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Dr. Donna Martin, Assistant Professor, Faculty of Nursing;

Three Heads are Better than One! Undergraduate Nursing Students’ Experiences with Collaborative Testing. Dr. Donna Martin, Assistant Professor, Faculty of Nursing; Eunice Friesen, Associate Director Educational Innovations, Centre for Advancement of Teaching/Learning;

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Dr. Donna Martin, Assistant Professor, Faculty of Nursing;

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  1. Three Heads are Better than One!Undergraduate Nursing Students’ Experiences with Collaborative Testing Dr. Donna Martin, Assistant Professor, Faculty of Nursing; Eunice Friesen, Associate Director Educational Innovations, Centre for Advancement of Teaching/Learning; Antonina De Pau, Graduate Student

  2. Acknowledgements We extend our deep appreciation to the student volunteers that participated in this study and to the staff of the Manitoba Centre for Nursing & Health Research for their assistance and guidance. The study was funded by the Professional Foundations Research Fund from the Manitoba Centre for Nursing & Health Research via the Nursing Endowment Fund, Faculty of Nursing, University of Manitoba.

  3. COLLABORATIVE TESTING (CT) is an formative assessment approach that allows students to work in teams while taking an examination to foster deeper learning/teamwork skills (Sandahl, 2009, 2010;Wiggs, 2010). BACKGROUND: • CT has been implemented and evaluated in higher education for > 20 years (Centrella-Nigro, 2012;) . Only recently have studies emerged in the nursing literature (Centrella-Nigro, 2012; Durrant, Pierson, & Allen, 1985; Hickey, 2006; Heglund & Wink, 2011; Hickey, 2006; Jones & Lishman, 2011; Lusk & Conklin, 2003; Mitchell & Melton, 2003; Molsbee, 2013; Sandahl, 2010; Wiggs, 2010). • Because implementation of CT “has been used in a number of different formats and designs for many years” (Jones and Lishman, 2011, p. 176), there is great difficulty in discerning the evidence (Pandey and Kapitanoff, 2011). • Most of the research has been descriptive in nature with some studies using a quasi-experimental design (Sandahl, 2010).

  4. OUTCOMES: • Consistent outcomes of using CT include student and faculty’s positive perceptions of the learning experience. When asked, students consistently reported that the CT experience taught them negotiation skills(Cortright, Collins, Rodenbaugh, & DiCarlo, 2003; Gallagher, 2009; Giuliodori, Lujan, & DiCarlo, 2008, 2009; Haberyan & Barnett, 2010; Jones and Lishman, 2011; Lusk and Conkin, 2003; Rao, Collins, & DiCarlo, 2008). • Inconsistent outcomes included impacts on grades, test anxiety, critical thinking and retention of course material (Bloom, 2009; Cortright, Collins & DeCarlo, 2005; Kapitanoff, 2009; Leight et al, 2012; Meseke et al, 2009; Molsbee, 2013; Murray, 2010; Pollard & Miers, 2008; Rao & DiCarlo, 2000; Slusser & Erickson, 2006; Woody, Woody, & Bromley, 2008; Zipp, 2007).

  5. Rationale A study comparing and contrasting nursing students’ experiences with CT versus traditional testing was warranted to determine if CT is an effective strategy for students to “learn better” and hone teamwork skills. Nurses are required to actively participate as a health team member to promote patient safety (Institute of Medicine, 2010). Nursing schools must develop models that educate nurses to practice more effectively within health care teams (Eggertson, 2013; IOM 2010).

  6. Guiding Frameworks http://www.emeraldinsight.com/fig/1350080301003.png Social Interdependence Theory Group learning enhances student success, critical thinking and deeper learning (McWhaw 2003, as cited in Bloom, 2009).

  7. Guiding Frameworks (Continued) Cognitive Elaboration Perspective Deep learning requires cognitive restructuring best accomplished by explaining material to others (Whittrock, 1985). Neuroscience - It’s biological! Social learning requires collective problem solving challenging the individual’s own thinking process which results in development of areas in the brain which further enhances learning (Caine & Caine, 2006; Ericsson, 2006; Immordino-Yang, & Damasio, 2007).

  8. Research Questions Is there a statistically significant difference between formative test scores in the CT versus traditional test-taking groups of undergraduate nursing students? Does CT enhance retention of course material? What are the educational and group process experiences of undergraduate nursing students when CT is implemented?

  9. Research Method: Sampling Procedure Following ERB approval, Nursing students were recruited from 2 sections of the same course offered by the same instructor over the same term. Recruitment of study subjects and data collection procedures ensured that the instructor was “blind” to the identification of students that were/were not participating.

  10. Method: Data Collection Procedures • Informed consent obtained • Demographic surveys completed • Students randomly assigned into Group A or B (Section 1), Group C or D (Section 2) • Cross over research design

  11. Method: Data Collection Procedures (Continued) Non-participating students wrote all tests using traditional test-taking format. [test = 45 questions (MCQ and short answer) worth 15% each]. Immediately prior to CT, study subjects were randomly assigned to groups of 3. CT written in one room. Non-participants and subjects assigned to traditional testing wrote in a separate room. Each small group submitted 1answer sheet. All students provided 2 hours to write formative tests. All students wrote final exam individually.

  12. Method: Data Collection Procedures (Continued) Immediately following CT, subjects completed CT Testing Evaluation Survey (14-items rated on a 5-point Likert Scale). Two audiotaped focus groups (n=3, n=9) were conducted at the end of the term using an interview guide.

  13. Research Questions Data Analysis Procedures Is there a statistically significant difference between formative test scores in the CT versus traditional test-taking (TT) groups of undergraduate nursing students? Does CT enhance retention of course material? What are the educational and group process experiences of undergraduate nursing students when CT is implemented? Scores from demographic survey , CT evaluation survey, Test 1, Test 2, final test scores uploaded into SAS Version 9.3 Challenging questions on informative tests were repeated in the final exam. % of correct responses in CT, TT and final compared (Chi-square). Audio-tapes from focus groups transcribed verbatim. All names and identifying features removed. 2 research team members independently analyzed data, then compared codes, categories, themes using NVivo 9.

  14. Description of the Sample • Convenience sample, initially 74 volunteered to participate with 4 withdrawing from the study • n=70 (out of 110 students enrolled in 2 sections of the same course offered by the same instructor over the same term) • Most participants were female (60 female; 8 male; 2 unanswered) • Most were < 30 years of age • Almost 2/3rds of the sample was 20-24 years of age • Almost 83% had completed 2 years of course work in the Faculty of Nursing • 14% had previous degree • Participants from both sections were similar • Overall, student population in this program is culturally diverse – although cultural heritage was not measured by the demographic survey, this sample was representative of the target population

  15. Results • Impact On Grades • Using cross-over analysis - the treatment effect (CT) was highly significant; CT scores were on average 7.99 units higher than traditional testing scores (5.21 – 10.77, p value <0.0001) when the test was allocated a score out of 100. • However, formative tests were allocated a total score of 15. Students’ overall grades increased by an average of 1.2 points/100 by participating in CT. • Period effect was not significant (p value = 0.9721), indicating that students did not perform better on the 2nd test

  16. Results Continued • Impact On Retention of Course Material • CT, TT and final exam groups were similar in their rates of responses to specific, challenging test questions. • Using Chi-square, no statistically significant differences existed between groups.* • Based on no statistically significant difference, CT did not impact retention of course material. *Note: 13% of data missing

  17. Students’ Experiences of CT: Findings from 2 focus group interviews Main Theme: “Three Heads are Better Than One”I just thought 3 heads are better than 1 so chances of getting a better mark are better and yeah, I studied more.

  18. Students’ Experiences of CT: 5 Major Categories Studying more – studying differently I found I was more motivated to study for the CT Cognitive collectivism I feel like when others are dependent on me, I would want to be able to provide the answer. It stuck in my head better I feel like I learn a lot better when I discuss things or talk them out, then they stick in my head better. Confidence It strengthens your knowledge coming out [of the CT] that you felt good that you knew your material down pat because someone else knew that too Practicing how to share knowledge/negotiate You need to understand the materials in order to communicate and you need to be able to communicate that. So in a way, it’s a good strategy for team working to be able to get everybody’s input, take it all apart, and put it all back together and make sure that you have the right answer…

  19. Students’ Experiences of CT: Results from CT Evaluation Surveys Student’s Perceptions • Most students perceived that their grades were enhanced by the CT process. • Approx. 79% agreed that CT helped them understand the course material better.

  20. Discussion CT was an effective learning strategy, particularly when formative tests were weighted appropriately and written in multiple choice format. Differences b/w CT and traditional test-taking scores were statistically significant supporting the previous findings from Sandahl (2010) and Wiggs (2010). Effective CT requires a relaxed yet professional environment with an encouraging invigilator with sufficient time allotted for group discussion as per Wiggs’ recommendations (2010). A future research study using different methods to test retention of course material is needed. For example, a study similar to Pollard and Miers’ work in the United Kingdom (2004, 2008) is needed. Future research about the effectiveness of CT with culturally diverse nursing students would be beneficial.

  21. Conclusion Nursing education must provide ample opportunity for nursing students to foster deeper learning/teamwork skills. CT produced statistically significant higher test scores. Because formative tests were weighted appropriately, students participating in CT scored an average of 1.2/100 higher than the traditional testing group in their final course grades. In this study, there were no statistically significant differences between CT, TT and final exam groups in rates of correct responses to repeated challenging questions indicating that CT did not impact their learning. This sample perceived that CT was a positive learning experience. The main theme that emerged from the two focus group transcripts was “three heads are better than one.” This study has strong practical significance in that teamwork skills were facilitated.

  22. References Bloom, D. (2009). Collaborative test taking: Benefits for learning and retention. College Teaching. Retrieved October 20, 2010, from http://heldrefpublications.metapress.com/index/327U1011736Q2467.pdf. Caine, R., & Caine, G. (2006). The way we learn. Educational Leadership, 64(1), 50-54. Retrieved from http://web.ebscohost.com.proxy2.lib.umanitoba.ca/ehost/pdfviewer/pdfviewer?sid=b6b0fe8a-8f06-4428-8976-286275d22b91%40sessionmgr14&vid=2&hid=110 Centrella-Nigro, A. (2012). Collaborative testing as posttest review. Nursing Education Perspectives, 33 (5), 340-341. Cortright, R. N., Collins, H. L., & DiCarlo, S. E. (2005). Peer instruction enhanced meaningful learning: ability to solve novel problems. Advances in Physiology Education, 29(2), 107-11. doi: 10.1152/advan.00060.2004. Cortright, R. N., Collins, H. L., Rodenbaugh, D. W., & DiCarlo, S. E. (2003). Student retention of course content is improved by collaborative-group testing. Advances in Physiology Education, 27(1-4), 102-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12928319. Durrant, L. K., Pierson, G., & Allen, E. M. (1985). Group testing and its effectiveness in learning selected nursing concepts. The Journal of the Royal Society for the Promotion of Health, 105(3), 107-111. doi: 10.1177/146642408510500306. Ericsson, K.A. (2006). The influence of experience and deliberate practice on the development of superior expert performance. In K.A. Ericsson, N. Charness, P. Feltovich, and R.R. Hoffman, R.R. (Eds.). Cambridge handbook of expertise and expert performance (pp. 685-706). Cambridge, UK: Cambridge University Press. Giuliodori, M. J., Lujan, H. L., & DiCarlo, S. E. (2008). Collaborative group testing benefits high- and low-performing students. Advances in Physiology Education, 32(4), 274-8. doi: 10.1152/advan.00101.2007. Haberyan, A., & Barnett, J. (2010). Collaborative testing and achievement: Are two heads really better than one? Journal of Instructional Psychology, 37, 1, 32-41. Heglund, S., Wink, D. (2011), Impact of double testing on student knowledge in a professional issues course. Journal of Nursing Education (50) 5, 278-280. Hickey, B. L. (2006). Lessons learned from collaborative testing. Nurse Educator, 31(2), 88-91.

  23. References (Continued) Immordino-Yang, M. H. and Damasio, A. (2007). We feel, therefore we learn: The relevance of affective and social neuroscience to education. Mind, Brain, and Education, 1: 3–10. doi: 10.1111/j.1751-228X.2007.00004.x Jones, J., Lishman, K. (2011). Collaborative posstesting in an adult health nursing course. Teaching and Learning in Nursing, 6, 176-180. Kapitanoff, S. H. (2009). Collaborative testing: Cognitive and interpersonal processes related to enhanced test performance. Active Learning in Higher Education, 10(1), 56-70. doi: 10.1177/1469787408100195. Leight, H., Saunders, C., Calkins, R., Withers, M. (2012). Collaborative testing improves performance but not content retention in a large-enrollment introductory biology class. CBE – Life Sciences Education (11), 392-401. Lusk, M., & Conklin, L. (2003). Collaborative testing to promote learning. The Journal of Nursing Education, 42(3), 121-4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12661712. Meseke, C., Bovee, M., Gran, D. (2009). Impact of collaborative testing on student performance and satisfaction in a chiropractic science course. Journal of Manipulative and Physiological Therapeutics, (32) 4, 309-314. Mitchell, N. & Melton, S. (2003). Collaborative testing: An innovative approach to test taking. Nurse Educator, 28(2), 95-97. Retrieved February 3, 2011, from http://ovidsp.tx.ovid.com.proxy1.lib.umanitoba.ca/sp-3.3.0b/ovidweb.cgi?&S=ECIEFPKNGIDDELDFNCCLAELBPCKPAA00&Link+Set=S.sh.15.16.19.22%7c13%7csl_10. Molsbee, C.P. 2013.) Collaborative testing and mixed results. Teaching and Learning in Nursing (8), 22-25. Murray, J. P. (2010). Better testing for better learning. Learning, 38(4), 148-152. Pandey, D., Kapitanoff, S. (2011). The influence of anxiety and quality of interaction on collaborative test performance. Active Learning in Higher Education, (12), 163-174. Pollard, K. & Miers, M. (2008). From students to professionals: Results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom. Journal of Interprofessional Care,22(4), 399-414. Retrieved from, http://informahealthcare.com.proxy1.lib.umanitoba.ca/doi/abs/10.1080/13561820802190483  Pollard, K.C., Miers, M.E. and Gilchrist, M. (2004). Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health & Social Care in the Community, 12, 346–358. doi: 10.1111/j.1365-2524.2004.00504.x

  24. References (Continued) Rao, S. P., Collins, H. L., & DiCarlo, S. E. (2008). Collaborative testing enhances student learning. Society, 37-41. Rao, S. P., & DiCarlo, S. E. (2000). Peer instruction improves performance on quizzes. Advances in Physiology Education,24(1), 51-55. Retrieved February 2, 2011, from http://advan.physiology.org/cgi/content/abstract/24/1/S51. Sandahl, S. S. (2009). Collaborative testing as a learning strategy in nursing education: A review of the literature. Nursing Education Perspectives, 30(3), 171-175. Sandahl, S. S. (2010). Collaborative testing as a learning strategy in nursing. Nursing Education Perspectives, 31(3), 142-147. Slusser, S. R., & Erickson, R. J. (2006). Group quizzes: An extension of the collaborative learning process. Teaching Sociology, 34(3), 249-262. doi: 10.1177/0092055X0603400304. Wiggs, C. (2010). Collaborative testing: Assessing teamwork and critical thinking behaviors in baccalaureate nursing students. Nursing Education Today,31(3), 279 - 282. doi:10.1016/j.nedt.2010.10.027 Woody, W. D., Woody, L. K., & Bromley, S. (2008). Anticipated group versus individual examinations: Teaching of Psychology, 35, 13-17. doi: 10.1080/00986280701818540. Zipp, J. F. (2007). Learning by exams: The impact of two-stage cooperative tests. Teaching Sociology, 35(62), 62-76. DOI: 10.1177/0092055X0703500105

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