorize — 25 sets of drugs,” says Phil Dickison, PhD, RN, Chief Officer of NCSBN operations and examinations. “That's not how we work anymore. I have a reference library; I have a phone,” he explains. Students can simply type in a question “and see what the PDR might say about it or some other reference.”

Far more important than regurgitating data is being able to measure a student’s clinical judgment skills. The Next Generation NCLEX — the name NCSBN has conferred on the project — would include new item types designed specifically for that task.

Dr. Dickison recently discussed this topic during an interview with Sheryl Sommer, PhD, RN, CNE, ATI Vice President and Chief Nursing Officer.Sheryl Sommer interviews Phil Dickison 

A proposed Next Generation NCLEX item type

One idea for a more advanced item type is an enhanced version of multiple response.

Dr. Dickison describes an example:

“What if you put a client history and the PDR for a medication side by side,” Dr. Dickison suggests. “Now ask an entry-level nurse why he or she would not give a medication that was ordered.”

The goal of such a question type: To test a novice nurse’s ability to say, “’Wait. We probably shouldn’t do this,’” Dr. Dickison says.

“We want them to be clinical thinkers and say, ‘There might be a problem here.’”

The test might highlight words in the PDR along with text describing client progress. 

“That information would be the combination of reasons why you’d withhold that med,” Dr. Dickison explains.Quote by Phil Dickison

Creating a hybrid of NCLEX item types

Dr. Dickison says one way to describe this new item type would be to imagine fusing a standard multiple-response question with a hot-spot question. 

“Think of a multiple-response item now,” Dr. Dickison explains. “You might have a response set of six of which you pick three. What if that response set were 22?”

He goes on: “You pick seven, and I pick eight of which we both get six right. You picked one wrong; I picked two wrong,” Dr. Dickison says. “We have to have a scoring mechanism that ensures your abilities are higher than mine. It can’t just be right or wrong, which is how we score items today.

“So even in our multiple-response now, if you had three correct responses, but you missed one of them, you get zero. If I didn’t pick any of them, I get zero.”

Determining a new method of NCLEX scoring

Dr. Dickison says NCSBN is working on overcoming the “right-or-wrong” scoring model in the Next Generation NCLEX. The exam needs to better measure students’ skills at clinical judgment and deliver more accurate information on their abilities. 

3 people standing at patient bedside“The other thing we’re looking at is breaking some of the rules that we’ve taught educators for years,” Dr. Dickison says, such as putting time constraints in an item type.

He offers another example for explanation: Imagine an item type in which the student clicks a series of radio buttons to view 30-minute increments of a client’s progress under a nurse’s care over two hours. The test asks the student to identify the point at which the nurse in the scenario made a mistake. 

“We’ve all been taught that you don’t put negative stuff in an exam,” Dr. Dickison explains. But these types of questions tell us whether the student can think clinically. “They should be able to,” he says.

Specifically, as mentioned previously, students should be able to see a scenario and recognize when something is wrong, he says.

Precluding an NCLEX guessing game

But the enhanced multiple-response item type shouldn’t end at that point, Dr. Dickison goes on. After all, the student could simply have gotten lucky in guessing the right answer.

“Now, you’ve got to add a short-response type-in,” Dr. Dickison says, describing how the test would require the student to key-in an answer describing what the nurse in the scenario did wrong. Next? The student must state what the nurse’s next step should have been. 

Now, rather than a simple right-or-wrong answer on which to assess the student, Dr. Dickison explains, “You’ve got three pieces of information.

“It’s that more in-depth look that is really the sort of fidelity in how we operate,” Dr. Dickison adds. 

But enhanced multiple response is only one of several item types NCSBN is developing. Others include extended drag-and-drop, CLOZE (select the missing word), dynamic exhibits, and constructed response.

“They’re really exciting items,” Dr. Dickison adds. “Right now, they’re all being investigated.”  


Provide feedback about the Next Generation NCLEX to the National Council of the State Boards of Nursing (NCSBN) at:

  • Mail: 111 East Wacker Drive, Suite 2900, Chicago, IL 60601-4277
  • Phone: 312.525.3600
  • International phone: 011 1 312 525 3600
  • Fax: 312.279.1032
  • Email: [email protected]

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