1. Oermann, Marilyn H. PhD, RN, ANEF, FAAN

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Important decisions about students are made based on the data collected in an assessment. Tests, written assignments, observations of performance in simulation and clinical settings, and other strategies provide data for making these decisions. Tests and other assessments you develop for your courses are often high stakes, regardless of whether you use this label for them, because they have important consequences-determining if students pass the course and in some cases can continue in the nursing program. This is the time of the semester in which many faculty members develop their end-of-course examinations or revise earlier versions and soon will be determining students' grades in their courses. This editorial provides 10 principles on testing that might be helpful to you as you prepare these examinations for your students.


1. Focus your test items on the outcomes of your course. Our goal in teaching in nursing is to help students learn. Our goal in assessment at the end of the course (for summative evaluation) is to determine if students have achieved the outcomes of the course and developed the essential competencies. The course outcomes, objectives, or whatever label you use for these in your school provide the framework for writing your test items.


2. Use a test blueprint. The blueprint is your plan for the test: it lists the main topics to assess, number of items or points allotted for each topic (consistent with the importance of the content and emphasis given to it in the course), and level of complexity of the test items (eg, an item that assesses students' knowledge of facts or one that assesses their ability to apply concepts to a new scenario). The blueprint guides you in preparing a test that focuses on the learning outcomes that were important in your course.


3. Share the blueprint with students. The blueprint not only guides you in developing a valid and fair examination, but students can use it to prepare for the test. Review the blueprint with students so they know the emphasis given to certain topics and types of items to expect on the test. Students will prepare differently for a matching item on definitions of terms than they would for a higher-level multiple-choice question in which they need to prioritize interventions for a patient.


4. Don't add test items as fillers (so you can have a certain number of items, eg, 50 or 75, on the examination). Every test item should measure something important.1 It is better to have fewer items on the test than adding questions that are too easy or test obscure content areas.


5. Check that each test item is clearly written. Students should be able to read the item and know what information it is asking for. Your goal is to assess what students have learned, and to do that, your test items need to be clear and unambiguous. Ask a colleague who does not have expertise in the content to read through the questions for clarity. Check that there are no grammatical or punctuation errors: these might give a clue to a correct or an incorrect answer.1


6. Type out acronyms and abbreviations (unless you are testing students' knowledge of them). Related to this is avoiding jargon in testing.


7. Avoid using not and except in an item, if possible. Sometimes these are confusing to answer especially if students have been selecting the correct or best answer in prior questions. If you include this type of item, add bold, underlining, or some other formatting to not and except to make it clear to students.1


8. Check that the item has only 1 correct or best answer. Review multiple sources to confirm the answer.


9. Be cautious about using items from a test bank as is. Items in the test bank may not be consistent with your course outcomes or the emphasis you placed on different topics you taught in the course (as indicated in the blueprint). The quality of items from a test bank is sometimes questionable. If you use items from a test bank, revise them to fit your blueprint and to ensure principles of writing test items are met. In this issue, Bristol et al2 present the findings of their study on test writing practices of 674 nursing faculty. One of the findings that stands out for me is that while many nursing faculty obtained items from textbooks or test banks, they modified the items before using them.


10. Do peer review of tests in your school of nursing. Ask a colleague to review your test items, and you can do the same with their examinations. In this issue, White and Heitzler3 describe their study that examined the effect of increasing objectivity of evaluation methods on grade inflation. Some of the best practices they used were developing test blueprints, having all items peer reviewed, and doing item analyses after examinations to identify and revise poor-performing items. This is good advice for all of us.



It is also important to give some thought to the order of items on your end-of-course examinations and other tests in your courses. Items should be arranged in a logical order: the order might be based on difficulty of items, with the easy items placed in the beginning of the test and more difficult ones near the end. Other ways are to group similar formats together (eg, place all of the matching items together) or use a combination of these approaches.1 It seems wise to place easier questions in the beginning so students can answer them quickly (and with confidence) and have more time near the end for items that require higher-level thinking and analysis.


These are my "top 10" principles on testing. I hope these are helpful to you in preparing the end-of-course examinations and other tests in your courses. One last tip: Don't wait until the last minute to prepare your test. It takes time to write good test items and seems to always take longer than you expected.




1. Oermann MH, Gaberson KB. Evaluating and testing in nursing education. 5th ed. New York: Springer; 2017. [Context Link]


2. Bristol TJ, Nelson JW, Sherrill KJ, Wangerin VS. Current state of test development, administration, and analysis: a study of faculty practices. Nurse Educ. 2018;43(2):68-72. [Context Link]


3. White KA, Heitzler ET. Effect of increased evaluation objectivity on grade inflation: Precise grading rubrics and rigorously developed tests. Nurse Educ. 2018;43(2):73-77. [Context Link]