Bow-tie items address all six steps of the Clinical Judgment Measurement Model in one item. The exam-taker reads a scenario, recognizes cues, analyzes cues, and generates solutions. The exam-taker then completes the bowtie layout to determine the most likely condition that the client is experiencing (Prioritize Hypotheses), the appropriate actions to take (Take Action) and the parameters to monitor (Evaluate Outcomes).
The solution looks like a bow-tie with two “Actions to Take” on the left, two “Parameters to Monitor” on the right, and a single “Condition Most Likely Experiencing” response in the middle.
NCLEX Example: Bowtie Item Type
Note: The above information and example are from Next Generation NCLEX News, Spring 2021.
In Legacy Portal: ExamSoft, you can approximate the bowtie format. Even though these questions don't look exactly like the NCLEX example, they require the same critical-thinking processes. And they require the exam-takers to consider multiple aspects of the clinical scenario within a single item.
Procedures
Legacy Portal: Create a Bowtie Item
- In any software that you prefer, create an image that shows the options in a bowtie layout.
Designate each option in each column with a letter. Each action to take will be designated with A, B, C, and so on. Likewise, each condition and each parameter will also have a letter.
Example
- In ExamSoft, create a question, and select the Fill in the Blank question type.
Note: For more information, see: Legacy Portal: Tips for Fill in the Blank Questions
- In the Question area, enter the text that you want to appear above the bowtie layout.
- Below the question text, press the Enter key a couple of times to make space for an image.
- Select the image button, and then select the image that you created.
- Below the image, press the Enter key a couple of times to make space.
- Enter instructions that you want the exam-takers to see above the text entry fields, such as "For each numbered item, indicate your answers by entering a letter."
- Insert a table:
- Select the table button.
- In the pop-up window, enter 5 rows and 2 columns, and then select OK.
- Select the table button.
- In the first column, enter:
Action to take:
Action to take:
Condition most likely experiencing:
Parameter to monitor:
Parameter to monitor: - In the second column, click in the first cell, and then select the Add New Blank button (below the Question area).
- Insert a New Blank in each remaining cell.
Note: As you add each blank, a number appears. Corresponding numbers also appear in the Answers area.
- In the Answers area, enter the answers and the alternative answers.
Note: Since there are two correct Actions to Take and two correct Parameters to Monitor, you'll need to enter two acceptable answers for each of those text fields. In the box, enter the pipe character between the two answers. For example, let's say that the two correct Actions are A and C. You would enter: A|C
- (Recommended) Assign categories to this question.
Note: For more information, see: Legacy Portal: Assign Categories to Questions
- (Optional) Select other options, if needed.
Tips:
- If the question involves an electronic health or medical record, you can upload an attachment.
Note: For more information about attachments, see: Attachment Types and Requirements
- If there are multiple questions related to the same case, you can group the questions together after you add them to an assessment.
- If the question involves an electronic health or medical record, you can upload an attachment.
- Save the question.