Einfluss verschiedener Lernanreize auf das Lernverhalten und die Prüfungsleistungen von Studierenden der Humanmedizin

Abstract

Background: Electrocardiogram (ECG) interpretation is an important clinical examination and skill that needs to be improved in undergraduate medical education. This study assessed the impact of summative assessment and financial incentive compared with formative assessment on learning behaviour and outcome in the context of self-directed learning regarding ECG interpretation skills in undergraduate medical students.<br> Methods: Two consecutive cohorts of year 4 medical students (n=301) participated in three validated exams of ECG interpretation skills, consisting of a module entry exam, exit exam and an unannounced retention test at the end of the cardiovascular course. The teaching format was self-directed learning. The first cohort was assessed in a summative written ECG examination. The second cohort was randomised to an intervention (financial incentive) or a control (formative assessment with book voucher raffle) group. Primary outcome was the proportion of students who correctly identified at least 3 out of 5 ECG diagnoses. Secondary outcome evaluates student self-study in ECG interpretation and the student learning behaviour in the context of spending time on independent study and use of further study material. <br>Results: Summative assessments and financial incentives, compared with formative assessments, enhanced the odds of correct identification ≥ 3 out of 5 ECG diagnoses (summative assessment: aOR 8,13; 95% CI 3,76-17,57; financial incentive: aOR 2,44; 95% CI 1,06-5,59) and of self-assessment regarding the ECG interpretation (summative assessment: aOR 5,66; 95% CI 2,76-11,63; financial incentive aOR 2,25; 95% CI 1,10-5,80). Students, who were assessed in a summative examination (aOR 4,47; 95% CI 2,30-8,67) or were randomised to the intervention group with financial incentive (aOR 3,22; 95% CI 1,49-6,96) spent at least 2h/week extra on ECG self-study. There was no significant effect on additional learning material and performance levels in the retention exam. <br>Conclusion: Summative assessments and financial incentives increase student self-assessment, learning time and learning outcome in the short-term of ECG interpretation. Further investigation needs to be focused on absent sustained effect on performance.