Effectiveness of an Adaptive Quizzing System as an Institutional-Wide Strategy to Improve Student Learning and Retention E’Loria Simon-Campbell, PhD, RN & Julia Phelan, PhD Exploring ways to help students achieve success in nursing programs is critical to increase retention and the number of nurse graduates. This study examined the impact of an adaptive quizzing system implemented as a strategy to support student persistence and performance measured by use, grades, and graduation. Results indicated that use of the system increased course content mastery and predicted final course grades. Retention and program completion rates were also positively influenced. Keywords: Adaptive Quizzing; NCLEX; Nursing Education; Retention; Remediation; Technology T he first-time National Council Licensure Examination (NCLEX) pass rate has emerged as one indicator of a successful and high-quality nursing program and as an indicator of quality for state boards of nursing and the nursing school’s community of interest. 1-3 The focus on first-time pass rates is further supported by data showing higher failure rates for repeat NCLEX takers compared to first-time test takers. 4 The National Council of State Boards of Nursing attributes the difference in failure rates to the extended time between graduation and retaking examina- tions for the repeat test-takers. Nursing schools also may risk the stigma of students with repeated failures, influencing the support of their community as well as continuing school accreditation. Moreover, if a student cannot pass the NCLEX, they are unable to pursue their chosen career. The likelihood of a nursing student graduating and passing the NCLEX the first time is difficult to predict given the myriad interacting variables that influence success or failure. 5 Despite this difficulty, many nursing programs use standardized assessment programs to try and predict student success on the NCLEX, with some schools imple- menting graduation policies based on standardized test scores. 2 In Texas, for example, a survey of 74% of the state approved nursing programs found 98.8% of schools used standardized tests, and 47.9% of schools used scores on standardized tests to make progression or graduation deci- sions. 6 Nationally, the percentage of nursing programs with progression policies that mandate students meet a bench- mark on a standardized test to qualify for graduation is 20%. 1,7 But as Spurlock 8 has indicated, little or no guidance or validity evidence is available to faculty who wish to set cut, or decision, scores for their progression or graduation policies. The process of using standardized tests (and achieve- ment of a benchmark on those tests) to determine progres- sion and graduation eligibility is also known as ‘‘high-stakes’’ testing. 1 Two of the most commonly used programs used in high-stakes testing are the Health Educational Systems, Inc. (HESI) and Assessment Technologies Institute. Although both companies have a suite of examination offerings, many schools use the HESI Exit Exam (HESI E 2 ) as an NCLEX predictor test. Research indicates that although predictor tests may predict high-performing students who are likely to pass the NCLEX, they are much less precise in identifying the likelihood of failure. 8,9 This distinction in describing the accuracy of a test is especially important when pro- gression policies are in place and data may be used to pre- clude graduation. There is, of course, another possible use for data from standardized tests; rather than only using the data to make progression decisions, information may also help students shape their remediation and studying efforts—before taking the NCLEX. Despite successful completion of nursing programs, some students may have difficulty achieving the benchmark on a standardized measure. If this is the case, standardized test results can provide students and faculty Nurse Educator Volume 00 & Number 0 & Month 2016 1 Nurse Educator Nurse Educator Nurse Educator Vol. 00, No. 0, pp. 00-00 Copyright * 2016 Wolters Kluwer Health, Inc. All rights reserved. Author Affiliations: Assistant Professor (Dr Simon-Campbell), School of Nursing, Sam Houston State University, Texas; and Senior Researcher (Dr Phelan), National Center for Research on Evaluation, Standards, and Student Testing, University of California at Los Angeles. Disclosure: Dr Simon-Campbell was a consultant for Lippincott pro- viding faculty support related to the adaptive quizzing software. Dr Phelan is an assessment expert and research consultant for Wolters Kluwer Health. Correspondence: Dr Simon-Campbell, Citizen’s National Bank Building, 1 Financial Plaza, Suite 215, Huntsville, TX 77340 (exs063@shsu.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.nurseeducatoronline.com). Accepted for publication: January 30, 3016 Published ahead of print: March 10, 2016 DOI: 10.1097/NNE.0000000000000258 Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.