Effects Of Testing Research Articles

Retention of Stroke Education Provided during Hospitalization: Does Provision of Required Education Increase Stroke Knowledge?

Background: Provision of stroke education to patients is a Centers for Medicare/Medicaid (CMS) requirement. However, little is known about retention of the educational content. Methods: Two pilot studies were conducted: Pilot A delivered CMS-required stroke education during hospitalization in a standardized manner and tested knowledge retention in patients returning to the Stroke Clinic for 1-month follow-up; Pilot B randomized patients to either a control group with standardized education or a test-enhanced learning group (target), with measurement of stroke knowledge retention at hospital discharge. Results: A total of 198 patients/caregivers participated in Pilot A, with only 25% scoring 100% correct on required stroke education items. The question most commonly answered incorrectly (n = 117; 59%) was “personal risk factors for stroke,” and 74 (37%) could not correctly identify stroke signs and symptoms. Pilot B found that significantly more target group patients could identify their personal stroke risk factors (100 vs. 67%; p = 0.04) and the purpose of their secondary prevention medications (87 vs. 40%; p = 0.02) compared to controls. Discussion: While stroke education is required during hospitalization, its ability to produce retention may be poor. We propose study of test-enhanced learning methods through the Targeted Education in Stroke Trial (TEST) to examine the effect of novel teaching methods on patient/caregiver knowledge retention.

Transfer of test-enhanced learning: Meta-analytic review and synthesis.

Attempting recall of information from memory, as occurs when taking a practice test, is one of the most potent training techniques known to learning science. However, does testing yield learning that transfers to different contexts? In the present article, we report the findings of the first comprehensive meta-analytic review into that question. Our review encompassed 192 transfer effect sizes extracted from 122 experiments and 67 published and unpublished articles (N = 10,382) that together comprise more than 40 years of research. A random-effects model revealed that testing can yield transferrable learning as measured relative to a nontesting reexposure control condition (d = 0.40, 95% CI [0.31, 0.50]). That transfer of learning is greatest across test formats, to application and inference questions, to problems involving medical diagnoses, and to mediator and related word cues; it is weakest to rearranged stimulus-response items, to untested materials seen during initial study, and to problems involving worked examples. Moderator analyses further indicated that response congruency and elaborated retrieval practice, as well as initial test performance, strongly influence the likelihood of positive transfer. In two assessments for publication bias using PET-PEESE and various selection methods, the moderator effect sizes were minimally affected. However, the intercept predictions were substantially reduced, often indicating no positive transfer when none of the aforementioned moderators are present. Overall, our results motivate a three-factor framework for transfer of test-enhanced learning and have practical implications for the effective use of practice testing in educational and other training contexts. (PsycINFO Database Record

Testing Encourages Transfer Between Factual and Application Questions in an Online Learning Environment

Quizzing improves retention compared to additional study opportunities, a phenomenon known as test-enhanced learning. Two experiments investigated whether the type of question at quiz improves retention for factual and applied course material on exams in an online college course. Students were given quizzes with either factual questions or questions designed to encourage application of a particular concept. As expected, quizzing with feedback improved exam performance compared to material that had not been quizzed. Further, the benefits of quizzing transferred to different question types. Performance on application exam questions improved if students were quizzed with factual questions. Likewise, performance on factual exam questions improved if students were quizzed with application questions. These results replicate the finding that quizzing benefits retention in an online learning environment and, more importantly, that the benefits of quizzing transfer to exam questions that differ in type from the quiz question.

Test-Enhanced Learning

Test-enhanced learning is a technique instructors can use to increase recall on summative assessments (e.g., exams) via formative assessments (e.g., quizzes). The present research examined recommendations based on the transfer-appropriate processing and level-of-processing (LOP) perspectives to assess the question, does deeper processing on quizzes (i.e., using application questions compared to factual) benefit exam performance? Students were more likely to correctly answer application questions on the exam when quizzes required a deeper LOP, and students appeared to gain a relatively equivalent definitional understanding using either factual or application questions on quizzes. Consequently, the present research supports the use of quiz questions that require a deeper LOP, especially when students are expected to learn beyond rote memorization.

Reconsidering the role of assessments in undergraduate medical education

In this commentary, Raupach & Schuelper discuss the mechanisms underlying test-enhanced learning and their practical implications for curriculum design.

Daniel Koretz’s Big Con: The Testing Charade: Pretending to Make Schools Better, by Daniel Koretz (Book Review)

This article critically reviews Daniel Koretz's book, The Testing Charade: Pretending to Make Schools Better (University of Chicago Press, 2017). The text challenges the book's most important claims, such as: there exists little to no evidence of testing's beneficial effects; tests do not — indeed, cannot — test entire domains (i.e., sets of content standards); stakes are much higher for students currently than they were thirty years ago; the cause of test-score inflation is high-stakes; he conducted the first ever study of score inflation; and no-stakes test scores trends are always reliable and so can be used to audit the trends in parallel high-stakes tests. An appendix includes over 60 specific point-by-point challenges to the book's claims, with the relevant text and location identified.

Neural activations associated with feedback and retrieval success

There is substantial behavioral evidence for a phenomenon commonly called “the testing effect”, i.e. superior memory performance after repeated testing compared to re-study of to-be-learned materials. However, considerably less is known about the underlying neuro-cognitive processes that are involved in the initial testing phase, and thus underlies the actual testing effect. Here, we investigated functional brain activity related to test-enhanced learning with feedback. Subjects learned foreign vocabulary across three consecutive tests with correct-answer feedback. Functional brain-activity responses were analyzed in relation to retrieval and feedback events, respectively. Results revealed up-regulated activity in fronto-striatal regions during the first successful retrieval, followed by a marked reduction in activity as a function of improved learning. Whereas feedback improved behavioral performance across consecutive tests, feedback had a negligable role after the first successful retrieval for functional brain-activity modulations. It is suggested that the beneficial effects of test-enhanced learning is regulated by feedback-induced updating of memory representations, mediated via the striatum, that might underlie the stabilization of memory commonly seen in behavioral studies of the testing effect.

Effects of Didactic Instruction and Test-Enhanced Learning in a Nursing Review Course.

Determining the most effective approach for students' successful academic performance and achievement on the national licensure examination for RNs is important to nursing education and practice. A quasi-experimental design was used to compare didactic instruction and test-enhanced learning among nursing students divided into two fundamental nursing review courses in their final semester. Students in each course were subdivided into low-, intermediate-, and high-score groups based on their first examination scores. Mixed model of repeated measure and two-way analysis of variance were applied to evaluate students' academic results and both teaching approaches. Intermediate-scoring students' performances improved more through didactic instruction, whereas low-scoring students' performances improved more through test-enhanced learning. Each method had differing effects on individual subgroups within the different performance level groups of their classes, which points to the importance of considering both the didactic and test-enhanced learning approaches. [J Nurs Educ. 2017;56(11):683-687.].

Repeated testing improves achievement in a blended learning approach for risk competence training of medical students: results of a randomized controlled trial

BackgroundAdequate estimation and communication of risks is a critical competence of physicians. Due to an evident lack of these competences, effective training addressing risk competence during medical education is needed. Test-enhanced learning has been shown to produce marked effects on achievements. This study aimed to investigate the effect of repeated tests implemented on top of a blended learning program for risk competence.MethodsWe introduced a blended-learning curriculum for risk estimation and risk communication based on a set of operationalized learning objectives, which was integrated into a mandatory course “Evidence-based Medicine” for third-year students. A randomized controlled trial addressed the effect of repeated testing on achievement as measured by the students’ pre- and post-training score (nine multiple-choice items). Basic numeracy and statistical literacy were assessed at baseline. Analysis relied on descriptive statistics (histograms, box plots, scatter plots, and summary of descriptive measures), bootstrapped confidence intervals, analysis of covariance (ANCOVA), and effect sizes (Cohen’s d, r) based on adjusted means and standard deviations.ResultsAll of the 114 students enrolled in the course consented to take part in the study and were assigned to either the intervention or control group (both: n = 57) by balanced randomization. Five participants dropped out due to non-compliance (control: 4, intervention: 1). Both groups profited considerably from the program in general (Cohen’s d for overall pre vs. post scores: 2.61). Repeated testing yielded an additional positive effect: while the covariate (baseline score) exhibits no relation to the post-intervention score, F(1, 106) = 2.88, p > .05, there was a significant effect of the intervention (repeated tests scenario) on learning achievement, F(1106) = 12.72, p < .05, d = .94, r = .42 (95% CI: [.26, .57]). However, in the subgroup of participants with a high initial numeracy score no similar effect could be observed.ConclusionDedicated training can improve relevant components of risk competence of medical students. An already promising overall effect of the blended learning approach can be improved significantly by implementing a test-enhanced learning design, namely repeated testing. As students with a high initial numeracy score did not profit equally from repeated testing, target-group specific opt-out may be offered.

Does Test-enhanced Learning Improve Success Rates of Ultrasound-guided Peripheral Intravenous Insertion? A Randomized Controlled Trial.

Teaching procedural skills in medicine is time- and resource-intensive, and it is therefore important to determine which educational strategies are most effective. Test-enhanced learning (TEL) has been demonstrated to be effective in improving learner retention; however, there is little research evaluating the testing effect on the acquisition of procedural skills in medicine. The objective of this study was to examine the impact of TEL on learning ultrasound-guided intravenous (USG IV) insertion on a simulated model. We conducted a prospective randomized controlled trial of medical students at a single tertiary care academic hospital. Participants were randomized to either the TEL group (TEG) or control group (CG). Each group received an USG peripheral IV teaching session that included a didactic portion and hands-on skills training. The training sessions were identical except that the TEG was informed at the outset that there would be an assessment at the end of the session. The TEG then received a formal assessment of the skill during the last 15 minutes of the session, whereas the CG had continued practice time. Subjects in both groups were evaluated 10-14 days later to compare skill performance using a simulation-based assessment tool consisting of a global rating scale (GRS) and checklist items. Thirty medical students completed the study, 15 in the TEG and 15 in the CG. There were no significant differences between the two groups at baseline based on year of medical training or prior IV or ultrasound experience. The overall procedural success rate was 93.3% (95% CI= 79.0%-100.0%) in the TEG and 80.0% (95% CI= 57.1%-100%) in the CG (p=0.60). The first-attempt failure rate was 13.3% (95% CI= 0.0%-32.8%) in the TEG and 33.3% (95% CI= 6.3%-60.4%) in the CG (p=0.39). There were no statistically significant differences between the means of the GRS (TEG=4.7, CG=4.2; p=0.53, r=0.11) or checklist scores (TEG=78.6%, CG=75.3%; p=0.20, r=0.24). In this study of novice learners, both TEL with structured practice and structured practice alone lead to high success rates performing USG IV insertion on a simulated model. While we noted a trend toward higher procedural success rates and lower first-attempt failure rates in the TEG, these did not meet statistical significance. Further studies with larger sample sizes are required to determine whether the beneficial effects of TEL can be transferred to procedural skills teaching.

Influence of Triaenophorus nodulosus plerocercoids (Cestoda: Pseudophyllidea) on the occurrence of intestinal helminths in the perch (Perca fluviatilis).

Concurrent infections of helminths in vertebrates are widespread and may demonstrate synergistic, antagonistic or negligible levels of interactions between species that share a common site. However, indirect interactions between species that occur in different organs of a host are poorly documented, particularly in fish. Plerocercoids of Triaenophorus nodulosus are common liver infections of European perch (Perca fluviatilis). These larval cestodes cause extensive liver damage, resulting in systemic pathologies that include alteration of the physiochemical environment of the intestine. Perch harbour a wide range of intestinal helminths whose occurrence may be potentially influenced by the concurrent presence of T. nodulosus plerocercoids. The present study, using an existing dataset, investigated the effects of T. nodulosus on the infection levels of four common perch helminths - Acanthocephalus lucii, Camallanus lacustris, Proteocephalus percae and Bunodera luciopercae. The prevalences of A. lucii and C. lacustris were significantly reduced in fish infected by T. nodulosus, although the mean intensity of infections remained unaffected for any helminth species, while the mean abundance of C. lacustris was significantly reduced in plerocercoid-affected perch. Differences in site selection and individual interactions between the four helminth species in the intestine of T. nodulosus-infected and non-infected perch were rarely observed.

Effectiveness of Test-Enhanced Learning (TEL) in lectures for undergraduate medical students.

Objective:To determine the effectiveness of Test-Enhanced learning as a learning tool in lectures for undergraduate medical studentsMethod:This quantitative, randomized controlled trial included eighty-four students of 4th year MBBS from Yusra Medical & Dental College, Islamabad. The duration of study was from March 2016 to August 2016. After obtaining the informed consent; participants were equally assigned to interventional and non-interventional study groups through stratified randomization. Single best answer MCQs of special pathology were used as data collection instrument after validation. A pre- and post-test was taken from both groups, before and after the intervention, respectively and their results were compared using SPSS version 21.Results:There were 13 male (31%) and 29 female (69%) participants in each study group who showed an equivalent baseline performance on pre-test (p=0.95). Statistically significant difference was found among mean scores of interventional and non-interventional study groups at exit exam (p=0.00). Interventional group also showed a significant improvement in their post-test scores (mean: 17.17±1.59) as compared to pre-test scores (mean: 6.19±1.81).Conclusions:Test-enhanced learning has significant effect on improving the learning of course content delivered to undergraduate medical students through lectures.

When is the test effect most effective in aphasia rehabilitation?

When is the test effect most effective in aphasia rehabilitation?

Learning through Self-Assessment: Investigating the Relationship between Performance on the NBME® Clinical Science Mastery Series Self-Assessments and Clinical Science Subject Examinations

Self-assessments provide students with an opportunity to test their understanding of content covered in their curriculum and help them prepare for subsequent assessments. Perhaps more importantly, self-assessments may also serve a pedagogical purpose. Research on test-enhanced learning suggests that material is remembered better if one or more tests are included as part of the learning strategy. The NBME® Clinical Science Mastery Series (CSMS) are web administered self-assessments built to the same content specifications as the NBME clinical science subject examinations that provide students with an opportunity to become familiar with content, format, and pacing. This study examined the relationship between performance on CSMS and on the corresponding clinical science subject examinations. The study included students from United States and Canadian medical schools who took CSMS under standard- or self-paced conditions prior to sitting for the corresponding subject examination for the first time. Linear regression analyses investigated the relationship between performance on CSMS and on the corresponding subject examination. CSMS scores explained 29 %–44 % of the variation in first subject examination scores when taken in standard-paced mode and 25 %–33 % when taken in self-paced mode; the relationship was somewhat different for the two pacing groups for most of the subjects as indicated by statistically different sets of regression parameters for the models based on each group. Results confirm that performance on the CSMS self-assessments and clinical science subject examinations is related. Usage patterns suggest that students may be using the CSMS as a learning tool and as an instrument to gauge their clinical science knowledge.

Revisiting 'Effectiveness of problem-based learning curricula: theory, practice and paper darts'.

Revisiting 'Effectiveness of problem-based learning curricula: theory, practice and paper darts'.

Test-enhanced learning of clinical reasoning: a crossover randomised trial

Clinical reasoning is an essential skill, the foundations of which should be acquired during undergraduate medical education. Student performance in clinical reasoning can be assessed using key feature examinations. However, within a paradigm of test-enhanced learning, such examinations may also be used to enhance long-term retention ofprocedural knowledge relevant to clinical reasoning. This study tested the hypothesis that repeated testing with key feature questions is more effective than repeated case-based learning in fostering clinical reasoning. In this randomised crossover trial, Year4 medical students attended 10 weekly computer-based seminars during which patient case histories covering general medical conditions were displayed. The presentation format was switched between groups every week. In the control condition, students studied long case narratives. The intervention condition used the same content but augmented case presentation with a sequence of key feature questions. Using a within-subjects design, student performance on intervention and control items was assessed at 13weeks (exit examination) and 9months (retention test) after the first day of term. A total of 87 of 124 eligible students provided complete data for the longitudinal analysis (response rate: 70.2%). In the retention test, mean±standard deviation student scores on intervention items were significantly higher than those on control items (56.0±25.8% versus 48.8±24.7%; p<0.001). The results remained unchanged after accounting for exposure time in a linear regression analysis that also adjusted for sex and general student performance levels. This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning as assessed with key feature questions. In this randomised trial, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing may considerably enhance student learning outcomes in relevant aspects of clinical medicine.

Programmes' and students' roles in test-enhanced learning.

Programmes' and students' roles in test-enhanced learning.

Effects of reinforcement on test-enhanced learning in a large, diverse introductory college psychology course.

A robust finding within laboratory research is that structuring information as a test confers benefit on long-term retention-referred to as the testing effect. Although well characterized in laboratory environments, the testing effect has been explored infrequently within ecologically valid contexts. We conducted a series of 3 experiments within a very large introductory college-level course. Experiment 1 examined the impact of required versus optional frequent low-stakes testing (quizzes) on student grades, revealing students were much more likely to take advantage of quizzing if it was a required course component. Experiment 2 implemented a method of evaluating pedagogical intervention within a single course (thereby controlling for instructor bias and student self-selection), which revealed a testing effect. Experiment 3 ruled out additional exposure to information as an explanation for the findings of Experiment 2 and suggested that students at the college level, enrolled in very large sections, accept frequent quizzing well. (PsycINFO Database Record

P121: Does test-enhanced learning improve success rates of ultrasound-guided peripheral intravenous insertion? A randomized-controlled trial

Introduction: Optimising teaching techniques when introducing learners to new skills such as ultrasound guided peripheral IV insertion (UGPIV) is essential due to the time and resource intense nature of skills learning. The testing effect has been demonstrated to be effective in improving learner retention, however there is little research evaluating the testing effect on the acquisition of technical skills in medicine. This study aims to determine whether test-enhanced learning improves learner performance of UGPIV. Methods: A prospective randomized control trial is ongoing with medical students on rotation at Sunnybrook Health Sciences Centre. Participants are randomized to one of two study groups, the control group (CG) and the test-enhanced learning group (TEG). Each group receives a teaching session lasting 1.5 hours surrounding ultrasound guidance for peripheral IV insertion. The TEG receives a formal evaluation of the skill during the last 15 minutes of that session, whereas the CG has continued practice time. Subjects in both groups are being evaluated two weeks later to compare skill performance using an objective structured assessment of technical skills. Results: Data collection is ongoing and is expected to be completed with an recruitment of 40 by March 31st. Conclusion: Given the importance and resource intensive nature of technical skill training it is important to have an understanding of the most efficient ways to teach new techniques. The results from this study will help provide evidence on the testing effect as a method of improving competency and retention for ultrasound guided procedures.

Effects of successive relearning on recall: Does relearning override the effects of initial learning criterion?

Retrieval practice improves memory for many kinds of materials, and numerous factors moderate the benefits of retrieval practice, including the amount of successful retrieval practice (referred to as the learning criterion). In general, the benefits of retrieval practice are greater with more than with less successful retrieval practice; however, learning items to a higher (vs. lower) criterion requires more time and effort. If students plan on relearning material in a subsequent study session, does the benefit of learning to a higher criterion during an initial session persist? In Session 1, participants studied and successfully recalled Swahili-English word pairs one, two, three, four, five, six, or seven times. In subsequent sessions, all of the pairs were relearned to a criterion of one correct recall at one-week intervals across four or five successive relearning sessions. Experiments 1 and 2 revealed that the substantial benefits of learning to a higher initial criterion during the first session do not persist across relearning sessions. This relearning-override effect was also demonstrated in Experiment 2 after a one-month retention interval. The implications of relearning-override effects are important for theory and for education. For theories of test-enhanced learning, they support the predictions of one theory and appear inconsistent with the predictions of another. For education, if relearning is to occur, using extra time to learn to a higher initial learning criterion is not efficient. Instead, students should devote their time to subsequent spaced relearning sessions, which produce substantial gains in recall performance.