The increasing interest in the expanded role of the nurse during recent years has led to the unprecedented demand for clinical nursing specialists. Consequently, nurse-midwifery educational programs have been deluged with applicants. They are well-qualified individuals whose academic preparation ranges from diploma graduates to holders of master's degrees with professional nursing experience of from one year to a decade or more of clinical practice.

Due to the shortage of nurse-midwifery faculty and the limited number of existing educational programs, it is unlikely that the programs will be able to meet the manpower demand in the near future. A proposed solution to the problem could be the development of the challenge examination.

The challenge examination currently given at various baccalareate programs in nursing allows a diploma student to elect to take a test specific to a course in her nursing program. Upon passing the test satisfactorily, the student is granted credits. It is conceivable that nurse-midwifery education could also use this methodology to help students expedite their education.

The challenge examination can also be used for refresher students whose nurse-midwifery education was not in the United States. Foreign-prepared nurse-midwives would be able to qualify by measuring objectively against their American-prepared counterparts without having to go through a refresher program of several months.

Written, oral, and practical examinations should be constructed by qualified nurse-midwifery educators to measure what phase of concepts, knowledge, and nursing activities the student knows and what deficiencies remain in her understanding, skills, and clinical judgment within a total context. Through this kind of assessment, the nurse-midwifery educational programs can build on the strengths and capitalize on the resources which the student brings with her to the program. Educators must take into consideration what the students' capabilities are and allow for flexibility and modification in the individual programs. Challenge examinations therefore could be one of the most effective ways whereby qualified nurses could become nurse-midwives in a shorter period of time.

The construction of challenge examinations which will have meaning, validity, and reliability may require new tools and techniques yet unfamiliar to many nurse-midwifery educators. Nurse-midwifery faculties from various programs must work together and learn from the testing and measurement experts in the field of education. Directors of educational programs need to share resources, exchange information, and even obtain guidance from professional consultants on the methodology and validity of test construction.

Lily Hsia, C.N.M., M.S.11New York, N.Y.