Elsevier

Nurse Education in Practice

Volume 29, March 2018, Pages 53-58
Nurse Education in Practice

Original research
Dialogic oral exam in nursing education: A qualitative study of nursing students' perceptions

https://doi.org/10.1016/j.nepr.2017.11.008Get rights and content

Highlights

  • Dialogue exams mimic the challenges of working life.

  • Dialogue exams develop students' ability to plan holistic patient care.

  • Students value the learning opportunity that dialogue exams offer.

Abstract

The purpose of this articl is to explore nursing students' experiences of dialogic group oral exams used in the assessment of a medical nursing course. We discuss a small-group, educator-facilitated exam (dialogue exam). The data were gathered in April 2015 via an online survey including open questions. The participants were nursing students (n = 58) at a University of Applied Sciences. The data were subjected to inductive content analysis. The results suggest that students’ experiences of the dialogue exam can be represented by four themes: context bound dynamics, new shared understanding, verified competences and holistic nursing care. The students liked the dialogue exam format, preferring it to the traditional individual written exam. The prerequisite for successful use of the dialogue exam format is that candidates perceived the exam situation as safe. Students need to be given information about the schedule and assessment criteria beforehand and should have some experience of the format.

Introduction

There has been a shift in the focus of education programs in health care. Curricula have moved away from being process-based towards being competence-based. Whereas students used to be required to demonstrate that they have completed a specific learning course they now have to demonstrate mastery of a variety of competences. The continuously changing nature of work requires graduates to have new skills and competences, such as shared expertise, collaborative and team working skills. Assessments cover not only specific course content but also more general competences such as problem solving and decision making skills (Virtanen et al., 2015). It is important that educational courses promote the development of these competences and assessment methods should take into account the learning approach. The term constructive alignment is used to describe situations in which the whole learning process is logically and coherently organised: planning, learning outcomes, teaching and learning methods, assessment methods and learning atmosphere. This requires a broad perspective on learning and the learning process. The constructive alignment perspective implies than when learning outcomes are changed new methods of assessment should be developed (Biggs and Tang, 2009).

The purpose of this study is to start a debate about the assessment methods used in nurse education. A small-group dialogue exam facilitated by an educator is discussed.

A review of the literature on assessment suggested that small-group, dialogue-based assessment is very rarely used (Habron et al., 2012) or at least that there has been little research on the method. There have been studies of written group exams (Hodges, 2004, Lin and Brookes, 2012) and individual oral exams (especially in relation to medical doctors’ education) (Carter, 2012, Davis and Karunathilake, 2005, Lunz and Bashook, 2008, Tibbo and Templeman, 2004); however there is scant published research on oral group assessment (Dressel, 1991, Drouin, 2010). There were a few studies published in the 1990s, but hardly any in the 2000s. There is need for research on assessment using small-group oral exams.

In this study a dialogue exam is defined as one in which a small group of students (four or five) take part in an educator-facilitated discussion of a particular case. The participants try to find solutions to the problems the patient's care poses based on documented cases. The goal is to create a learning situation in which the learning objectives are to understand the key issues of the topic on which the case centres and achieve a comprehensive perspective on patient care, rather than learning by rote in preparation for an exam. The setting of a dialogue exam has a resemblance to clinical conferences or case studies (see e.g. Rossignol, 2000, Yehle and Royal, 2010) that have traditionally widely used in nursing education, however, in a dialogue exam a setting of the exam is carefully structured according to the framework of dialogue pedagogy as well as the students' assessment adheres to the evaluation criteria.

Section snippets

Literature

An electronic literature search was conducted of three international databases published between 2007 and 2017: Academic Search Elite, Science Direct and ERIC. The English search phrases were in Academic Search Elite: “dialogue exam*" or “oral group exam*" or “collaborative group exam*" or (“collaborative learning”) AND (“oral assessment” or exams or examination*). In Science Direct search phrases were: “dialogue exam*" OR “oral group exam*" OR “collaborative group exam*" OR (“collaborative

Aim

The aim of this study was to explore nursing students' experiences of dialogic group oral exams used in the assessment of a medical nursing course. The study contributes to the knowledge related to assessment methods in health care professionals’ education.

The research question was: what are nursing students’ experiences of dialogic group oral exams?

Study design

The study was conducted in a Unit of Health Care, University of Applied Sciences, in Finland. The participants were students on a medical nursing

Results

The following four themes emerged from the data describing the students’ experiences of the dialogic group oral exam: (1) context bound dynamics; (2) new shared understanding; (3) verified competences and (4) holistic nursing care. (see Table 1).

Study limitations

Limitations of this study consisted of two reasons that should also be taken into account. First, our findings do not necessarily represent the views of all nursing students in Finland, and this should be taken into consideration. Second, the researchers were doing research on their own work environment and one researcher had a pre-existing pedagogic relationship with the participating nursing students. According to Burns and Growe (2009) this can be decrease the reliability of a study if it

Conclusions

This study explored nursing students’ experiences of assessment by means of a dialogic group oral exam facilitated by a lecturer. The results indicate that the students valued the way in which the format embodies the principle of continuous learning and highlighted the importance of the context to creating an appropriate dynamic. The success of the dialogue exam depends on creating an atmosphere in which students feel safe and able to participate freely and openly in the discussions and this

Contributions

Study design: RT, M-AH, IM, E-RY.

Data Collection and Analysis: RT, M-AH, IM, E-RY.

Writing of the Manuscript: RT, M-AH, IM, E-RY.

Acknowledgements

None.

References (28)

  • H. Aarnio et al.

    Dialogic knowledge construction as the crucial issue in network-based learning in vocational education

  • J. Biggs et al.

    Applying constructive alignment to outcomes-based teaching and learning

  • N. Burbules
    (1993)
  • N. Burns et al.

    The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence

    (2009)
  • S. Carter

    English as an additional language (EAL) viva voce: the EAL doctoral oral examination experience

    Assess. Eval. High. Educ.

    (2012)
  • T. Castor

    Making student thinking visible by examining discussion during group testing2004

    New Dir. Teach. Learn.

    (2004)
  • M. Davis et al.

    The place of the oral examination in today's assessment systems

    Med. Teach.

    (2005)
  • J. Dressel

    The Formal oral group exam; challenges and possibilities-The oral exam and critical thinking

  • M. Drouin

    Group-based formative summative assessment relates to improved student performance and satisfaction

    Teach. Psychol.

    (2010)
  • S. Elo et al.

    The qualitative content analysis process

    J. Adv. Nurs.

    (2008)
  • G. Habron et al.

    Embracing the learning paradigm to foster systems thinking

    Int. J. Sustain. High. Educ.

    (2012)
  • L. Hodges

    Group exams in science courses

    New Dir. Teach. Learn.

    (2004)
  • M. Huxham et al.

    Oral versus written assessments: a test of student performance and attitudes

    Assess. Eval. High. Educ.

    (2012)
  • S. Lauri et al.

    Developing Nursing Theories (Finnish: Hoitotieteen Teorian Kehittäminen)

    (2005)
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