Larsen encourages educators and researchers to expand their definition of learning beyond cognitive processes to include practices that emerge from social interactions and system changes.
Context In education, tests are primarily used for assessment, thus permitting teachers to assess the efficacy of their curriculum and to assign grades. However, research in cognitive psychology has ...shown that tests can also directly affect learning by promoting better retention of information, a phenomenon known as the testing effect.
Cognitive psychology research Cognitive psychology laboratory studies show that repeated testing of information produces superior retention relative to repeated study, especially when testing is spaced out over time. Tests that require effortful retrieval of information, such as short‐answer tests, promote better retention than tests that require recognition, such as multiple‐choice tests. The mnemonic benefits of testing are further enhanced by feedback, which helps students to correct errors and confirm correct answers.
Application to medical education Medical educational research has focused extensively on assessment issues. Such assessment research permits the conclusion that clinical expertise is founded on a broad fund of knowledge and effective memory networks that allow easy access to that knowledge. Test‐enhanced learning can potentially strengthen clinical knowledge that will lead to improved expertise.
Conclusions Tests should be given often and spaced out in time to promote better retention of information. Questions that require effortful recall produce the greatest gains in memory. Feedback is crucial to learning from tests. Test‐enhanced learning may be an effective tool for medical educators to use in promoting retention of clinical knowledge.
Context
Educators often encourage students to engage in active learning by generating explanations for the material being learned, a method called self‐explanation. Studies have also demonstrated ...that repeated testing improves retention. However, no studies have directly compared the two learning methods.
Methods
Forty‐seven Year 1 medical students completed the study. All students participated in a teaching session that covered four clinical topics and was followed by four weekly learning sessions. In the learning sessions, students were randomised to perform one of four learning activities for each topic: testing with self‐generated explanations (TE); testing without explanations (T); studying a review sheet with self‐generated explanations (SE), and studying a review sheet without explanations (S). Students repeated the same activity for each topic in all four sessions. Six months later, they took a free‐recall clinical application test on all four topics.
Results
Repeated testing led to better long‐term retention and application than repeatedly studying the material (p < 0.0001, η2 = 0.33). Repeated generation of self‐explanations also improved long‐term retention and application, but the effect was smaller (p < 0.0001, η2 = 0.08). When data were collapsed across topics, both testing conditions produced better final test performance than studying with self‐explanation (TE = 40% > SE = 29% p = 0.001, d = 0.70; T = 36% > SE = 29% p = 0.02, d = 0.48). Studying with self‐explanation led to better retention and application than studying without self‐explanation (SE = 29% > S = 20%; p = 0.001, d = 0.68). Our analyses showed significant interaction by topic (p = 0.001, η2 = 0.06), indicating some variation in the effectiveness of the interventions among topics.
Conclusions
Testing and generating self‐explanations are both learning activities that can be used to produce superior long‐term retention and application of knowledge, but testing is generally more effective than self‐explanation alone.
Discuss ideas arising from the article at ‘discuss’
Introduction
Test‐enhanced learning (TEL) is an impactful teaching and learning strategy that prioritises active learner engagement through the process of regular testing and reviewing. While it is ...clear that meaningful feedback optimises the effects of TEL, the ideal timing of this feedback (i.e. immediate or delayed) in a medical education setting is unclear.
Method
Forty‐one second‐year medical students were recruited from the University of Melbourne. Participants were given a multiple‐choice question test with a mix of immediate (i.e. post‐item) and delayed (i.e. post‐item‐block) conceptual feedback. Students were then tested on near and far transfer items during an immediate post‐test, and at a one‐week follow‐up.
Results
A logistic mixed effects model was used to predict the probability of successful near and far transfer. As expected, participants in our study tended to score lower on far transfer items than they did on near transfer items. In addition, correct initial response on a parent question predicted subsequent correct responding. Contrary to our hypotheses, the feedback timing effect was non‐significant—there was no discernible difference between feedback delivered immediately versus delayed feedback.
Discussion
The findings of this study suggest that the timing of feedback delivery (post‐item versus post‐item‐block) does not influence the efficacy of TEL in this medical education setting. We therefore suggest that educators may consider practical factors when determining appropriate TEL feedback timing in their setting.
Building on the literature suggestive of Test‐enhanced Learning offering a powerful education strategy, the authors report that immediate & delayed feedback is equally beneficial.
Context Laboratory studies in cognitive psychology with relatively brief final recall intervals suggest that repeated retrieval in the form of tests may result in better retention of information ...compared with repeated study.
Objectives Our study evaluates if repeated testing of material taught in a real‐life educational setting (a didactic conference for paediatric and emergency medicine residents) replicates these findings when measured at a more educationally relevant final recall interval of 6 months.
Methods Residents participated in an interactive teaching session on two topics: (i) status epilepticus, and (ii) myasthenia gravis. Residents were randomised to two counter‐balanced groups which either took tests on status epilepticus and studied a review sheet on myasthenia gravis (SE‐T/MG‐S group) or took tests on myasthenia gravis and studied a review sheet on status epilepticus (MG‐T/SE‐S group). Testing and studying occurred immediately after teaching and then at two additional times at intervals of about 2 weeks. Residents received feedback after each test. Tests consisted of short‐answer questions and the review sheets consisted of information identical to that on the answer sheets for the tests. At about 6 months residents took a final test on both topics.
Results Nineteen residents in the SE‐T/MG‐S group and 21 residents in the MG‐T/SE‐S group completed the study. Collapsing across groups, repeated testing produced final test scores that were an average of 13% higher than those produced by repeated study (39% versus 26%) at > 6 months after the initial teaching session (t78 = 3.93, standard error of the difference = 0.03, P < 0.001, d = 0.91).
Conclusions Repeated testing with feedback appears to result in significantly greater long‐term retention of information taught in a didactic conference than repeated, spaced study. Testing should be considered for its potential impact on learning and not only as an assessment device.
Purpose: We investigated the effect of Team-Based Learning (TBL) on long-term retention of knowledge in comparison to a traditional curriculum.
Methods: As TBL was incorporated into our curriculum in ...the 2008-2009 academic year, students were compared with those who received the traditional curriculum the year prior. Students in both the groups completed multiple-choice knowledge test at four time points spanning two years. Test performance was compared at each time point to assess changes in knowledge retention as a function of time.
Results: Baseline knowledge did not differ significantly between the TBL and control groups 51% versus 46%; t(84) = 0.91, p = 0.37, d = 0.20. Performance improved after the course for both the groups, but was significantly higher in the TBL group 79% versus 59%; t(84) = 4.96, p = 0.000004, d = 0.95. However, when assessed prior to the pediatrics clerkship, learning gains from TBL had largely disappeared and the small difference in performance was not significant 57% versus 51%; t(84) = 1.51, p = 0.14, d = 0.32.
Conclusion: Incorporating TBL into the pre-clinical pediatrics curriculum led to large gains in knowledge over the short-term, but these gains did not persist. Further research should focus on extending the impact of TBL on long-term knowledge retention.
Context
Learning goal programmes are often created to help students develop self‐regulated learning skills; however, these programmes do not necessarily consider the social contexts surrounding ...learning goals or how they fit into daily educational practice.
Objectives
We investigated a high‐frequency learning goal programme in which students generated and shared weekly learning goals with their clinical teams in core Year 3 clerkships. Our study explores: (i) how learning goals were incorporated into the clinical work, and (ii) the factors that influenced the use of students’ learning goals in work‐based learning.
Methods
We conducted semi‐structured interviews with 14 students and 14 supervisors (attending physicians and residents) sampled from all participating core clerkships. Interviews were coded for emerging themes. Using cultural historical activity theory and knotworking as theoretical lenses, we developed a model of the factors that influenced students’ learning goal usage in a work‐based learning context.
Results
Students and supervisors often faced the challenge of reconciling contradictions that arose when the desired outcomes of student skill development, grading and patient care were not aligned. Learning goals could function as tools for developing new ways of acting that overcame those contradictions by facilitating collaborative effort between students and their supervisors. However, for new collaborations to take place, both students and supervisors had to engage with the goals, and the necessary patients needed to be present. When any one part of the system did not converge around the learning goals, the impact of the learning goals programme was limited.
Conclusions
Learning goals are potentially powerful tools to mediate interactions between students, supervisors and patients, and to reconcile contradictions in work‐based learning environments. Learning goals provide a means to develop not only learners, but also learning systems.
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