Post-examination (exam) reviews are an essential part of the learning process in nursing education. A well-facilitated session provides opportunities for students to clarify missed content, receive feedback on their exam performance, and further develop future decision-making skills.1 Traditionally, post-exam reviews are faculty-led, occur in a face-to-face setting, and include the discussion of questions and rationales for correct answers. The rapid shift to online learning and the use of online testing platforms have resulted in faculty needing to consider best practices for offering virtual post-exam reviews. Faculty may be hesitant to offer virtual reviews due to concerns over exam security. However, planning post-exam review sessions that are student-led and focus on self-reflection of exam content and test performance can support the development of clinical reasoning and clinical judgment skills while ensuring exam security. Incorporating purposeful activities in review sessions that do not involve the sharing of the exam and identifying the correct answer allow students to improve their cognitive processes.2 Structuring review sessions around self-reflective activities moves students away from fighting for points and toward engaging in metacognition.3 This article discusses items to address when planning for virtual post-exam review sessions. Strategies that support student reflection, such as exam wrappers, are offered.
Planning Considerations
To facilitate a meaningful virtual post-exam review, faculty should first become familiar with the capabilities of the video teleconferencing platform (eg, Zoom) that will be used. The ability to share a screen or files, participate via chat, ask polling questions, and engage in breakout rooms are common features available. Faculty should identify how use of the features could enhance or hinder the facilitating of the session. For example, opening the review session with an icebreaker polling question can help create a sense of community and a relaxed environment. However, having students post questions via chat during the review might present as a distraction.
When post-exam reviews are poorly executed, students become more focused on debating the correct answer choice than discerning the strengths and weaknesses of their test performance.4 Therefore, faculty should consider the rules students will be expected to follow during the virtual review session. Faculty should have a thorough understanding of current program policies directed toward academic and professional conduct. Expectations of appropriate behavior and the format of the review session should be discussed with students ahead of time. For example, students should be made aware that taking pictures, recording dialogue, or sharing information from the review session are inappropriate behaviors and could result in an academic integrity violation. In addition, students should enter the session prepared to engage in reflective activities versus discussing each exam question and correct answer. Posting an announcement in the learning management system (LMS) prior to the scheduled review can serve as a useful method for relaying this information to students.
Having an established plan for addressing student-instructor and student-student incivility is another essential component of successful review sessions. Faculty should identify ahead of time steps to take to maintain a controlled environment while reflecting a calm and professional manner. Guidelines need to be established to ensure the experience does not become contentious particularly if students are argumentative and view the session as a time to debate the correct answer choice.4 For example, de-escalating a challenging learning environment by pausing the review session instead of engaging in argumentative dialogue provides students with the opportunity to regain their sense of calmness, become aware of their feelings, and redirect their thoughts. In addition, review sessions should follow a predetermined length of time that allows for adequate dialogue about the covered exam content (eg, 30-50 minutes). Keeping to and reminding students of the time left during the session can help prevent interruptions and keep students on task. Students benefit from faculty who are transparent, reflect a sense of normalcy, and provide structured learning experiences.
Group size is another important consideration. Holding a virtual review session with a large group of students may be difficult to facilitate. Students can easily become distracted, overlooked, and disengage from the learning experience. Holding 2 review sessions or utilizing breakout rooms for structured small group reflective activities may be more conducive to student learning.
Strategies
Similar to self-evaluation of clinical performance, nursing students need time to reflect on their test performance.1 Self-evaluation can occur independently from looking at the actual exam during a post-exam review by incorporating appropriate strategies. Self-reflective post-exam reviews involve activities that promote students' reflection on decision making, thought processes, and test preparation.1,2 Reflections promote metacognition3 and assist students in confirming what they know and identifying where their knowledge is deficient.
Requiring students to complete an exam wrapper prior to a virtual post-exam review is one method for promoting student reflection and equipping faculty with a quick assessment. An exam wrapper is a structured post-exam questionnaire used to assist students in understanding their exam performance. Use of exam wrappers has been identified as an effective tool for evaluating student performance, effort, and study habits.3 When used as an entrance ticket for a review session, students answer the following 3 questions: (1) How did you prepare for this exam? (2) How much time did you spend preparing for this exam? and (3) Which content/concept areas did you have the most problems with? Using the LMS to collect responses as a nongraded quiz or survey allows for an easy way to summarize collected responses, identify study resources to share with students, recognize areas that need clarified, and award points for participation.
Facilitating a review session through student-led discussions creates a unique learning opportunity for students. Students tend to be more receptive to receiving feedback and thinking differently about course topics when engaging in dialogue with peers. Student-led discussions also allow faculty to identify errors in students' thought processes and create just-in-time teachable moments. Student-led discussions can be supported in a variety of ways. For example, the faculty member can identify the topic or concept based on the entrance ticket responses (eg, heart failure) and pose a broad question to the group to start the discussion (eg, What are the signs and symptoms of heart failure?). Then, students take turns posing additional questions to one another about the identified topic for discussion. The faculty provides clarification when needed to redirect and encourage further dialogue through Socratic questioning (eg, Can you provide an example? Tell the group more about how you arrived at that conclusion). Students could also be grouped in breakout rooms and directed to discuss the content/concept areas identified on their entrance tickets. Using a shared workspace in the LMS, students could create collaborative concept maps to illustrate connections to the nursing process. When visiting breakout rooms, faculty can provide feedback, clarification, and redirect as needed.
At the conclusion of the virtual post-exam review, it is important for students to develop a plan for success for the next exam. Faculty can easily use an app such as Ziplet or use electronic survey software to create a digital exit ticket from the review session. For example, students could be asked to select one new study strategy they are going to use for a future exam. Another question could relate to identifying a strategy they learned from the review session they plan on trying.
Conclusion
Faculty should consider best practice methods for facilitating virtual post-exam reviews. Structuring sessions to focus on self-reflective activities can help students' development of clinical reasoning and clinical judgment skills. Incorporating exam wrappers, planning student-led discussions, and creating exit tickets are strategies faculty can consider using when facilitating virtual review sessions.
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