Our clients often ask us how to use the results of their students’ or residents’ Exam Master board practice exams to predict their performance on the actual board exam. For example, if a student achieves a score of 70% on our high-yield NCLEX-RN practice exam, what does that mean in terms of their likelihood of passing the actual NCLEX-RN? Good question!

Let us first briefly describe how we develop our practice exams. Exam Master’s many practice exams, which we have carefully developed for RN and PN Nursing, Physician Assistant, Pharmacy, and Medicine, are designed to give the student a realistic board exam experience prior to taking the actual board exam. A critical component of this experience is providing the student with a detailed diagnostic of their strengths and weaknesses in the content areas covered by the exam.

All of our practice exams are designed with these requirements in mind:

  1. Use the most current test plan to ensure that we are testing the concepts and constructs that are supposed to be tested.

  2. Employ processes for developing quality test items, including alternate test items when applicable (like NCLEX).
  3. Weight the exam by topic or subject based on the actual exam weighting (e.g., 18% of the questions should cover cardiology) when such weighting information is publicly available.

  4. Include the same number of questions as the actual board exam, when possible.

  5. Match the item types (often multiple choice) found on the actual exam, including a mixture of item types where applicable.

With these objectives in mind, we are confident that our practice exams cover the broad topics and subtopics found on the exams they are modeled after, providing the student with as close to the real board exam experience as possible. Of course, we do not have access to the specific contents of the board exam, so we make an educated judgment about what content should be covered.   This means that as a diagnostic tool, they are very helpful and they may even serve as a secondary predictive tool.

When extrapolating board exam results from practice exam results, we exercise a healthy caution due to two caveats: scaled scores and cut-off scores. Most standardized exams report scaled scores rather than the raw scores Exam Master reports. Scaled scores are obtained by statistically adjusting and converting raw scores onto a common scale to account for differences in difficulty across different forms. A cut-off (or cut) score is a score that a student must earn to pass the exam: to be considered proficient. Cut scores are determined through a variety of means. The Angoff method, for example, involves a panel of experts estimating the probability of a minimally qualified candidate answering a given item correctly.

Comparing the results of one of our practice exams to those of the actual exam would require rigorous controls to be put in place. A primary reason we do not claim to predict board scores based on practice exam results is because these exams are accessed under a wide variety of circumstances that are generally outside of our control. Some students may be accessing these exams in study mode; some students may review one of our practice exams more than once; some students may have already reviewed some of the practice exam questions from our discipline-specific question banks.

Our practice exams offer key benefits to our end users, both helping them to identify their strengths and weaknesses and providing realistic board exam practice before they sit for the actual exam. In fact, students have often reported to us that our practice exams are more rigorous than what they end up experiencing on the real thing! That’s why we say, “If you can do Exam Master, you can do the boards!”

According to the National Council of State Boards of Nursing (NCSBN) over 5.4 million nursing professionals have taken the NCLEX since April of 1994.  That’s a lot of aspiring nursing professionals, and not surprising given that there are close to five million active nurses in the United States. Since those days, when Green Day, Nirvana and Pearl Jam were at the tops of the charts(!), the nursing profession has undergone many changes.  Not least of these is the movement to raise the educational and practiced standards of the profession in response to the ever-changing demands of our health care system. Magnet status is now ubiquitous among hospitals and hospital systems a status that requires, among other things, that RN nursing staff working at these facilities have at least a BSN degree.  The Doctor of Nursing Practice Degree (DNP), not really seen before 1999, is now the capstone of the nursing profession. According to the American Association of Colleges of Nursing, there are over 330 DNP programs in the U.S. with another 100+ in the planning stages.

Stakeholders in the nursing profession recognize the valuable and vital role that the nursing professional plays in our healthcare system and healthcare delivery.  That system has been characterized by rapid change, driven in part by the rapid expansion of knowledge required by nursing and other health professionals to function in interdisciplinary teams.  The system is increasingly complex, increasingly data-driven, with major emphasis placed on cost-effective and safe delivery of care. Evidence-based practices are de rigueur. These changes have placed new demands for nurses to function at higher levels than ever before as they navigate the increasing complexity of our health care system.

These changes in the landscape where nurses work bring us to “the Next Generation NCLEX” or NGN.  A 2013-14 NCSBN Strategic Practice Analysis brought to light the increasingly complex role newly licensed nurses faced during the course of patient care, particularly in the area of clinical judgment and clinical decision-making.  The study revealed that many or most newly- licensed nurses were not as prepared as they needed to be to meet the requirements of the modern healthcare system. These findings had serious implications for patient safety, the hallmark of all nursing practice.

If nursing programs need to better prepare nurses for success going forward, it was vitally important that these attributes be measurable by means of the NCLEX, the licensure pathway for all RN and PA nurses.  The NGN, therefore, is a research project designed to determine if higher level skills can be assessed by means of a standardized exam. Central to the new NCLEX will be use of new item types, now under research, that are expected to better measure clinical judgment. We will be keeping an eye on this landscape and are working to help prepare the next generation of nursing professionals.  Assuming the outcomes of the NGN research demonstrate efficacy in these methods of higher level assessment, the Next Generation NCLEX will be coming to a testing center near you!