Nurse Education in Practice (2008) 8, 76–87

Nurse

www.elsevierhealth.com/journals/nepr

Educationin Practice

Use of classroom ‘‘clickers’’ to promoteacquisition of advanced reasoning skills

Gregory A. DeBourgh

School of Nursing, University of San Francisco, San Francisco, CA, United States

Accepted 18 February 2007

Summary Use of classroom response systems (a.k.a. ‘‘clickers’’ or ‘‘audience poll-ing systems’’) are growing in popularity among faculty in colleges and universities.When used by faculty in a strategic instructional design, clickers can raise the levelof participation and the effectiveness of interaction, promote engagement of stu-dents in active learning, foster communication to clarify misunderstanding and incor-rect thinking, and provide amethod to instructionally embed assessment as a learningactivity rather than reliance on the traditional approach of summative assessment forassigning grades. This article describes the use of clicker technology in a baccalaure-ate nursing program to promote acquisition and application of advanced reasoningskills. Methods are suggested for embedding formative assessment and the tacticaluse of questioning as feedback and a powerful learning tool. Operational aspects ofclickers technology are summarized and students’ perceptions and satisfaction withuse of this teaching and learning technology are described.

�c 2007 Elsevier Ltd. All rights reserved.

KEYWORDSAudience responsesystems;Classroom responsesystems;Clickers;Assessment;Reasoning

1d

Introduction

Instructors have long struggled with devising meth-ods to capture and maintain students’ attention inthe classroom. An even greater challenge is that ofdesigning effective presentation of complex con-tent in a manner that limits intimidation, generatesstudent interest, and provides opportunities for ac-tive student engagement in learning. The use ofclassroom response systems (a.k.a. ‘‘clickers’’ or‘‘audience polling systems’’) is growing in popular-ity among faculty in colleges and universities.

471-5953/$ - see front matter �c 2007 Elsevier Ltd. All rights reseroi:10.1016/j.nepr.2007.02.002

E-mail address: debourghg@usfca.edu

These response systems offer enhanced opportuni-ties for interaction during the learning process andprovide both students and faculty immediate, real-time feedback reflecting students’ understandingof presented material. When used by faculty in astrategic instructional design, clickers can raisethe level of participation and the effectiveness ofinteraction, promote engagement of students inactive learning, foster communication to clarifymisunderstanding and incorrect thinking, andprovide a method to instructionally embed assess-ment as a learning activity rather than relianceon the traditional approach of summative assess-ment for assigning grades. Beyond these benefits,

ved.

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 77

clicker technology can support innovative instruc-tional designs and the delivery of dynamic learningevents in the classroom that result in high-levelsynthesis and application of complex concepts,thereby promoting advanced reasoning.

Good thinking in nursing practice

Critical thinking is a contemporary label for whatmany educators have long described as higher-ordercognitive processes. The processes involved inthinking critically are widely agreed to includeinterpreting, synthesizing and internalizing con-cepts and principles; applying facts, concepts, andprinciples to demonstrate effective decision-mak-ing and problem-solving; making inferences basedon evidence and experience resulting in accuratepredictions; and evaluating the effectiveness ofoutcomes based on these thinking processes. Thegoal of thinking critically is to achieve a ‘‘coher-ence of understanding’’ (Forneris, 2004).

Reasoning is about using intellectual power todraw conclusions, form judgments, and make infer-ences based on evidence, education, and experi-ence. Reasoning involves the self-awareness ofboth the content and process of thought (metacog-nition). The practical significance of acquiring skillin advanced reasoning is to move to the level ofpredictive clinical reasoning which enables one toanticipate both ideal and likely outcomes given aset of data. Predictive reasoning, guided by exper-tise in pattern recognition and description of defin-ing features, enables one to confirm that data areassociated in order to make accurate inferences.

Competence in nursing practice represents thedynamic integration of knowledge, technical andthinking skills, and experience applied to optimizepatient outcomes. Effective nurses must develop,apply, and maintain capacity, confidence, andcapability (Stephenson and Yorke, 1998). Capacityis developing potential to acquire, retain, and ap-ply new knowledge and skills that enable perfor-mance. It is the about the acquisition offundamental skills that serve as a foundation tobuild range in abilities and performance. Capabilityis observable behavior that is purposive, sensible,and effective considering the variables and con-text. Capable practitioners use knowledge and rea-soning to function equally well in both familiar andhighly-focused contexts, and in unfamiliar environ-ments with dynamic, complex variables. Confi-dence is self-awareness of the power or impact ofone’s knowledge and skills and how these relateto a given circumstance. Confidence enables capa-

bility. Capability is observed when people are con-fident in their ability to take effective andappropriate action, explain their thinking andrationale for actions, demonstrate interpersonalskills to work effectively with others, and continueto learn from their experiences (Stephenson andYorke, 1998). These abilities represent the essenceof good thinking in nursing practice.

Instructional imperatives for theinteractive classroom

Nursing faculties are challenged to provide learningexperiences for students that are as authentic aspossible to represent the complex and dynamicnature of contemporary patient care settings. Thelecture format is economical, efficient, and com-monly used to impart didactic information andexplanations to large groups, but this format limitsoptions for instruction. Small-group sessions aremore effective for building advanced reasoningskills and clinical problem management expertisebecause they enable manageable communicationbetween faculty and students. Fewer students inthe classroom creates more opportunities for inter-action and in-depth feedback using iterative ques-tioning, coaching, and collaboration. Establishingand maintaining an inquiry-based, participativeclassroom environment is challenging, and moreso when class sizes must remain large. Using inter-active classroom response systems and high-levelquestions that are strategically placed throughoutinstruction can enhance participation and feed-back, even in very large-size classes.

Participation and feedback

Undergraduate students in classrooms are oftennot actively engaged with either the process orcontent of the learning experience (King, 1993;McKeachie, 1994). Many variables impact interac-tion and participation in classrooms, including thecourse instructional design, the instructor’s pre-sentation skills, standards and expectations forstudent participation in discussions, individuallearning styles that avoid involvement, communi-cation and feedback mechanisms, students’ confi-dence in their own interpersonal skills, andstudent preparation for class. When students donot prepare assigned readings or homework theyarrive in the classroom unprepared to activelyparticipate in the learning process, whichoften manifests as disengagement and inattention(Buck, 1997), and negatively impacts academic

78 G.A. DeBourgh

achievement (Nystrand and Gamoran, 1989). Re-sults of some studies suggest that when instructorsdo not regularly question students in class aboutassigned reading, students habitually delay readinguntil just prior to exams (McDougall and Cordeiro,1992; Tuckman, 1994). When students are not pre-pared to participate in class sessions, they pas-sively receive information and then attempt tomemorize it for the upcoming examination (Buck,1997).

Large class sizes wherein the instructor is physi-cally far away from student seating and content isdelivered by didactic one-way lectures are per-ceived by students as impersonal and intimidating.Students fear being identified as uninformed,unprepared, or reluctant to express an unpopularopinion. Neer (1990) described this avoidance ofverbal participation in the classroom as ‘‘classroomcommunication apprehension’’. Neer asserts thatit limits academic achievement, but adds that fac-ulty behaviors and instructional methods can medi-ate this apprehension about communication. In astudy of the effects of random oral questioning incollege classrooms, Buck (1997) found that stu-dents demonstrated reduced levels of classroomcommunication apprehension and were more pre-pared for class when the instructor used question-ing during instruction.

Providing feedback to students during learningengages them in active learning and positively im-pacts achievement. Hattie (1992) reviewed almost8,000 studies and reported that the most powerfuleffect on enhancing student achievement is con-tributed by instructor feedback to students. For-mative feedback during the learning process helpsstudents to correct misunderstandings, gain clar-ity, to identify gaps in knowledge, and flaws in lo-gic (Beatty, 2004). Feedback from students to theinstructor allows on-the-spot adjustments toinstruction, such as trying a different explanation,providing amplification with discussion, or usingadditional learning exhibits such as graphics, pic-tures, sounds, or video clips.

A review of the literature on feedback (Marzanoet al., 2001), suggests the following strategies arecritical: (a) feedback should be specific to the tar-geted knowledge or skill (criterion-referencedfeedback is more powerful than norm-referencefeedback), (b) feedback must be timely, immedi-ately following assessment, (c) feedback shouldbe corrective in that it clearly provides studentsan explanation of what they are doing and under-standing that is correct, and what is incorrect,and (d) instructors should design opportunities forstudents to provide their own feedback throughmonitoring their progress (e.g. performance rub-

rics and scoring guidelines for assignments andexams).

Questioning as an instructional strategy

Tactical use of focused questioning is a powerfulmethod to provide feedback to students. The con-sistent use of questioning as an instructional strat-egy during class lectures and discussions has beenshown to promote preparation for class, enhanceactive participation, and results in higher achieve-ment (Buck, 1997; Dean, 1986; Gall, 1984; Redfieldand Rousseau, 1981). In a widely cited meta-analy-sis of research on the instructional use of question-ing, Redfield and Rousseau (1981) report that useof higher-level questions during instruction demon-strates positive gains on student achievement forboth factual recall and application of thinkingskills. In a review drawn from 37 research docu-ments, Cotton (2000) reports there is consensusthat instruction that employs questioning duringclass sessions is more effective in increasingachievement than instruction without questioningstudents, and that oral questions posed during classsessions are more effective for learning gains thanwritten questions.

Using questioning, instructors can shift the fo-cus of classroom interaction from recall to reason-ing. An interesting phenomenon occurs wheninstructors use a clicker system to manage thequestioning technique. Because students becomefocused on the task of responding, they concur-rently engage in the process of reasoning, makea commitment and externalize their answersthrough public display, and become emotionallyinvested in the learning process. This investmentheightens attention and focus in the classroom(Beatty, 2004). In a summary review of 26 studiesexploring outcomes of using clickers in a varietyof settings, Roschelle et al. (2004) report thecommon findings: greater student engagementand participation in learning; increased under-standing of subject content matter; higher levelsof student enjoyment of class sessions; improvedgroup interaction; a consistent mechanism isestablished for students to gauge their under-standing of material being taught; and instructorsreport an increased awareness of those studentshaving difficulties.

Clickers technology

Classroom response systems (clickers) are hand-held, pocket-size remote control-like devices that

Figure 1 Radio frequency receiver and response pad.

Figure 2 On-screen question with response display.

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 79

use infra-red or radio-frequency signals to trans-mit and record audience responses to questions.Vendors for these products are easily located byInternet search. The response system used in thisstudy is the Classroom Response SystemTM devel-oped and marketed by eInstruction, Inc. (http://www.eInstruction.com). The system is based on acomputer software program that processes radiofrequency input from a small handheld multi-but-ton ‘‘response pad’’ (Fig. 1) that transmits a sig-nal to a receiver unit connected to a computer inthe classroom. Students register their clickers byaccessing an online website provided by the ven-dor. Once students register their own clicker andenroll in a course, a unique signal is identified bythe classroom receiver and tracks responses byindividual students (optionally students may usea generic clicker supplied to them for each classsession that remains anonymous).

During class sessions the software program re-cords student entries and response data are in-stantly aggregated and displayed (Fig. 2).Questions can be created within the software itself(templates for a variety of formats are included) orbecause the program is designed to function as anadd-in to PowerPoint and runs ‘‘in the back-ground’’ (a toolbar for the application appears atthe bottom of the screen), existing PowerPoint les-sons can be used. Graphics, pictures, and multime-

dia can be embedded in PowerPoint slidesproviding rich-context learning objects for studentresponse using the clickers.

80 G.A. DeBourgh

Features of the software are plentiful and in-clude such options as a grade book (which studentscan view online), attendance and participationmonitoring, and recording answers to quizzes andexams (students enter answers via the clickerrather than on paper or scan forms) with resultsavailable immediately upon completion. Followingeach class session, instructors can view and exportvarious reports and databases, including analysis ofresponse frequencies by question, answer,distracters, and even by individual student ifdesired.

Elements of design for engaging learningevents

Chickering and Gamson (1987) posit seven ‘‘princi-ples for good practice in undergraduate educa-tion’’ (Fig. 3). Many of these ‘‘good practices’’are enhanced by use of clickers. Using clickers topose questions in the classroom connects studentswith the instructor’s perspective of critical contentand priority principles, and encourages dialogueabout thinking and reasoning. The resulting dia-logue not only communicates the instructor’sexpectations for performance and participation,but capitalizes on the positive effects of collabora-tive, cooperative learning. By the tactical place-ment and frequency of questions, instructors canfocus time on task and impart clear direction aboutwhat is most important content. When clickers areused with text and multimedia learning prompts(pictures, graphics, sounds, video clips, and anima-tion), students’ diverse learning styles are re-spected and accommodated-kinesthetic learnerslove clickers!

In advance of each classroom clicker session,both cognitive and application goals should be con-sidered. Learning goals may include: (a) expressing

1. Encourage contact between students and faculty

2. Develop reciprocity and cooperation among students

3. Encourage active learning

4. Give prompt feedback

5. Emphasize time on task

6. Communicate high expectations

7. Respect diverse talents and ways of learning

Chickering and Gamson (1987)

Figure 3 Seven principles for good practice in under-graduate education.

pre-requisite knowledge, beliefs, and perceptions;(b) clarifying areas of confusion or misunderstand-ing; (c) differentiating two related concepts (com-pare and contrast); (d) identifying similarities,associations, and connections among ideas, con-cepts, and principles; (e) elaborating, extending,and amplifying a concept; or (f) exploring implica-tions of an idea in new context (Beatty, 2004).

Consider beginning each class with a series ofquestions focused on important content from pre-class reading and assignments. Unannounced quiz-zes work well for this purpose and clicker systemscan capture and record these responses as well.Posing questions right up front in the sessioncreates a ‘‘mind-set’’ for the lecture or discussion,and also provides feedback to students about theeffectiveness of their preparation. Asking ques-tions does not necessarily lead to answering them.Posing one question may lead to more questions.This is actually an ideal opportunity for the instruc-tor to point out associations and identify similari-ties, differences, and related topics. Inquiry-based learning is not about correct answers andnot limited to problem-solving. It is about prob-lem-posing as well. Anticipate likely incorrect re-sponses and prepare ‘‘talking points’’ fordiscussion as this facilitates ‘‘thinking on yourfeet’’ and makes more visible to students how anexpert uses heuristics, reasoning, and refined prob-lem-solving skills to gain command of a clinical sit-uation. The concept of ‘‘witnessed dialogue’’ is apowerful teaching strategy (DeBourgh, 2002).When the expert ‘‘thinks aloud’’ in the presenceof a novice about what, why, and how they arethinking, that novice becomes a witness to expertthinking, reasoning, and actions (responses). Thedeveloping practitioner sees how the expert usesfactual knowledge and experience to effectivelyrecognize and respond to complex situations.

Through careful design of the questions, instruc-tors can use provocative or even purposefully va-gue questions to stimulate debate and discussion.The technique of ‘‘deliberate engineering’’ ofquestions (Beatty, 2004) can advance pedagogicgoals. Ambiguity in question design helps sensitizestudents to the variability, subtle nuances, andlack of certainty that are expected in clinical prac-tice settings. During instruction, the goal is not toteach the right answers, but to demonstrate think-ing strategies, as developing this capability is farmore powerful for future clinical practice thanmemorizing correct answers for a test. Wrong an-swers during class sessions are not failure-theyguide the path to correct understanding if concur-rent discussion is conducted. Ask students follow-up questions in the context of the original question

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 81

but change the focus to add new variables, such as‘‘What if the patient developed this sign or symp-tom?’’, or ‘‘Why is this a priority at this time?’’,or even ‘‘What would make the other answers cor-rect?’’ Using questions to frame discussion andpresent new content promotes flexible knowledgeand creates a more interesting, lively, and interac-tive classroom environment than presentation ofcontent by lecture alone.

Pacing and placement of questions are criticalconsiderations. Teachers commonly underestimatehow often they ask questions in classroom settings.Posing questions too frequently can result in cogni-tive overload. Learners use a lot of thinking energyto focus on the context of each question. Using‘‘sets’’ of related questions helps to reduce cogni-tive load because the circumstances are familiar.Reusing a situation and applying sequential ques-tions allows students to concentrate on the princi-

Figure 4 Progressive case study with question andfollow-up prompts.

ple or concept rather than spending mental energyconstructing a mind set and sorting out which infor-mation is related. Questions used about every20 min will maintain engagement, attention, andrefocus important aspects. Posing multiple ques-tions (repetition) on a given learning point whilethe context of the question and concept are cur-rent, improves learning results over a single ques-tion (Boyd, 1973).

The progression of question slides begins withthe question and response options (Fig. 2), theclickers are activated and when the time limit isreached, the response histogram is revealed as anoverlay, followed by the correct answer, and thena follow-up reasoning question. In this example,the histogram indicates that most students se-lected the correct answer ‘‘D’’, but not all ofthem. In the example about priorities for asthmainterventions (Fig. 5), note that student responsesare distributed over all options, alerting theinstructor that the students were guessing on thisquestion and additional instruction is needed. Ask-ing a volunteer who selected the correct responseto explain why that option was selected creates apeer-to-peer teaching moment and benefits boththose students answering incorrectly and the stu-

Figure 5 On-screen question with response indicatingguessing.

82 G.A. DeBourgh

dent speaker who is practicing articulating ratio-nale. Before ‘‘revealing’’ correct answers, con-sider facilitating a 50–50 decision process,wherein the instructor queries the students aboutwhich half of the response options should be elim-inated from consideration and why. This techniquehelps students develop skill in discrimination andidentifying relationships among data. Create addi-tional practice in reasoning by asking students toturn to their nearest neighbor and convince eachother of the ideal answer, the rationale for the cor-rect answer, and why the other choices are not cor-rect. After this brief peer-to-peer coachingsession, re-launch the clicker software to updatethe class response to visually demonstrate howaggregate thinking has changed through the consul-tative process. This ‘‘peer-pair and share ratio-nale’’ method is critical to minimize the potentialfor clicker ‘‘button pressing’’ to take the place ofverbal articulation of response and rationale.

Using progressive clinical case studies with ques-tion prompts are another effective way to providetransitions, reduce cognitive overload, and buildincreasing complexity into simulated clinical sce-narios (Fig. 4). Because clicker technology ‘‘runsin the background’’ with PowerPoint, on-screencase studies can be amplified by embedding pic-tures, graphics, and sound clips to represent clini-cal signs, symptoms, and manifestations. Videoclips can also be inserted with or without soundto display dynamic representations of clinical con-ditions. Patient cases can be ‘‘progressed’’throughout the class session and series of questions

Table 1 Student satisfaction with operation of clickers

Please rate the followinglogistical activities with yourclicker:

Really easy Somewhateasy

Purchasing your clicker fromthe USF bookstore

73% (47) 16% (10)

Registering the clicker on theeInstruction Website

43% (28) 32% (21)

Turning on the clicker 58% (38) 22% (14)Joining during the initial classsession

52% (34) 28% (18)

Joining during subsequentclass sessions

64% (41) 11% (7)

Sending my responses duringclasses

66% (43) 17% (11)

Determining if my clicker wasworking during class

38% (25) 32% (21)

Total respondentsSkipped this question

Total enrolled = 92; total responding = 65; response rate 70.65%. L

inserted to highlight important aspects of patientcare management. Playing video clips of interper-sonal interactions depicting conflict or scenes re-lated to ethical or moral issues that evoke strongemotional responses among students, with ques-tions posed afterward is another powerful use ofthe anonymous clicker response system. Takingthe class ‘‘temperature’’ on controversial topicswithout fear of judgment is an excellent discussionstarter.

Student perceptions of clicker use

A convenience sample of students enrolled in a 15-week advanced nursing therapeutics course wassurveyed for perceptions of clicker use in the class-room. Ninety-two students were enrolled in thecourse, with 65 completing an anonymous satisfac-tion survey during the 14th week of the semester(70.54% response rate). University Human SubjectsCommittee approval was granted by policy, as vol-untary anonymous participation in the survey waspart of the course evaluation process and isolatedfrom assignment of grades. Data were collectedusing online survey methodology to inform theinstructor of students’ satisfaction with opera-tional aspects of using the technology, and for theirperceptions of the effectiveness of this tool infacilitating understanding complex concepts anddevelopment of advanced reasoning skills (re-sponse items are represented in Tables 1–3).

Neither easynor hard

Somewhatdifficult

Verydifficult

Mean SD

9% (6) 0% (0) 2% (1) 4.52 0.91

12% (8) 11% (7) 2% (1) 4.05 1.07

8% (5) 11% (7) 2% (1) 4.25 1.096% (4) 12% (8) 2% (1) 4.17 1.10

16% (10) 9% (6) 0% (0) 4.30 1.05

12% (8) 5% (3) 0% (0) 4.45 0.88

9% (6) 11% (7) 9% (6) 3.80 1.31

650

ikert-type scale: really easy = 5; very difficult = 1.

Table 2 Student ratings of clicker use for understanding

Please rate the instructionaleffectiveness of the clickersystem

Veryuseful

Somewhatuseful

Neither usefulnor unhelpful

Somewhatunhelpful

Veryunhelpful

Mean SD

Testing my pre-requisiteknowledge

52% (33) 33% (21) 11% (7) 2% (1) 2% (1) 4.33 0.86

Testing my comprehension of thetextbook readings

48% (30) 29% (18) 16% (10) 6% (4) 2% (1) 4.14 1.01

Confirming my understanding of aconcept being discussed in class

63% (40) 24% (15) 8% (5) 5% (3) 0% (0) 4.46 0.84

Confirming my understanding of aconcept from the textbookreadings

45% (28) 26% (16) 26% (16) 3% (2) 0% (0) 4.13 0.91

Correcting a misconception ormisunderstanding from thetextbook reading

48% (30) 22% (14) 29% (18) 2% (1) 0% (0) 4.16 0.90

Correcting a misconception ormisunderstanding of a conceptbeing discussed in class

59% (37) 19% (12) 19% (12) 3% (2) 0% (0) 4.33 0.90

Providing feedback about mydecision-making about casestudies

60% (38) 22% (14) 14% (9) 3% (2) 0% (0) 4.40 0.85

Total respondents 63Skipped this question 2

Total enrolled = 92; total responding = 65; response rate 70.65%. Likert-type scale: very useful = 5; very unhelpful = 1.

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 83

On the average, students were highly satisfiedwith both operational aspects and instructionaleffectiveness of using the technology in the class-room, with 75.8% (n = 47) recommending continueduse of clickers and 12.9% (n = 8) of respondentsindicating ‘‘maybe’’. Table 1 displays students’satisfaction scores for operational aspects. Thevendor (www.eInstruction.com) provides onlineinstructions for students to create their personalprofile (school affiliation, demographics, and con-tact data), register their newly purchased clickers(establish personal clicker identify), and to enrollin courses using clickers. Students quickly and eas-ily learned to operate the clickers and except forthe occasional battery failure, no other technicalcomplications occurred during the semester usingeither the radio-frequency clicker technology orthe database software.

Table 2 provides students’ ratings of the useful-ness of clickers as an instructional tool for validat-ing their understanding of concepts, correctingmisconceptions, and for providing feedback duringlearning activities. Strong positive ratings were re-ported for use of the clicker for testing pre-requi-site knowledge and comprehension of preparatorytextbook readings (85% and 77% very useful orsomewhat useful, respectively), for confirmingunderstanding of concepts from class discussionand textbook readings (87% and 71% very or some-

what useful, respectively), and for correcting mis-conceptions about content from readings and fromclass sessions (70% and 78% very or somewhat use-ful, respectively). When clickers were used to pro-vide feedback to students about the accuracy oftheir thinking and decision-making in case studies,72% (n = 52) of students found this immediate feed-back as very or somewhat useful.

When students were asked to comment on howclickers supported their understanding (immediatefeedback about concepts, focusing on the ‘‘big pic-ture’’, and heuristics to apply knowledge), stu-dents again reported high ratings (Table 3). Ofinterest was the finding that 66% of studentsresponding to the survey reported that use of click-ers helped them to ‘‘do better’’ on quizzes and ex-ams. Application-style questions requiring studentsto synthesize knowledge and to determine priori-ties of patient care management were used inclass. The formats for practice questions and forthose on quizzes and exams were consistent.Fifty-three percent of students (n = 42) perceivedthat use of clickers in classroom learning activitiesencouraged them to come to class ‘‘betterprepared’’.

Samples of students’ narrative comments areprovided in Table 4. Overall, students perceivedan added value in using clickers in the classroom.Comments indicate students became more aware

Table 3 Student ratings of clicker use for reasoning

Please rate your level ofagreement with the followingstatements about clicker use inyour class:

StronglyAgree

SomewhatAgree

Neither Agreenor Disagree

SomewhatDisagree

StronglyDisagree

Mean SD

Using clickers gave me immediatefeedback about myunderstanding of a concept

65% (40) 26% (16) 6% (4) 3% (2) 0% (0) 4.52 0.76

Using clickers encouraged me tofocus on the ‘‘big picture’’ inclass

48% (30) 27% (17) 18% (11) 5% (3) 2% (1) 4.16 0.99

Using clickers allowed me tounderstand ‘‘rule of thumb’’and ‘‘general approach’’strategies in class

57% (35) 30% (18) 10% (6) 2% (1) 2% (1) 4.39 0.86

Using clickers encouraged me toreally understand the materialsrather than just recognizing thecorrect answer

47% (29) 31% (19) 11% (7) 6% (4) 5% (3) 4.11 1.10

Using clickers helped me to applythe concept during class

58% (36) 26% (16) 6% (4) 8% (5) 2% (1) 4.31 1.02

Using clickers with case studies inclass helped develop my clinicalreasoning skills

52% (32) 31% (19) 10% (6) 6% (4) 2% (1) 4.24 0.99

Using clickers helped me toidentify misunderstandings andmisconceptions in my thinkingwhile in class

53% (33) 29% (18) 11% (7) 5% (3) 2% (1) 4.27 0.96

I prefer the more traditionallecture approach rather thanthe clicker approach

26% (16) 13% (8) 18% (11) 23% (14) 20% (12) 3.10 1.49

I do more thinking during clickersessions than in regular lecturesessions

40% (25) 24% (15) 21% (13) 10% (6) 5% (3) 3.92 1.15

Using clickers in class helped medo better on quizzes and exams

34% (212) 32% (20) 23% (14) 5% (3) 6% (4) 3.82 1.15

Using clickers encouraged me tocome to class better prepared

34% (21) 19% (12) 29% (18) 8% (5) 10% (6) 3.60 1.30

Given two class sections that arethe same in all other respects, Iwould prefer the section thatuses clickers

48% (30) 19% (12) 19% (12) 6% (4) 6% (4) 3.97 1.24

Total respondents 62Skipped this question 3

Total enrolled = 92; total responding = 65; response rate 70.65%. Likert-type scale: strongly agree = 5; strongly disagree = 1.

84 G.A. DeBourgh

of their thinking strategies, were able to practicevarious approaches to complex problem solving,and that using clickers provided prompt, specificfeedback during the teaching and learning process.Many students reveal that using clickers in theclassroom reduces the intimidation factor relatedto participation in class, and the anonymity to-gether with the opportunity to ‘‘answer freely’’without a penalty for the wrong answer encouragesthem to participate more in class and to ‘‘under-stand the class topics better’’. Students offer that

class is more ‘‘fun’’ using clickers compared withthe traditional lecture format, and that they areprompted to spend more time preparing for classknowing that ‘‘fact flash’’ clicker questions willbe posed in the classroom.

Costs and challenges

Most vendors for classroom clicker products offerfree-of-charge to instructors adopting the technol-

Table 4 Sample narrative comments of students using clickers

The most useful thing about using clickers this semester was:I was not embarrassed if I had the wrong answer. I could see immediately if I was going down the wrong path forunderstanding the main pointsBeing able to be active in my learningI could choose the answer freely from what I thought without being penalized by choosing a wrong answer with agrade and using the clicker to select the answers helped me to participate more in class and understand the classtopic(s) betterAnonymously answering the questions. . . .seeing what classmates were thinking. Seeing instant results from thequestion being asked.The discussion before and after questions was extremely helpful in pointing out key elements as well as explainingthe thinking processGave my answers anonymously which later helped me understand why my answer was correct or incorrect withoutbeing humiliated.I had to focus in on the question and with four possible answers, I had to logically see the big picture when selectingan answer.Also, I found this helpful in timing myself to process the question being answered.Seeing the responses and thoughts of other students as we worked through material-good to see whether or not Iwas thinking the same way as othersHelped me focus on clinical reasoning skills and test taking. Case studies helped me in the clinical practice and tosee the big picture.Clickers were fun and did allow for class participation and discussion. They also, along with your other teachingtechniques, such as the quizzes, homework assignments and the calling on students individually to answerquestions, most assuredly encouraged me to come to class well prepared. This was crucial in such a class as this,that covers so much complex material.

The least useful/least fun aspect of using clickers this semester was:Cost. There were times when the clicker did not work or ran out of battery?The initial learning of how to turn the clicker on and join was the only problem I can think ofPaying so much for the clicker each semester and forgetting to bring the clicker to classWorrying about getting the answer in time, the case study questions brought up more questions than did solvequestionsI think it is way too expensive a machine to use in class. It is also something we’ll never use again and we can’t evensell it back.The fact that other classes do not use the clicker right now seems hard to justify the price for one semester.The questions were often extremely difficult and presented too quickly for my learning style. That is especially truefor the questions you asked on material just presented.It was really difficult to see if my clicker was working or not

Why or why not would you recommend continued use of clickers in this class?The clickers show the classroom understanding of concepts. Everyone is able to participate instead of one personanswering the questions.Because they are useful and help people be more involved during class, and they help people think more criticallyIt is helpful to incorporate the students to focus and participate more in your class, There are people who do notlike to ask during the class because they think that the other students will laugh at him/her because of making astupid question?. It is also helpful because you are given an idea to the students how to prepare for your exams andwhat to focus on.It assisted in my attention span in class. . . .and also jogged my memory in learningProvided good immediate feedback and helped students participate that would not have normally participated.It helps understanding. Plus it helps students read the questions and how to become a good test taker by only takingout what is needed from the question.Students are encouraged to be prepared prior to class. Active participation motivates students to learn the conceptrather than to memorize everything.It makes class more fun. It makes class more interesting and helps us grasp difficult concepts.It’s too expensive. I think we could learn the material with or without it.It keeps the student interested in the lecture. It is a form of stimulant and much better than having just a plainlecture

Total enrolled = 92; total responding = 65; response rate 70.65%.

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 85

86 G.A. DeBourgh

ogy the program software (on CDROM), access tothe online vendor-maintained database, as well asthe clicker receiver and a ‘‘practice clicker’’. Coststo students for the clicker itself (a one-time pur-chase) and a semester registration fee vary amongproviders, however these costs are nominal com-pared with other required resources for courses,such as skills laboratory use fees, clinical equip-ment and uniforms, and textbooks. Cost for theradio-frequency (RF) model clicker itself averagesabout $22.00 (US dollars). Although the RF clickeris slightly more costly than infra-red models, thelater technology is becoming outdated and not rec-ommended due to limitations in distance for recep-tion of signal transmission and in the number ofstudents accommodated (RF models accommodateas many as 1000 students on a single receiver unit).Student registration fees for an unlimited num-ber of ‘‘clicker courses’’ each semester averages$13.00–$15.00 (US dollars) (www.eInstruc-tion.com). Some vendors will ‘‘bundle’’ or packagethe clicker without charge to students when theypurchase textbooks from affiliated publishers(www.turningtechnologies.com), however this sin-gle-source arrangement may limit faculty optionsfor textbook adoptions. Students’ reactions to costare highly influenced by how effectively and fre-quently faculty integrate and use the clicker tech-nology. If students perceive value, they seeclickers as a tool for successful learning and feed-back about their performance.

A most important consideration is standardiza-tion across the educational enterprise. Requiringstudents to purchase and learn operation of differ-ent clicker products generates unnecessary costs,complaints, and influences adoption and accep-tance of this teaching and learning technology forboth students and faculty. Other important consid-erations are the availability of cross-platform soft-ware (PC and MAC), and the availability ofknowledgeable technical assistance to faculty forsetting up the computer interface, operating thetechnology during class, and problem resolution.

Challenges for students in courses employingclassroom clickers are minimal. Students learn tooperate the clicker itself without difficulty as mostcontemporary college-age students were born in anera where use of computer and communicationstechnologies have always been part of their lives.Because clicker use promotes higher levels of indi-vidual engagement and classroom participation,and because faculty have the ability to ‘‘track’’this individual participation, expectations for pre-paring for class and participation during class areincreased, and some students may resent this per-formance expectation.

Challenges for instructors include learning thetechnology, increased pre-class preparation timeto develop questions that promote higher-orderthinking, decisions about where to strategicallyplace them in the instructional plan, and the timefor analysis of response data. The task of learningto set up and operate the clicker system is achievedrather quickly. The rich data that are recorded dur-ing class sessions create opportunities for analysisat many levels: individual responses to specificquestions, response trends for students working inteams, scores on clicker quizzes and exams, andquestion item-response statistics. Although time-consuming, analysis is facilitated by the well-de-signed software databases that enable one to selectspecific elements for user-defined data reports. Thegreatest challenge is the new role for faculty-toplan the curriculum and instruction around ‘‘deepcomprehension’’ rather than ‘‘covering content’’using a traditional lecture format. ‘‘The art ofdesigning effective questions is deceptively non-trivial and can be time-consuming for an instructornew to [classroom communication systems].’’(Beatty, 2004, p. 6) The investment of time andthe willingness to refocus instructional goals androles become well worth the effort once facultyand students experience a change in the classroom.The learning environment is modified from animperative teacher-directed approach (lecture) toan interrogative model wherein frequent but highlyselective higher-order questions are posed to stim-ulate interaction with the content and to increaseawareness of metacognition (thinking about think-ing). When used with a purposeful pedagogy, click-ers motivate students to actively interact with thecontent in a less-threatening learning session thatprovides immediate performance feedback to stu-dents and faculty. Research suggests that use of thishigher-order questioning technique can actuallycreate additional synapses between nerve cells inthe brain-called neural branching (Cardellichioand Field, 1997). Just as physical exercise buildsmuscle tissue, the frequent use of a variety of high-er-order questions during instruction enables newconnections, strengthens brain function, and en-hances thinking.

Conclusion

Classroom response systems provide faculty withoptions to enhance interaction during the learningprocess and provide both students and facultyimmediate, real-time feedback reflecting students’understanding of course content. Integrated with a

Use of classroom ‘‘clickers’’ to promote acquisition of advanced reasoning skills 87

purposeful instructional design, use of clickers in-creases the level of student participation, pro-motes engagement of students in active learning,supports innovative instruction that results inhigh-level application and synthesis of complexconcepts, and supports skill development for ad-vanced reasoning. Students report high levels ofsatisfaction with clicker use and appreciate theindividual feedback instructors can provide duringthe learning process using this technology.

References

Beatty, I.D., 2004, February 3. Transforming student learningwith classroom communication systems. Educause Center forApplied Research (ECAR) Research Bulletin ERB0403. <http://www.educause.edu/LibraryDetailPage/666?ID=ERB0403> (Re-trieved June 12, 2006).

Boyd, W.M., 1973. Repeating questions in prose learning.Journal of Educational Psychology 64, 31–83.

Buck, H.J., 1997. Maximizing student learning with the use ofrandom oral questioning in the college classroom. FloridaJournal of Educational Research 37. <http://www.coedu.us-f.edu/fjer/1997/1997_Buck.htm> (Retrieved May 19, 2006)

Cardellichio, T., Field, W., 1997. Seven strategies to enhanceneural branching. Educational Leadership 54 (6), 33–36.

Chickering, A.W.,Gamson,Z.F., 1987.March. Sevenprinciples forgood practice in undergraduate education. American Associ-ation of Higher Education Bulletin. <http://www.csuhayward.edu/wasc/pdfs/End%20Note.pdf> (Retrieved June 10, 2006).

Cotton, K., 2000. The schooling practices that matter most.Portland: OR: Northwest Regional Educational Laboratory.<http://www.nwrel,org/scpd/sirs/3/cu5.html> (RetrievedJune 5, 2006).

Dean,D., 1986.Questioning techniques for teachers: A closer lookat the process. Contemporary Education 57 (4), 184–185.

DeBourgh, G.A., 2002. Simple elegance: Using a course man-agement system as pedagogical infrastructure to enhancescience learning. The Technology Source [On-line]. <http://distance.wsu.edu/facultyresources/savedfromweb/elegance.htm>.

Forneris, S.G., 2004. Exploring the attributes of critical thinking:A conceptual basis. International Journal of Nursing Educa-tion Scholarship 1 (1).

Gall, M.D., 1984. Synthesis of research on teachers’ questioning.Educational Leadership 42 (3), 40–46.

Hattie, J., 1992. Measuring the effects of schooling. AustralianJournal of Education 36 (2), 99–136.

King, A., 1993. From sage on the stage to guide on the side.College Teaching 41 (1), 30–35.

Marzano, R., Pickering, D., Pollock, J., 2001. Classroominstruction that works: Research-based strategies forincreasing student achievement. Association for Supervisionand Curriculum Development, Alexandria, VA.

McDougall, D., Cordeiro, P., 1992. Effects of random questioningexpectations on education majors’ preparedness for lectureand discussion. College Student Journal 26 (2), 193–198.

McKeachie, W.J., 1994. Teaching tips strategies, research andtheory for college and university teachers, 9th ed. Lexington,MA, D.C. Heath and Company.

Neer, M., 1990, November. Instructor communication behaviouras a factor influencing the class participation of classroomcommunication apprehensives. Paper presented at theannual meeting of the Speech Communication Association,Chicago, IL. (ERIC Document Reproduction Service No.ED324731).

Nystrand, M., Gamoran, A., 1989. Instructional discourse andstudent engagement. University of Wisconsin-Madison, Cen-ter for Education Research. (ERIC Document ReproductionService No. ED 319 780).

Redfield, D.L., Rousseau, E.W., 1981. A meta-analysis ofexperimental research on teacher questioning behavior.Review of Educational Research 51 (2), 237–245.

Roschelle, J., Penuel, W.R., Abrahamson, L., 2004, April.Classroom response and communication systems: Researchreview and theory. Paper presented at the annual meeting ofthe American Educational Research Association, San Diego,CA. Retrieved June 10, 2006 from: http://ubiqcomput-ing.org/CATAALYST_AREA_Proposal.pdf.

Stephenson, J., Yorke, M. (Eds.), 1998. Capability and Quality inHigher Education. Kogan Page Limited, London.

Tuckman, B.W., 1994. Comparing incentive motivation tometacognitive strategy in its effect on achievement. Paperpresented at the annual meeting of the American EducationalResearch Association (New Orleans, LA, April). (ERIC Docu-ment Reproduction Service No. ED 368 790).

Available online at www.sciencedirect.com