NUR 6023 Module 6 Deep Learning Assessment Plan Example

Measuring Whether They Can Reason, Not Only Recall: An Assessment Plan for Pharmacology II Built on Constructive Alignment, the SOLO Levels, Case Items, a Clinical Judgment Rubric and a Delayed Retention Check

Student Name

American College of Education

NUR6023: Transformational Teaching in Nursing Education

Module 6 Assignment

Instructor Name

June 10, 2030

Why Assessment Has to Change Too

This course has changed how I teach pharmacology: Peer Instruction for concept questions, team-based learning for application, cumulative retrieval and spacing for retention, strategy-focused feedback and recovery paths for students who struggle. The assessments have not changed. They are still four unit examinations and a final, almost entirely single-answer multiple-choice items. Biggs (1996) argued that teaching and assessment should be constructively aligned: outcomes spell out the performances expected of students, teaching activities are chosen to help them do it, and assessment tasks require them to show that they can. When assessment rewards recall, students study for recall, whatever the teaching intends. Students learn what the examination asks for, so an examination that asks only for facts undoes a semester of teaching for reasoning.

Auditing the Current Examinations

To see what the examinations measure, I classified every item from last year's four unit examinations using the SOLO taxonomy, which describes levels of understanding from prestructural, where the student misses the point, through unistructural and multistructural, where the student knows one or several relevant facts, to relational, where the student integrates facts into a coherent explanation, and extended abstract, where the student generalizes to new situations (Biggs, 1996). Of 200 items, 118 were unistructural, asking for a single fact such as a drug's class or a common side effect; 57 were multistructural, asking students to identify several facts; 25 were relational, asking students to use several facts together to decide on an action; and none were extended abstract. Only one item in eight required the kind of reasoning the course's outcomes describe.

The Plan

The plan has five components. First, a leveled blueprint for every unit examination: 30% of items at the unistructural or multistructural level, since nurses do need facts, and 70% at the relational level or above. Relational items will present a patient and require an action, such as whether a scheduled furosemide dose should be given when the morning potassium result reads 3.1 mmol/L and the blood pressure has dropped to 88/50, and why that choice is safer than the others.

Second, case-based item sets. Each unit examination will include one unfolding case of four to six items following a patient through changes, written to the cognitive steps of the NCSBN Clinical Judgment Measurement Model, from recognizing and analyzing cues to evaluating outcomes (Dickison et al., 2019), so that students practice the reasoning the licensure examination measures.

Third, a short written reasoning component. On each unit examination, students will answer one question in three or four sentences explaining their reasoning for a decision, scored with a four-point rubric for accuracy, use of relevant data and consideration of alternatives. One such question is enough to signal that explanation matters and can be graded in the time available for 64 students.

Fourth, a simulation assessment. In the final weeks, each team will manage a simulated patient receiving several interacting medications, and each student will be scored individually using the Lasater Clinical Judgment Rubric, which was developed in the simulation laboratory from Tanner's model of clinical judgment and describes development across the phases of noticing, interpreting, responding and reflecting (Lasater, 2007). The rubric's reflecting phase will be assessed in a structured debriefing immediately after the simulation.

Fifth, a delayed retention check. The final examination will include 30 items from the first course, unchanged, so that retention of earlier learning is measured directly, and the medical-surgical faculty's first-week recall quiz will be given every year as a measure of the whole design.

One Case Item Set in Full

An example shows how the case item sets differ from the current items. The case follows a 68-year-old woman with atrial fibrillation and heart failure who takes digoxin, metoprolol, furosemide and apixaban. Item one presents her admission data, including nausea, a heart rate of 52, a potassium of 3.2 mmol/L and a digoxin level above the therapeutic range, and asks students to select every finding that requires follow-up, which tests recognizing cues. Item two asks which explanation best accounts for the findings taken together, with options including digoxin toxicity made more likely by low potassium, beta blocker excess and dehydration, which tests analyzing cues and prioritizing hypotheses. Item three asks students to choose, from six nursing actions, the three that should be taken first, such as holding digoxin and metoprolol, placing her on continuous cardiac monitoring and notifying the provider, which tests generating solutions and taking action. Item four gives her data twelve hours later and asks which findings show that the actions were effective, which tests evaluating outcomes.

Each item rewards integration rather than a single fact. A student who knows that digoxin's therapeutic range is narrow but does not connect it to the low potassium and the slow heart rate will miss items two and three. Scoring gives partial credit on the select-all and select-three items, so the set distinguishes students who are partly there from those who are not, and item analysis can show which step of the reasoning the class finds hardest. The unit's faculty will review every case set before use to check that the keyed answers reflect current practice.

Alignment and Grading

Each component maps to an outcome and a teaching activity. The outcome on explaining drug effects is taught through Peer Instruction and assessed by relational items and the written reasoning question. The outcome on nursing assessments and laboratory values is taught through readiness tests and retrieval quizzes and assessed by blueprint items at all levels. The outcome on deciding what to do when a patient's condition changes is taught through team application exercises and assessed by case item sets and the simulation. Retention is supported by spaced quizzes and measured by the delayed items. In the course grade, unit examinations count 50%, the final examination 20%, the simulation 10%, readiness tests 15% and weekly quizzes 5%. The simulation is weighted modestly because it is new and its scoring by several faculty needs to be checked for consistency before it carries more weight.

Testing the Plan

An assessment plan is itself a claim that needs evidence. I will check three things. First, item quality: after each examination, the item analysis will show whether the relational items discriminate between stronger and weaker students, and items with poor discrimination will be revised. Second, scoring consistency: two faculty members will independently score a sample of ten written reasoning answers and ten simulation performances each term, and if agreement is low the rubrics or training will be revised. Third, the relationship between components: if the plan measures what I intend, students who do well on relational items should also do well in the simulation and on the delayed retention items, and I will look at those correlations at the end of the year. If they are weak, the components may be measuring different things, and the plan will need to change.

References

Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education, 32(3), 347-364. https://doi.org/10.1007/BF00138871

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04