Assessing the Effect of Restudying Anatomy with Flashcards versus Handouts in Study Groups Equalized by Memory Test Scores

Abstract

IntroductionRetrieval practice through testing can strengthen long‐term memory. Experimentally, this concept known as the “testing effect” has often been demonstrated using word pairs. As many health science students quiz with flashcards to enhance recall, can the testing effect be detected within the more complex study of anatomy? It was hypothesized that participants utilizing flashcards for review would score higher on tests than those restudying a handout.MethodsStudents were recruited from Pacific Northwest University of Health Sciences (PNWU). On day 1 of the study, subjects were given 3 memory tests (assessing memory of printed words, pictures, and spoken words), the scores of which were combined and used to assign participants to groups with approximately equal “memory.” Participants studied a handout on ruminant digestive anatomy, a topic novel to most students. After the initial study session, subjects were divided into a “flashcard group” (FG) or a “handout group” (HG) and reviewed the learned material via their assigned method. Participants then took a 15‐question test, indicating whether they were confident or not for each answer, and took a similar test 1 and 3 weeks later. Participants completed surveys on demographics, existing knowledge of ruminants and anatomical terms, wellness, and study behaviors on day 1 of the study. Data were analyzed using Mann Whitney U test, Fischer’s exact test, Pearson Correlation Coefficient, and repeated measures ANOVA using SPSSv25.0 software with p<0.05 considered statistically significant. This study was deemed exempt by PNWU IRB (#2021‐015).ResultsThough not statistically so, mean scores were higher in the FG than in the HG for each of the ruminant digestive anatomy assessments. For day 1 test score means (FG 10.67 ± 1.50 vs HG 9.00 ± 2.68), a large effect size (ηp2=0.16) was detected. While the FG started with more experience with anatomical terms (p=0.046), this experience was not significantly correlated with day 1 test scores (n=17). Though the FG tended to perform better on day 1 tests, the HG was more confident in their answer choices (mean confidence scores HG 10.00 ± 1.10 vs FG 7.78 ± 1.72), with a large effect size present (ηp2=0.38). Memory scores were not significantly different between the FG and the HG. Though not significant, most memory scores were negatively correlated with age. Sleep was negatively correlated with memory scores, which was significant for memory of printed words (r=‐0.56; p=0.019). Female memory scores consistently ranked higher than male scores.ConclusionsParticipants who restudied with flashcards tended to outperform those restudying handouts on tests covering a novel anatomy topic, suggesting that the testing effect may have occurred. Interestingly, the opposite pattern was seen in confidence, with those studying handouts seemingly more confident in their test answers. Utilizing memory test scores resulted in evenly distributed groups with respect to memory, and some intriguing potential differences were seen related to sleep on the night before day 1 of the study, age, and gender. This study was limited by a small sample size and should be expanded to further investigate the effect of various restudy techniques, such as using flashcards or handouts while learning anatomy.