ArticleJournal of educational evaluation for health professions2026
Validity evaluation of a mock examination including multimedia-assisted items for the Korean Nursing Licensing Examination: a mixed-methods study with a counterbalanced design.
Article in Journal of educational evaluation for health professions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to evaluate the validity of multimedia-assisted items (MAIs) in a mock examination by examining their psychometric properties and nursing students' perceptions.
methodsThis methodological study used a within-group counterbalanced design in which fourth-year nursing students in South Korea completed an online mock examination consisting of paired text-based items and MAIs. Psychometric properties were examined using classical test theory and item response theory, and learner perceptions and response processes were explored through post-examination surveys and focus group interviews.
resultsAmong 515 participants, MAIs demonstrated overall difficulty and discrimination comparable to those of text-based items in both classical test theory and item response theory analyses, with similar test characteristic curves across counterbalanced groups, supporting measurement equivalence across item formats. Post-test surveys indicated that participants perceived MAIs as realistic reflections of clinical practice and as more helpful for problem solving and ability assessment than text-based items. Qualitative findings from focus group interviews (n=15) further supported the educational value of MAIs for assessing clinical judgment while emphasizing the need for appropriate multimedia use. An order effect was also observed: presenting MAIs first led to higher item response theory discrimination parameters in subsequent text-based items (P=0.020).
conclusionMAIs demonstrated psychometric properties comparable to those of text-based items and were positively perceived as valid tools for assessing clinical judgment and practical competence. These findings support the feasibility of incorporating multimedia-based assessment into the Korean Nursing Licensing Examination as part of a rigorous computer-based testing framework.
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