The Basic Knowledge Assessment Tool (BKAT) 
For Medical/Surgical Nursing
MED-SURG BKAT (Copyrighted)
(Version One, 2010)

RESEARCH FROM S Parrish, North Carolina
July 07, 2015

"The MED-SURG BKAT was used for 8 newly licensed RNs at the beginning of a 14-week Residency [program] and at the end. ....learning occurred".

A dependent t-test was computed by BKAT.  The results 
were statistically signifant t(7)=3.5, p=.002

The Pre-Residency score was 78.4% correct answers;
The Post-Residency score was 86.5% correct answers.

Congratuations to Susan from North Carolina  



Basic knowledge in Medical-Surgical nursing is a body of knowledge that the nurse uses in order to provide safe nursing care to patients.  Since safe practice is regarded as a moral and professional responsibility, basic knowledge is information that is necessary for entry into Medical-Surgical nursing and represents the foundation for job performance.

A primary aim of in-service education is to assure that staff nurses demonstrate an understanding of this basic knowledge.  Because of on-going research studies (since 1979), publications, and the use of the BKAT over the past 31 years, it has become accepted as one standard for measuring basic knowledge in various areas of critical care nursing.  For example, to date, over 10,300 critical care nurse educators and nurse managers in the USA have requested and have received a copy of the BKAT to photocopy for use in their practice.  Critical care nurses in over 23 different foreign countries have also requested and received a copy of one of the BKATs.  

However, a review of the literature failed to locate a standardized test of basic knowledge in Medical-Surgical Nursing.  It was in response to this finding and inquiries from nurses across the USA, asking if a BKAT for Medical-Surgical nursing exists, that this research was begun.  This is the first BKAT  that has been developed outside of the critical care setting.


The MED-SURG BKAT is an 88-item paper and pencil test that measures basic knowledge in Medical/Surgical nursing.  These items measure content related to the following areas of nursing practice:  cardiovascular (19 items), endocrine (12 items), renal (10 items), neurology (7 items), gastrointestinal/ parenteral  (7 items), pulmonary (7 items), skin/wounds (5 items), and an ‘other’ category (21 items). The category ‘other’ includes pain control (4 items), safety/falls (4 items), infection control (3 items); communication, emotional/spiritual care, and drug calculation (2 items each), and one item each in the following:  Advanced directives, blood transfusion, hypothermia, and obesity.

The MED-SURG BKAT takes approximately 40 minutes to complete.  The total possible score is 88 points (100%).  Items on the test contain multiple choice and fill-in-the-blank questions that measure both the recall of basic information and the application of basic knowledge in practice situations.  Psychosocial aspects of nursing practice are integrated into specific questions in the MED-SURG BKAT.  Possible scores range from zero to 88 points with a high score indicating a high degree of basic knowledge in Medical-Surgical nursing.



Content for the initial version of the MED-SURG BKAT was identified through clinical experience, a review of the literature, interviews with staff nurses and head nurses working in Medical-Surgical nursing, a 10 member Panel of Experts in Medical-Surgical nursing, and from items on the BKAT-7S for Telemetry/Progressive Care.  The BKAT-7S contains 85 questions:  Fifty-three were used (62.4%) for the MED-SURG BKAT.  Of these, 22 (41.5%) were modified to better reflect Medical-Surgical nursing.  Modifications included changes in stems, answers, and/or distractors.  

In addition, 121 potential new items were suggested by the Panel of Experts; the most appropriate of these, 28 (23.1%) were used.  Many suggested items were similar among the Panelists.  An additional 7 items were written by the author and added to the test.  

Construct validity was supported through suggestions from the 10 member Panel of Experts in Medical-Surgical nursing practice and education.  .  During reliability testing, additional construct validation was conducted, using the MED-SURG BKAT as a pretest and a posttest for18 new graduate nurses in two different internship/residency programs from Delaware (n=15) and Tennessee (n=3).  The length of the programs ranged from 10 to 16 weeks.  As cognitive learning theory would predict, posttest scores were significantly higher t(17)=2.18, p < .025 one-tail. 

Item Analyses

Based on the item analyses of the 284 subjects who answered the MED-SURG BKAT, minor changes were made to improve clarity of 27 (30.7%) of the questions.  This included minor changes in stems (n=4), in stems and distractors (n=2), in stems and the order of the responses (n=1), in distractors (n=17), and in distractors and the order of responses (n=2).  In addition, grammar was corrected in one of the distractors.  The remainder of items (n=61, 69.3%) were left unchanged.  


Cronbach’s Coefficient Alpha (a) was used to measure reliability of the MED-SURG BKAT, and ranged from 0.80 to 0.72, computed towards the beginning of the study (n=20) and at the end (N=284). 

Uses of the BKAT

The MED-SURG BKAT can be used prior to orientation classes in Medical-Surgical nursing to identify needed content for the classes, and as a pretest and/or a posttest to measure learning in groups of nurses.  It can also be used as a dependent variable to test different teaching methods for orientation classes, and as a means to identify content for in-service education programs for currently employed Medical-Surgical nurses.  In addition, nurses with previous experience in Medical-Surgical nursing who do well on the MED-SURG BKAT could be considered for exemption from classroom content that they already know.

The BKAT is only one measure of basic knowledge in Medical-Surgical nursing and is not to be used in screening, hiring, or firing situations.  It is copyrighted  and may not be altered, added to, or used in part.  Permission must be obtained to use the BKAT.

Passing Score

No one is expected to achieve 100%.  Rather, it is expected that following orientation, Medical-Surgical nurses will achieve an average score.  The average score for 284 Medical-Surgical nurses, on whom reliability was tested, was 66.3 points (75.3% correct answers) with a standard deviation of 6.7 points.  

Whether or not an average score is considered to be a passing grade depends upon which specific questions are missed; for example, being able to prevent falls is recognized as critical to know in any nursing unit.  Since the BKAT is being used in a wide variety of clinical settings, which specific questions are essential to know for that setting is decided by the nurse administering the BKAT.

Requests for Copies of the MED-SURG BKAT

The MED-SURG BKAT is being provided at cost to nurses who work in Medical/Surgical units, as a service to nursing and to the ministry that nursing represents.  A payment of $15.00 is requested to cover photocopying, postage, handling, and continued updating and validity and reliability testing.  Permission to use the MED-SURG BKAT and to photocopy it can be obtained by writing to:

Jean C Toth, RN, MSN, CNS, PhD, BCCC
PO Box 6295
Washington, DC 20015,

or sending an email to

Additional information related to what BKATs are available and what research is currently being conducted can be found on the BKAT Webpage at

Panel of Experts for the MED-SURG BKAT

The Panel of Experts include the following Medical-Surgical nurses:

The MED-SURG BKAT is dedicated, 
In loving memory to
Nelda Logan, RN, C, BSN, Fort Worth, Texas

Dora Bradley, RN-BC, PhD, Professional Development, Dallas, Texas
Mark Handy, RN-BC, MSN, Washington, DC
Candice Hanrahan, RN, MSN, CSC, CCRN, Bethesda, MD
Cora Luz, RN, BSN, CPAN, Dallas, Texas
Deborah Mabrey, RN, Dallas, Texas
Michelle Marty, RN, BSN, Fort Worth, Texas
Tracey McCall, RN, BSN, Fort Worth, Texas
Virginia Payne, RN, Dallas, Texas
Ruth Rekha, RN, MSN, FNP-C, PCCN, CMSRN, Garland, Texas

Data Collectors for the MED-SURG BKAT

The Data Collectors include the following Medical-Surgical nurses:

Mallory Atilano, RN, MSNEd, CCRN, CNRN, Arizona
Kendra Bishop, RN, MSN, Ohio
Julie Bowen, RN, Illinois
Yvonne Brown, RN, MA, Texas
Marianne Bundy, RN, BS, CEN, Florida
Jeanine DeLucca, RN, BC, MSN, Pennsylvania
Pamela Dunn, RN-BC, MSN, Virginia
Shellie Fedis, RN, BSN, CAPA, CPAN, Arizona
Norma Hall, RN, BC, MSN, Indiana
Martinious Handy, RN-BC, MSN, Washington, DC
Andrea Heimer, RN, MSN, CCRN, Illinois
Ramona Hercules, RN-BC, MSN, Virginia
Kathy H Nickell, RN, BC, BSN, Arizona
Tejuana Holmes, RN, BSN, MS, Tennessee
Penny Huddleston, RN, MSN, CCRN, Irving, Texas
Kristin Labbe, RN, MSN, CNS/AH, Ft Worth, Texas
Tammie Luman, RN, BSN, Florida
Cora Luz, RN, BSN, CPAN, Dallas, Texas
Deborah Mabrey, RN, MSN, Dallas, Texas
Janice Marl, RN, BSN, Michigan
Michelle Marty, RN, BSN, Ft Worth, Texas
Kim Montgomery, RN, CCRN, Ft Worth, Texas
Janette Moss, RN, MSN, NE-BC, Nevada
Cheryl Muffley, RNC, BSN, Delaware
Virginia Payne, RN, ADN, Dallas, Texas
Elizabeth Scruggs, CMSRN, BS, Virginia
Mary Jean Vickers, RN, MS, APRN, BC, Minnesota
Jane Wrede, RN, MSN, Illinois
Denise Zabriskie, RN, RN-BC, WCC, Nevada

Authors of the BKAT

The initial version of the BKAT (BKAT-1) was developed for use in the adult intensive care unit and was co-authored by Jean C Toth, RN, MSN, CNS, PhD, BCCC, The Catholic University of America, Washington, DC, and Kathleen Ritchey, RN, MSN, CNS, formerly of the Veterans Administration Medical Center, Washington, DC.  All subsequent BKATs and their versions were authored by Dr Toth. 

Other BKATs Available

BKAT-8 for Adult Intensive Care Unit (2009)
BKAT-8S for Telemetry/Progressive Intensive Care (2010)
PICU-BKAT6r for Pediatric Intensive Care Unit (ICU) (2014)
NICU4-BKAT for Neonatal ICU (2009) 
ED-BKAT2 for Emergency Department (2012)
PEDS-ED BKAT for Pediatric Emergency Department [in development]

Official BKAT Website:

Selected References

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