CIN: Computers, Informatics, Nursing & Vol. 29, No. 6, 326–334 & Copyright B 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins CONTINUING EDUCATION Effectiveness of an It has been proposed that students’ use of an Audience Response audience response system, commonly called clickers, may promote comprehension and re- System in Teaching tention of didactic material. Whether this method actually improves students’ grades, however, is Pharmacology to still not determined. The purpose of this study was to evaluate whether a lecture format utilizing multiple-choice PowerPoint slides and an audi- Baccalaureate ence response system was more effective than a lecture format using only multiple-choice PowerPoint Nursing Students slides in the comprehension and retention of phar- macological knowledge in baccalaureate nurs- KIMBERLY D. VANA, MS ing students. The study also assessed whether the additional use of clickers positively affected GRACIELA E. SILVA, PhD, MPH students’ satisfaction with their learning. Results DIANN MUZYKA, PhD from 78 students who attended lecture classes LORRAINE M. HIRANI, MSN with multiple-choice PowerPoint slides plus click- ers were compared with those of 55 students who utilized multiple-choice PowerPoint slides only. Test scores between these two groups were not significantly different. A satisfaction questionnaire showed that 72.2% of the control students did not Educators have promoted inquiry, teaching through ques- desire the opportunity to use clickers. Of the tioning, to engage students dynamically in the attainment group utilizing the clickers, 92.3% recommend the use of this system in future courses. The use of and retention of knowledge and skills. Traditionally, stu- multiple-choice PowerPoint slides and an audi- dents have assumed passive roles, observing the instruc- ence response system did not seem to improve tors’ performances, rather than actively participating with the students’ comprehension or retention of phar- 1–4 instructors and peers. Often, lectures present new macological knowledge as compared with those knowledge, but lack dedicated time for teaching higher- who used solely multiple-choice PowerPoint slides. order thinking skills such as analysis, synthesis, and problem-solving.1–4 Inquiry may be used to teach these KEY WORDS higher-order thinking skills and increase student partici- & 4 Audience response system pation. However, encouraging student participation in Computer-assisted instruction & large-lecture courses can be daunting due to time con- Educational technology & Feedback methods & straints and the reticence of pupils to ask or answer ques- Interactive-voice response system & tions in front of large groups. Student response system Audience response system (ARS) technology can address this need for increased interactivity and critical thinking in a large-classroom environment.1,2,5 Students’ use of an ARS may promote student comprehension and retention Author Affiliation: College of Nursing & Health Innovation, Arizona State University, Phoenix. by offering each learner several chances to participate in The authors do not belong to speaker bureaus that promote au- class, anonymously answering questions posed by the in- dience response system technology. No external funding was re- structor. Researchers have suggested that students are ceived for this project. satisfied with the use of ARSs, but the research is mixed Disclaimer: Authors declare no conflict of interest. on whether the use of these systems actually increases test Corresponding author: Kimberly D. Vana, MS, College of Nursing & Health Innovation, Arizona State University, Downtown Campus, 500 N scores. This study sought to investigate whether students’ Third St, Phoenix, AZ 85004-0698 ([email protected]). use of an ARS to answer multiple-choice PowerPoint DOI: 10.1097/NCN.0b013e3181f9dd9c 326 CIN: Computers, Informatics, Nursing & June 2011 Copyright @ 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. (MCPP) slides (Microsoft, Redmond, WA) is more effective Students, as well, have said that using the ARS helps in increasing test scores than using MCPP slides alone. them to judge their understanding of the content2,8,11,15 and provides them the safety of answering anony- mously.1,2,6,9,11,23–25 Many students believe that the ARS AUDIENCE RESPONSE SYSTEMS questions help them perform better on quizzes and exami- nations.2,13 Stein et al13 stated that 89% of nursing stu- An ARS is a communication technology that allows par- dents perceived a beneficial effect of discussing distracters, ticipants to interact with the lecturer; many of these systems citing increased comprehension of the lecture content. In seamlessly merge with PowerPoint presentations.2 The addition, the ARS questions may assist students in be- lecturer may post multiple-choice or true-false questions coming familiar with the lecturer’s test-question formats.13 on a PowerPoint slide, and then each student answers by Students may have ‘‘emotional’’ investments in their re- pressing an individual keypad button corresponding to his/ sponses, which increase their attentiveness6 and participa- her answer. These keypads, or clickers,useinfrared,radio tion.5,10,14 Lastly, the use of ARS positively influences class frequency, Bluetooth, or Wireless Fidelity (Wi-Fi) tech- attendance.6,22,26 Overall, this technology has been widely nology to communicate with a receiver, which is plugged embraced by students.2,6,8,11,17,20,27,28 This may be due to into a universal serial bus (USB) port on the podium com- the partitioning of lecture content into small, manageable puter.1,6,7 After polling the audience, a bar graph of the units and allowing students intermittent breaks from the classroom responses is displayed on a projected slide. The lecture while increasing student engagement and atten- graph allows the presenter to gauge the level of participant tion.3,6,11–13,27,29 DeBourgh2 suggested that ARS ques- understanding immediately and discuss the correct and tions be used every 20 minutes to prevent ‘‘cognitive incorrect answers.3 The lecturer may choose to review pre- overload.’’2(p81) Miller et al12 demonstrated that students vious content, tailoring the lecture to comprehension assign higher lecturer evaluation scores to instructors who level.1,2,8–15 The responses of each individual may be use an ARS. saved and then later printed in a variety of report for- Some researchers, however, have suggested that sat- mats.16,17 Thus, the responses to the ARS questions may isfaction levels are greater in the freshman-sophomore level be compared with future test scores if desired. courses than junior-senior level courses.20 They suggest that As new communication technologies become available, students may appreciate an ARS more when studying an ARSs continue to advance. Currently, radio frequency is unfamiliar topic. Some students have registered dissatisfac- preferred to infrared technology because it accommodates tion with the use of an ARS in taking attendance,6 and others larger audiences with less interference and does not re- resent the increased expectationtoparticipateinclass.2 Of quire that the keypads be aimed at the USB receiver while course, students have been known to deceive,6 responding inputting answers.1,16,17 Enterprising researchers are ex- with multiple keypads on quizzes and attendance. perimenting with using PDAs to communicate with the Although students are generally satisfied with audience audience response receivers.1,7 In addition, student ter- response technology, the literature is mixed on whether minals or full laptop keyboards may allow participants the students’ use of ARSs increases student performance to enter their answers to open-ended questions. The in- on test scores. Some researchers have demonstrated clear structor may randomly select a student’s typed response increases in test scores in ARS-enhanced lecture courses to project on the slide.18 Some students, however, may rather than typical lecture courses.19,22,28–30 Crossgrove find laptops too cumbersome to tote to class and too and Curran20 found that students performed signifi- slow to activate.19 Thus, laptop use in large lecture-class cantly better on test questions that had been discussed environments may be seen as burdensome by students. previously in ARS-enhanced lectures. However, reten- The use of ARSs may increase active learning by students tion of course material may be greater in introductory in large lecture classes5,13,20 andinsmallgroups.1,3,6,21,22 versus junior-senior level courses. Preszler et al26 dis- When inserting MCPP slides within a lecture, other con- covered that the test scores improved as the lecturer’s use tent slides must be omitted to stay within the lecture’s of ARS questions increased. Other research showed no allotted period. In addition, the lecturer must allow difference in test scores between courses utilizing didactic more time for each MCPP slide to present the question, lectures versus lectures that incorporated ARS.11–13 discuss the correct and incorrect answers, and possibly The conflicting results on ARSs’ ability to positively reteach the content area. Thus, the use of an ARS may affect test scores could be attributed to how closely ARS decrease the amount of lecture content that may be ad- questions parallel test content, the frequency of MCPP dressed.1,6,9 Increased student comprehension may, slides within the lecture, differences between freshman- however, outweigh