Addressing academic challenges: A quasi-experimental study on the effect of remedial exam strategy for nursing students with low academic performance

Background

Underachievement refers to the difference between a student’s potential, expected academic performance, and actual accomplishments (Veas et al., 2016). Although universities employ rigorous screening processes to admit the most promising candidates, a significant portion of students, approximately half, do not complete their degrees within the four-year timeframe (Renzulli, 2015; Symonds et al., 2011). In the United States, the retention rate for four-year private universities was 63% in 2020, while public and private non-profit universities boasted rates above 80% (National Center for Education Statistics (NCES), 2022). Unfortunately, a notable percentage of students either drop out or face expulsion due to persistently poor academic performance, ultimately failing to obtain a degree. Freshman year is particularly susceptible to dropout rates, often attributed to academic difficulties (Abdulghani et al., 2023). As a result, universities must identify the root causes of poor performance and implement various strategies to support struggling students in catching up with their peers.

Academic performance has been a subject of great interest among social scientists, particularly psychologists, as they seek to understand the factors influencing students’ achievement (Kolo et al., 2017). Unpreparedness for college-level work has been identified as the primary cause of student attrition (Symonds et al., 2011). Additionally, challenging course material, inadequate study skills, poor time management, lack of enthusiasm, and language barriers are among the potential contributors to subpar academic performance (Balduf, 2009; Deacon et al., 2017). Various strategies have been proposed and tested to address these issues. Some researchers have attempted to combat underachievement by modifying curriculum and course assignments while exploring the impact of changes in teaching methods and instructor performance (McCoach & Siegle, 2003; Ritchotte et al., 2015). However, the results of these efforts have often fallen short of expectations. In light of this, this paper aims to investigate whether remedial exams can effectively mitigate poor academic performance.

Remediation serves as a targeted strategy to address and rectify student performance deficiencies (Cleland et al., 2010). Students facing learning difficulties or those who would benefit from additional support can participate in remediation programs or activities to enhance their learning skills and comprehension of course material (International Bureau of Education, 2022). The remediation process typically involves three stages: diagnosis, implementation of corrective measures, and re-evaluation (Cleland et al., 2010). Within these stages, various remedial activities can be employed to assist students facing academic challenges, including re-testing, tutoring, academic advising, computer-assisted interventions, and the option to drop a course (Deacon et al., 2017; Drew, 2022). These interventions aim to provide targeted assistance and support to students experiencing academic difficulties.

Limited research exists regarding the optimal practices for remediation in universities. Bierer et al. (2015) highlighted in their published study that faculty members often lack knowledge about which remedial practices to employ to enhance student performance without overwhelming them. Snyder et al. (2019) encountered difficulties drawing generalizations from their systematic review due to the diverse range of interventions reported in the literature. They recommended that researchers focus on replicating studies on specific interventions rather than assessing the impact of new interventions in order to contribute to the existing body of evidence. Moreover, they suggested conducting further studies on underachieving college students better to understand the developmental needs of adolescents and young adults (Snyder et al., 2019).

Similarly, we faced a similar challenge while conducting this study. Our research specifically examines the effects of remedial exams; however, existing literature on remedial exams tends to predominantly focus on general remedial procedures. Most relevant studies test the outcomes of implementing multiple remediation programs and strategies simultaneously, evaluating the overall impact of remediation on students’ academic performance. In this paper, we will present our findings on the effects of remedial exams and compare them with the only other study we found that specifically focuses on remedial exams alone (Ferman & Fontes, 2021). Additionally, we will explore the literature on academic remediation strategies and relevant studies concerning the effects of implementing remedial strategies in general. By doing so, we aim to provide clearer insights and present more concrete results and recommendations.

A remediation test is a second-chance examination opportunity provided to students who have not achieved a passing grade on a required course exam (Carr, 2011). This test aims to assist students in improving their performance and raising their overall academic standing and GPA. Ferman and Fontes (2021) describe remedial exams as a means for students to catch up on essential material necessary for passing, offering them an opportunity to demonstrate their acquired knowledge. Following Brazilian legislation, students whose grades in a course fall below the passing threshold are eligible to take a remedial exam to elevate their grades. The pre-remediation course grades are combined with the remedial exam score to determine their eligibility for progression to the next level. Ferman and Fontes (2021) observed that the test scores of low-performing students showed improvement after participating in a remedial exam.

This study aimed to evaluate the effectiveness of the remedial midterm exam strategy in enhancing the academic performance of nursing students who did not achieve a passing grade on their initial midterm exam. In this context, “academic performance” is defined as the overall cumulative grade obtained by students from both formative assessments (such as quizzes, midterms, and ongoing evaluations) and summative assessments (including the final exam) conducted throughout the semester, which collectively determine the final course score. The term “remediation midterm exam” refers to the approach employed to support students who failed their initial midterm exam by providing them with a second opportunity to improve their performance. Students who are eligible for the remedial exam are required to acknowledge their agreement to participate in it.

The study aimed to address two research questions: 1) Is the remedial exam strategy effective in improving nursing students’ midterm exam scores and overall academic performance in the course? 2) Which students can benefit from the remedial exam strategy? Two hypotheses were formulated to investigate these research questions: First Hypothesis: The students’ scores in the remedial midterm exam are higher than their initial midterm exam scores. Second Hypothesis: There is a significant difference between the remedial and no-remedial exams groups concerning midterm and total course scores.

Methods

Results

The sample for this study consisted of 306 students who failed the midterm exam in various courses. Among them, 103 students opted to take the remedial exam (Remedial group) to enhance their midterm scores, while 203 students chose not to take the remedial exam (No-Remedial Group). The study encompassed 14 courses conducted at different levels, as illustrated in Table 1.

Discussion

Despite the potential benefits offered by the remedial exam strategy, it was observed that a majority of low-performing students did not take advantage of this opportunity to address their weaknesses. The findings revealed that students’ remedial exam scores showed only marginal improvements compared to their initial midterm exam scores. Surprisingly, only a small percentage of students (15%) demonstrated significant effort and were able to pass the remedial exam. Additionally, it was noted that the students who managed to improve their scores were those who narrowly missed passing the initial exam by a few points. Moreover, a positive correlation was observed between the students’ initial midterm exam scores and their scores in the remedial (re-take) exam.

In our study, we compared our findings with the research conducted by Ferman and Fontes (2021), which explored the impact of remedial exams. Ferman’s study revealed that the implementation of remedial exams led to an improvement in the overall performance of low-performing students, particularly among females. Additionally, it was found that students demonstrated better results in the year following remediation on cognitive and noncognitive tests. However, it is essential to note that the students who took the remedial exam in Ferman’s study had initial scores averaging around 58, which is very close to the passing cutoff point of 60. Therefore, their findings may not necessarily apply to students with significantly lower grades. Nevertheless, these results align with our findings, suggesting that the remedial exam strategy is most beneficial for students only a few grades away from passing the exam but may not provide substantial advantages for those with significantly lower performance levels.

Despite observing a statistically significant difference between midterm and remedial exam scores, the participation of students in the remediation strategy did not improve their chances of passing the midterm or the overall course. This lack of improvement may be attributed to the students’ failure to learn from their mistakes on the initial midterm exams and insufficient preparation for the remedial exam. It is possible that modifying the approach to conducting the remediation technique could yield better outcomes. In order to obtain a more comprehensive understanding of the subject, we deemed it necessary to investigate the effectiveness of remedial interventions as a whole. Consequently, we also considered studies that examined remedial strategies in general instead of focusing solely on remedial exams but implemented them in different ways. Vandenbussche et al. (2018) reported that a 2-hour revision program with teacher support between the initial and re-take exams was associated with higher student success, indicating that a lack of prerequisite knowledge presents a significant barrier for students. Additionally, Asio and Jimenez (2020) found significant academic improvement in fifth-grade students’ scores after implementing remediation activities in the subject of Technology and Livelihood Education (TLE). Similarly, studies evaluating the effects of providing remedial courses to college freshmen revealed that these interventions aided students in developing clear educational goals, practical skills, and a better understanding of what it takes to succeed in college, particularly considering the challenges freshmen often face due to the substantial transition from high school (Zeidenberg et al., 2007).

Furthermore, Bettinger and Long (2009) conducted an evaluation of the impact of remedial courses on students’ mathematics and English skills. Their findings revealed that students who enrolled in remedial courses demonstrated better academic performance than those who did not participate. Esposito et al. (2019) conducted a study investigating the effects of a rigorous 2-week remediation program for students who had failed a final exam with a score that fell 10% or less below the cutoff grade. The program required eligible students to sign a written contract outlining a concentrated study plan that thoroughly assessed their strengths and weaknesses. They also participated in study sessions with faculty members and engaged in personalized remediation activities. Upon completing the remediation period, the students were required to take a remedial exam. Esposito and her colleagues reported a pass rate of 75.2% among those who chose to participate in the remediation plan. This success rate is notably higher than the one observed in our study. It is important to note that the disparity in success rates may be attributed to the fact that in Esposito’s study, the remedial exams were preceded by a mandatory period of remediation where various techniques were applied to assist struggling students. Furthermore, they only allowed students within 10% of the required minimum grade to participate. In contrast, our study included all students who failed the exam, regardless of their initial grades.

Conflictingly, it is worth noting that several research studies on remedial interventions have produced negative results. Nietzel (2018) argued that remedial programs are less effective than commonly believed, citing data from the Complete College America advocacy group (CCA). The data indicated that only 1 in 10 students in two-year colleges who enrolled in remedial programs managed to obtain a degree within three years or less. Similarly, only 35% of four-year college students in remedial programs achieved a degree within six years. Additionally, the dropout rates for students enrolled in remedial courses were significant, with approximately 40% of students in two-year colleges and 25% of students in four-year colleges dropping out. Martorell and McFarlin Jr (2011) conducted a study on the effects of mathematics remediation on Texas College students, examining their academic scores and subsequent labor market outcomes. The findings revealed that the impact of remedial courses on academic success was small and statistically insignificant. Moreover, there were no labor market advantages observed among students who received mathematics remediation compared to those who did not. These outcomes may be attributed to the fact that many underperforming students fail to acknowledge their deficiencies and often do not seek appropriate help or support (Cleland et al., 2010).

The participants’ decline in performance and lack of improvement in the remedial exam can be attributed to various factors, including poor study skills (such as planning and time management), inadequate English language proficiency, deficient time management skills, and underdeveloped critical thinking abilities. This is indicated by the finding that the remedial group’s performance in the final exam did not significantly differ from their performance in the initial midterm exam. Bergey et al. (2017) conducted a study on first-year university students and found that students with reading difficulties had a lower cumulative GPA of 2.8 (out of 4.3) in their first year compared to students without such difficulties, who achieved a GPA of 3.0. Tseng et al. (2016) and other studies have reported that students themselves identify inadequate learning strategies, course-related factors (e.g., difficulty, teaching styles, lack of prerequisite knowledge, comprehension challenges), personal factors (e.g., health issues, emotions, motivation, family difficulties), language barriers, and a lack of academic advising as the primary reasons for poor performance. Balduf (2009) and Ritchotte et al. (2014) suggested that low performance may stem from a lack of academic confidence, motivation, or self-regulation. Many of these factors cannot be fully addressed through remedial interventions, which could explain their limited effectiveness.

Several possible strategies can be implemented to address the identified factors hindering academic progress. Personal problems may be tackled by providing readily-available social-emotional counseling services, while course-related challenges can be addressed through academic counseling and support. Offering study-skills workshops and tutoring can also greatly assist students, particularly those with a history of reading difficulties (Chevalier et al., 2017; Deacon et al., 2017). However, a persistent challenge is that students in the current study have been observed to rarely seek assistance from academic advisors or university psychological counselors, and sometimes they do not even reach out to their course professors for help. Encouraging students to actively seek support and guidance is crucial in effectively implementing these strategies.

Moreover, a systematic review and meta-analysis conducted by Snyder et al. (2019) emphasized that despite numerous studies on interventions to improve underachieving students’ academic performance, definitive answers have yet to emerge. The findings of the review indicated that interventions had a moderate effect on enhancing students’ achievement and psychosocial outcomes, with the effectiveness varying across different grade levels. Notably, the effectiveness of interventions tended to be lower at older age levels, such as high school and post-secondary education.

Contrary to the second hypothesis, the group that participated in the remedial exam did not perform better than the group that did not. No significant difference was observed in final exam scores or total course scores between the remedial and non-remedial groups. Interestingly, it seems that the students in the non-remedial group, who experienced the negative outcome of failing the midterm exam, were motivated to study harder or strive for higher scores on the final exam to compensate for their earlier performance. This finding aligns with studies that suggest students’ responses to adverse academic events, such as being placed on college probation, can lead to improved performance in subsequent exams (Lindo et al., 2010). In a related study, Hvidman and Sievertsen (2021) reported that students in Denmark whose GPAs were negatively affected by a reform in GPA calculation performed better in subsequent examinations, particularly female students.

Conclusion

Despite the significant difference between the students’ midterm scores and their scores in the remedial exam, the majority of students were unable to pass the remedial exam or raise their total course scores to a level that would lead to passing the course. Additionally, the average performance of the students in the remedial group was worse than that of the no-remedial group on the final exam. The no-remedial group outperformed the remedial group in terms of midterm exam scores and total course scores. Although the remedial exam strategy proved beneficial for students who narrowly missed passing the initial midterm exam, it was insufficient to improve the academic performance of underachieving students on its own. Additional interventions or strategies may be necessary to address the needs of these students and enhance their overall academic performance.