HealthOctober 17, 2017

Using adaptive quizzing as a low-stakes measure of mastery

Nurse educators generally have three main goals for their students: 1) to learn to critically think in the healthcare setting, 2) to graduate from the nursing program, and 3) to pass NCLEX® on the first attempt.

By Gannon Tagher, EdD, MSN, RN, APRN

 Although we have many more goals for our students, these three are paramount to nursing student success. The question remains: “How do we help our students achieve these goals?” Much research in nursing education focuses on the issues of student success in nursing programs as well as on the NCLEX.  In an effort to increase success on the NCLEX, many programs instituted standardized testing throughout the curriculum. However, many programs began to use standardized testing as a measure of readiness for progression and graduation, making them high stakes for students and leading to unintended consequences.

Using standardized examinations as a high-stakes measure of content mastery produces psychological and physical anxiety, as well as a myriad of other negative effects on students (Tagher & Robinson, 2015).  Rather than implementing high-stakes testing and finding ways to mitigate their negative effects, we should be looking at alternative ways of measuring and ensuring content mastery.

Nurse educators know that one of the best ways for nursing students to prepare for both course tests and the NCLEX itself is repeated exposure to NCLEX-style questions that require students to master and apply course content (Magaldi, Colalillo, & Molloy, 2014).  Students who practice NCLEX-style questions from the time they enter the nursing program have a great deal of exposure to these types of questions, but how do we measure mastery?  Adaptive quizzing is a low-stakes measure of content mastery that reinforces the material taught in any nursing course.

The benefit of adaptive quizzing is that the student’s answers determine the difficulty of the questions. Thus, each student’s learning experience is individualized based on demonstrated proficiency, helping to ensure that the student remains engaged and that faculty can assist those most at risk for falling behind. In adaptive quizzing platforms, nurse educators can set the level of mastery students should achieve for each quiz.  According to Campbell and Phelan (2014) “Quizzes are delivered to students based on an adaptive algorithm, which personalizes the experience for each student, optimizing learning potential by selecting quiz questions targeted at the current level of understanding” (p. 247).  Therefore, different students taking the quiz will have a different number of questions to reach the mastery level based on how well they know the material.

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For example, in my pediatrics course I use PrepU adaptive quizzing and set the mastery level at 3 out of 8, which is the default from the publisher. Some students reach the mastery level of 3 in 35 questions, whereas other students need as many as 80 to 90 questions to reach the same mastery level. However, reaching the mastery level is the measure of learning, not the number of questions it takes a student to get there (Campbell & Phelan, 2014). Students set the number of questions they would like a quiz to contain from as little as five up to 20 questions.  They then take the quizzes until they reach the mastery level.  The nice part is students do not have to reach the mastery level in one sitting.  Students can take one or two quizzes and if they did not reach the mastery level, continue later in the day or even the following day.  Additionally, students can continue to quiz themselves after reaching the set mastery level, allowing them to reach an even higher mastery level.  In my class, after teaching the content, I assign the adaptive quizzes and give the students one week to reach the set mastery level.  Every semester I receive positive feedback regarding the adaptive quizzing from the students and continue to use it as a tool for reinforcing material learned in class.

Adaptive quizzing promotes mastery level learning, which in turn can promote hopefulness in nursing students, resulting in higher test scores (March & Robinson, 2015).  Furthermore, students using adaptive quizzing are able to answer the more difficult questions, indicating a greater understanding of NCLEX content (Cox-Davenport & Phelan, 2015).  However, nurse educators need to make sure that students are using adaptive quizzing properly and not simply going through the motions. If students continue to take quiz after quiz on the same material, they will ultimately see the same questions repeatedly (as there will be a finite number of questions to which they can be exposed), resulting in answering from memorization. This method of quizzing negates the benefits of adaptive quizzing. We need to make sure that students read the rationale of the questions they missed, look up material they do not understand, vary their quizzing experiences, and return to content for reinforcement in paced and reasonable intervals.

Campbell and Phelan (2014) found that using adaptive quizzing to augment material produced higher student engagement in learning. Engaging students in their own learning can help them to reach the goals we have for them as nurse educators.  The more we can engage students in low-stakes mastery of content application, the more likely we are to produce critical thinkers who will be successful in our programs and pass the NCLEX on the first attempt.


Campbell, E., & Phelan, J. (2016).  Effectiveness of an adaptive quizzing system as an institutional-wide strategy to improve student learning and retention.  Nurse Educator, 41(5), 246–251.

Cox-Davenport, R.A., & Phelan, J. C. (2015).  Laying the groundwork for NCLEX success: An exploration of adaptive quizzing as an examination preparation method. Computers, Informatics, Nursing, 33(5), 208–215.

Magaldi, C., Colalillo, G., & Molloy, J. (2014).  Faculty-facilitated remediation: A model to transform at risk students.  Nurse Educator, 39(4), 155–157.

March, A.L., & Robinson, C. (2015). Assessment of high-stakes testing, hopeful thinking, and goal orientation among baccalaureate nursing students.  International Journal of Nursing Education and Scholarship, 12(1), 1–7.

Tagher, C.G., & Robinson, E. (2015).  Critical aspects of stress in a high-stakes testing environment: A phenomenographic approach.  Journal of Nursing Education, 55(3), 160–163.

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