The big reason the Next Gen NCLEX centers on the case study
How the Next Generation NCLEX uses the case study to assess clinical judgment
As the Next Generation NCLEX (NGN) inches closer to launching, nurse educators are increasingly eager to understand how the new version of the exam will differ from the current version — so eager, in fact, that thousands registered to attend a recent edition of “The ATI Talk,” which focused on the topic.
Jason Schwartz, Director of Outreach at the National Council of State Boards of Nursing (NCSBN), said the audience was the largest he’d spoken to about the changes to the exam. “We may break the Internet with a thousand of you,” he joked as he prefaced some interactive elements to come later in the session.
Schwartz said he chose to focus his discussion on the case study because it “really is the single-most evident, visible, and prominent change coming to the exam.” He added, “You may have heard of bow-tie items or trend items, but the case study is really the biggest.”
THE NEXT GENERATION NCLEX’S BIGGEST CHALLENGE
“Measuring clinical judgment — not so easy, right?” Schwartz asked his audience. In fact, he explained, in 2012, no one at the NCSBN knew if it was possible to measure what sometimes is called a soft skill in testing.
“When we were huddled up at our NCLEX examination committee meeting room, and the question came up: ‘Is this something you can do?’ We weren't sure,” he said. Ultimately, the organization conducted research over 10 years to determine how to make it happen.
“I like to say we're not slow; we're thorough,” Schwartz said. Ultimately, the organization identified that, by breaking the concept down into simpler pieces, it was possible to assess the varying aspects of clinical judgment, such as communication, critical thinking, and problem-solving.
Specifically, the NCSBN created a Clinical Judgment Measurement Model. And in that model, 1 layer is particularly important in helping explain the processes behind clinical judgment. Layer 3 illustrates the concept of clinical judgment in six boxes:
- Recognize cues (What matters most?)
- Analyze cues (What does it mean?)
- Prioritize hypotheses (Where do I start?)
- Generate solutions (What can I do?)
- Take actions (What will I do?)
- Evaluate outcomes (Did it help?)
(These are commonly referred to as cognitive functions.)
“We found that we could test these 6 things that essentially add up to the whole,” Schwartz explained.
HOW THE NEXT GEN NCLEX MEASURES CLINICAL JUDGMENT
On the new exam, the clinical judgment-focused questions — also known as item types — target Layer 3’s 6 cognitive functions. “As we go through the 6 items [questions] in the case study, and you see 6 boxes, that is no coincidence,” Schwartz said. “The items in the case study follow these 6 boxes in [the same] exact order.”
Schwartz described case studies as a type of “6-pack worth of content.” But he noted that they aren’t the only way that the new exam will measure clinical judgment. The test will also include trend items and bow-tie items. Those item types are single questions that focus on clinical judgment. They offer examiners a “little bit more measurement information” but don’t take quite as long to read and answer.
Schwartz also reminded the audience that the NGN is far more similar to the current version of the NCLEX than it is different. While many focus on the clinical judgment aspects, he suggested considering them like "toppings on a cheese pizza" rather than the NGN being a whole new food group.
HAVE YOU BEGUN EXPLAINING THE NEW VERSION OF THE EXAM TO YOUR STUDENTS? SHARE THEIR RESPONSES IN THE COMMENTS BELOW.