An Exam Wrapper Uses Reflection to Improve Nursing Exam Scores
“Museums are like sports stadiums, hotels and hospitals: they are in the category of captive-audience dining.”
While working as a staff nurse, I was constantly teaching. I involved the patient and their whole family in everything - trending their lab values on the whiteboard, explaining all the equipment, reviewing their medications, and discussing their care team and how they all worked together.
Teaching to a Captive Audience 🔉
My rationale was that the patient was a captive audience. They were stuck in that hospital room for a few days with time to think (i.e., reflect). So even if they didn't immediately pay attention, maybe they would think about the importance of that walk or incentive spirometer later. Perhaps they would research it on their phone and ask a pertinent question tomorrow. And maybe, they would be more inclined to participate in their care because they understood the rationale.
So when are students a captive audience? 🔉 When are they in the mental space to sit and think? 🤔 I believe there are a few critical times in their journey through a semester, and one of them is immediately following an exam. These few days are the prime time for instructors to deploy interventions that directly improve nursing student exam grades.
When I moved into my educator role, the first exam in my theory course was challenging. Year after year, I would have half of the class below the benchmark, and improving these student exam grades felt like an uphill battle. I found that I could give warnings about the challenging content of the first exam, do practice questions, and continually tell students how to prepare. Still, it did not seem to sink in until after they had the experience of taking that first exam. That's when I realized that this was when they were my captive audience.
A challenge for all nursing educators is preparing students to take an exam. After all, they have a substantial licensing exam to prepare for at the end of their journey. However, this simple and practical activity can help improve nursing student exam scores using the power of the captive audience.
How to Implement an Exam Wrapper
The time immediately following an exam is a golden period for reflection. The weight of testing has been lifted, their bandwidth is not dedicated to studying, and they are eager to improve.
An Exam Wrapper is a short reflection exercise completed after students receive a grade for an exam. With open-ended questions, it asks direct questions about how students prepared and performed.
Sample Exam Wrapper
Below is an example of an exam wrapper worksheet. This template link is available below, but you can also complete this on scrap paper or index cards.
Reasons why this activity works:
🪙Self-assessment is the gold standard - We teach this in pain assessment, and it is also relevant to understanding how we learn. Learning is a highly personal experience. Not everyone has the same circumstances. As humans, our brains work differently. So finding a system, a structure, or a method that works for you as an individual is critical.
🖼️Big picture thinking - This activity allows students to zoom out and focus on the essential concepts rather than the intricate details.
📈Grounded in actual performance - Immediately following an exam, students have accurate data to reflect on their performance. The week leading up to the exam, their preparation schedule, and the experience of taking the exam are fresh in their minds. As a result, it is easier to extract an accurate measurement of their skills and discover areas to improve.
👋🏽Responsibility - This short reflection holds students responsible for their learning, test preparation, and performance in class. The instructor can lead the charge on improving exam scores, but the student needs to take on part of the load for themselves.
How to Implement an Exam Wrapper 🎁
A few ways to use this information
💭Discussion starters - For those who performed poorly, it is an excellent place to start the conversation about improving nursing student exam scores or study habits. It gives the instructor information that can uncover areas for improvement.
🧲Making connections - This reflection helps students connect their performance and preparation. For students who perform well, it reinforces good habits. For others, it helps them look for opportunities to improve.
📊Trending - As an essential skill of a nurse, it is also crucial for a student. Giving a variation of an exam wrapper at the start of the semester (another critical captive audience moment) and then having students compare their responses after an exam can be an eye-opening introspection. At the beginning of the semester, they were ready to commit 10 hours a week to class, but as the weeks went by, that number dwindled to 2. We need to re-ignite that spark, and reflection can help with that process.
Want to implement this activity following your next exam? Get a copy of the worksheet below and start improving your student's exam scores.
Best for:
This activity can help to improve nursing student exam scores through individual reflection following high-stakes exams. It could also be used (with modifications) after clinical experiences or large projects.
Variations of Exam Wrappers 🎁
Virtual Option
This exercise is easily adaptable to online learning. 💻 Add it as a short quiz following an exam and connect it to course participation.
Clinical Option
There are also moments in a clinical rotation where students are a captive audience. Depending on the length of the clinical experience, the halfway point may allow time for reflection. Dedicate post-conference to a short, reflective writing exercise.
Start Building an Exam Wrapper
There are times in the nursing school journey when students are a captive audience - mentally, emotionally, and physically ready to reflect on their performance and look for growth opportunities. One of these times is immediately following an exam. An Exam Wrapper, a worksheet that guides reflective thinking, gives nursing educators another tool to use following a test that can improve nursing student exam scores.
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