A comparison of three interactive examination designs in active learning classrooms for nursing students

Despite the advantages of using active learning strategies in nursing education, researchers have rarely investigated how such pedagogic approaches can be used to assess students or how interactive examinations can be modified depending on circumstances of practice (e.g., in online education). The aim was to compare three interactive examination designs, all based on active learning pedagogy, in terms of nursing students' engagement and preparedness, their learning achievement, and instructional aspects. A comparative research design was used including final-year undergraduate nursing students. All students were enrolled in a quality improvement course at a metropolitan university in Sweden. In this comparative study to evaluate three course layouts, participants (Cohort 1, n = 89; Cohort 2, n = 97; Cohort 3, n = 60) completed different examinations assessing the same course content and learning objectives, after which they evaluated the examinations on a questionnaire in numerical and free-text responses. Chi-squared tests were conducted to compare background variables between the cohorts and Kruskal-Wallis H tests to assess numerical differences in experiences between cohorts. Following the guidelines of the Good Reporting of a Mixed Methods Study (GRAMMS), a sequential mixed-methods analysis was performed on the quantitative findings, and the qualitative findings were used complementary to support the interpretation of the quantitative results. The 246 students who completed the questionnaire generally appreciated the interactive examination in active learning classrooms. Among significant differences in the results, Cohort 2 (e.g., conducted the examination on campus) scored highest for overall positive experience and engagement, whereas Cohort 3 (e.g., conducted the examination online) scored the lowest. Students in Cohort 3 generally commended the online examination's chat function available for use during the examination. Interactive examinations for nursing students succeed when they are campus-based, focus on student preparation, and provide the necessary time to be completed.