Barriers to creating a more culturally diverse nursing profession. Linguistic bias in multiple-choice nursing exams

As part of a grant to recruit and retain multicultural and economically disadvantaged nursing students, funding was approved for a study analyzing multiple-choice nursing course exams for linguistic and cultural bias. Nineteen exams, for a total of 673 multiple-choice test items, were analyzed for this study. The categories of analysis used to identify flaws in the test items were: testwise flaws, irrelevant difficulty in stem, irrelevant difficulty in option, linguistic/structural bias, and cultural bias. Twenty-eight types of flaws occurred at least 10 times in the reviewed exams. Flaws from each of the categories are presented and discussed; specific examples are analyzed and revised.