Does the use of annotated exemplars by nursing students predict academic performance? A cohort study
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Updated: Jan 23, 2026

Using Learning Outcome Measures to assess Doctoral Nursing Education
Published on: June 21, 2010
Rebekah Carter1, Elizabeth Halcomb2, Lucie M Ramjan3
1University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
Aims:
To examine the usefulness of the annotated exemplar as an academic support strategy, and explore the characteristics of students who were more likely to engage with this academic support tool. Additionally, to identify if there was any influence on the academic performance in the assessment activity among those who engaged with the annotated exemplar.
Background:
Annotated exemplars have the potential to target students en masse and provide meaningful, task specific comments that guide students prior to assessment submission. Effective strategies to support student learning are needed as nursing students are increasingly entering tertiary studies from non-traditional backgrounds.
Design:
A cohort study was used to collect administrative data, academic grades and annotated exemplar usage statistics.
Setting:
A large multi-campus university in NSW, Australia during Spring semester 2016.
Participants:
Second year undergraduate students enrolled in a single unit in the Bachelor of Nursing Program.
Methods:
Quantitative data related to marks, grades and usage information; and demographic data and contact details were extracted from the online learning management system and student electronic records.
Results:
Of the 1120 students enrolled in the unit, 49.5% of students engaged with the annotated exemplar. Students more likely to engage with the tool were older, female, born outside of Australia and had higher hit rates on the online learning management site. Of those who engaged with the annotated exemplar, there was no demonstrated increase in assessment mark.
Conclusion:
To improve student performance it is essential that feedback is engaging and effective. While, in this study, use of the annotated exemplar was not reflected in student marks, it is unclear how students may have performed without access to the exemplar. Further research is required to explore the reasons why students did not engage with the annotated exemplar and, for those who did, why the intervention did not impact on assessment mark.
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