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The benefits of testing for learning on later performance

Advances in Health Sciences Education volume 20, pages 305–320 (2015)Cite this article

A Commentary to this article was published on 07 January 2015

Abstract

Testing has been shown to enhance retention of learned information beyond simple studying, a phenomena known as test-enhanced learning (TEL). Research has shown that TEL effects are greater for tests that require the production of responses [e.g., short-answer questions (SAQs)] relative to tests that require the recognition of correct answers [e.g., multiple-choice questions (MCQs)]. High stakes licensure examinations have recently differentiated MCQs that require the application of clinical knowledge (context-rich MCQs) from MCQs that rely on the recognition of “facts” (context-free MCQs). The present study investigated the influence of different types of educational activities (including studying, SAQs, context-rich MCQs and context-free MCQs) on later performance on a mock licensure examination. Fourth-year medical students (n = 224) from four Quebec universities completed four educational activities: one reading-based activity and three quiz-based activities (SAQs, context-rich MCQs, and context-free MCQs). We assessed the influence of the type of educational activity on students’ subsequent performance in a mock licensure examination, which consisted of two types of context-rich MCQs: (1) verbatim replications of previous items and (2) items that tested the same learning objective but were new. Mean accuracy scores on the mock licensure exam were higher when intervening educational activities contained either context-rich MCQs (Mean z-score = 0.40) or SAQs (M = 0.39) compared to context-free MCQs (M = −0.38) or study only items (M = −0.42; all p < 0.001). Higher mean scores were only present for verbatim items (p < 0.001). The benefit of testing was observed when intervening educational activities required either the generation of a response (SAQs) or the application of knowledge (context-rich MCQs); however, this effect was only observed for verbatim test items. These data provide evidence that context-rich MCQs and SAQs enhance learning through testing compared to context-free MCQs or studying alone. The extent to which these findings generalize beyond verbatim questions remains to be seen.

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References

  • Barnett, S. M., & Ceci, S. J. (2002). When and where do we apply what we learn? A taxonomy for far transfer. Psychological Bulletin, 128, 612–637.

    Article  Google Scholar 

  • Bjork, R. A., & Bjork, E. L. (1992). A new theory of disuse and an old theory of stimulus fluctuation. In A. Healy, S. Kosslyn, & R. Shiffrin (Eds.), From leaning processes to cognitive processes: Essays in honor of William K. Estes (pp. 35–67). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Boulet, J. (2008). Teaching to test or testing to teach? Medical Education, 42, 952–953.

    Article  Google Scholar 

  • Butler, A. C. (2010). Repeated testing produces superior transfer of learning relative to repeated studying. Journal of Experimental Psychology. Learning, Memory, and Cognition, 36, 1118–1133.

    Article  Google Scholar 

  • Butler, A. C., & Roediger, H. L. (2007). Testing improves long-term retention in a simulated classroom setting. European Journal of Cognitive Psychology, 19, 514–527.

    Article  Google Scholar 

  • Carpenter, S. K. (2012). Testing enhances the transfer of learning. Current Directions in Psychological Science, 21, 279–283.

    Article  Google Scholar 

  • Carpenter, S. K., & DeLosh, E. L. (2006). Impoverished cue sup-port enhances subsequent retention: Support for the elaborative retrieval explanation of the testing effect. Memory & Cognition, 34, 268–276.

    Article  Google Scholar 

  • Carrier, M., & Pashler, H. (1992). The influence of retrieval on retention. Memory & Cognition, 20, 633–642.

    Article  Google Scholar 

  • Chamberland, M., & St-Onge, C. (2013). Back to basics: Keeping students cognitively active between the classroom and the examination. Medical Education, 47, 641–643.

    Article  Google Scholar 

  • Chan, J. C. K. (2010). Long-term effects of testing on the recall of nontested materials. Memory, 18, 49–57.

    Article  Google Scholar 

  • Chan, J. C. K., McDermott, K. B., & Roediger, H. L. (2006). Retrieval-induced facilitation: Initially nontested material can benefit from prior testing of related material. Journal of Experimental Psychology: General, 135, 553–571.

    Article  Google Scholar 

  • Colliver, J. A. (2002). Educational theory and medical education practice: A cautionary note for medical school faculty. Academic Medicine, 77, 1217–1220.

    Article  Google Scholar 

  • Cook, D. A., Thompson, W. G., & Thomas, K. G. (2014). Test-enhanced web-based learning: Optimizing the number of questions (a randomized crossover trial). Academic Medicine, 89, 169–175.

    Article  Google Scholar 

  • Hinze, S. R., & Wiley, J. (2011). Testing the limits of testing effects using completion tests. Memory, 19, 290–304.

    Article  Google Scholar 

  • Janssen, S. A. K., VanderMeulen, S. P., Shostrom, V. K., & Lomneth, C. S. (2014). Enhancement of anatomical learning and developing clinical competence of first-year medical and allied health profession students. Anatomical Sciences Education, 7, 181–190.

  • Johnson, C. I., & Mayer, R. E. (2009). A testing effect with multimedia learning. Journal of Educational Psychology, 101, 621–629.

    Article  Google Scholar 

  • Kang, S. H. K., McDermott, K. B., & Roediger, H. L. (2007). Test format and corrective feedback modulate the effect of testing on long-term retention. European Journal of Cognitive Psychology, 19, 528–558.

    Article  Google Scholar 

  • Karpicke, J. D., & Roediger, H. L. (2007). Repeated retrieval during learning is the key to long-term retention. Journal of Memory and Language, 57, 151–162.

    Article  Google Scholar 

  • Kromann, C. B., Bohnstedt, C., Jensen, M. L., & Ringsted, C. (2010). The testing effect on skills learning might last 6 months. Advances in Health Sciences Education, 15, 395–401.

    Article  Google Scholar 

  • Kromann, C. B., Jensen, M. L., & Ringsted, C. (2009). The effect of testing on skills learning. Medical Education, 43, 21–27.

    Article  Google Scholar 

  • Kromann, C. B., Jensen, M. L., & Ringsted, C. (2011). Test-enhanced learning may be a gender-related phenomenon explained by changes in cortisol level. Medical Education, 45, 192–199.

    Article  Google Scholar 

  • Larsen, D. P., & Butler, A. C. (2013). Test-enhanced learning. In K. Walsh (Ed.), Oxford textbook of medical education (pp. 443–452). Oxford: Oxford University Press.

  • Larsen, D. P., Butler, A. C., & Roediger, H. L. (2008). Test-enhanced learning in medical education. Medical Education, 42, 959–966.

    Article  Google Scholar 

  • Larsen, D. P., Butler, A. C., & Roediger, H. L. (2009). Repeated testing improves long-term retention relative to repeated study: A randomized controlled trial. Medical Education, 43, 1174–1181.

    Article  Google Scholar 

  • Larsen, D. P., Butler, A. C., Lawson, A. L., & Roediger, H. L. (2013a). The importance of seeing the patient: Test-enhanced learning with standardized patients and written tests improve clinical application of knowledge. Advances in Health Science Education, 18, 409–425.

    Article  Google Scholar 

  • Larsen, D. P., Butler, A. C., & Roediger, H. L. (2013b). Comparative effects of test-enhanced learning and self-explanation on long-term retention. Medical Education, 47, 674–682.

    Article  Google Scholar 

  • Marsh, E. J., Agarwal, P. K., & Roediger, H. L., I. I. I. (2009). Memorial consequences of answering SAT II questions. Journal of Experi-mental Psychology: Applied, 15, 1–11.

    Google Scholar 

  • McDaniel, M. A., Anderson, J. L., Derbish, M. H., & Morrisette, N. (2007a). Testing the testing effect in the classroom. European Journal of Cognitive Psychology, 19, 494–513.

    Article  Google Scholar 

  • McDaniel, M. A., Roediger, H. L., & McDermott, K. B. (2007b). Generalizing test-enhanced learning from the laboratory to the classroom. Psychonomic Bulletin & Review, 14, 200–206.

    Article  Google Scholar 

  • Medical Council of Canada. (2010). Guidelines for the development of multiple-choice questions. Ottawa: Medical Council of Canada.

    Google Scholar 

  • Morris, C. D., Bransford, J. D., & Franks, J. J. (1977). Levels of processing versus transfer appropriate processing. Journal of Verbal Learning and Verbal Behavior, 16, 519–533.

    Article  Google Scholar 

  • National Board of Medical Examiners. (2002). Constructing written test questions for the basic and clinical sciences. Philadelphia, PA: National Board of Medical Examiners.

    Google Scholar 

  • Roediger, H. L., & Karpicke, J. D. (2006). The power of testing memory: Basic research and implications for educational practice. Perspectives on Psychological Science, 1, 181–210.

    Article  Google Scholar 

  • Rohrer, D., Taylor, K., & Sholar, B. (2010). Tests enhance the transfer of learning. Journal of Experimental Psychology. Learning, Memory, and Cognition, 36, 233–239.

    Article  Google Scholar 

  • Schmidmaier, R., Ebersbach, R., Schiller, M., Hege, I., Holzer, M., & Fischer, M. P. (2011). Using electronic flashcards to promote learning in medical students: Retesting vs. restudying. Medical Education, 45, 1101–1110.

    Article  Google Scholar 

  • Schuwirth, L. W. T., Verheggen, M. M., van der Vleuten, C. P. M., Boshuizen, H. P. A., & Dinant, G. J. (2001). Do short cases elicit different thinking processes than factual knowledge questions do? Medical Education, 35, 348–356.

    Article  Google Scholar 

  • Wheeler, M. A., Ewers, M., & Buonanno, J. (2003). Different rates of forgetting following study versus test trials. Memory, 11, 571–580.

    Article  Google Scholar 

  • Wood, T. (2009). Assessment not only drives learning, it may also help learning. Medical Education, 43, 5–6.

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by the Medical Council of Canada Research and Development Fund #MCC1/1112. The authors would like to thank Ms. Linda Bergeron, MSc, and Ms. Katharine Fisher for their help and support with the realization of the study.

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Affiliations

  1. Program for Educational Research and Development, Faculty of Clinical Epidemiology and Biostatistics, McMaster University, MDCL 3510, Hamilton, ON, Canada

    Meghan M. McConnell

  2. Department of Medicine and Centre de pédagogie des sciences de la santé, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada

    Christina St-Onge

  3. Centre for Medical Education and Department of Medicine, McGill University, Montreal, Canada

    Meredith E. Young

Authors
  1. Meghan M. McConnell
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  2. Christina St-Onge
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  3. Meredith E. Young
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Correspondence to Meghan M. McConnell.

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McConnell, M.M., St-Onge, C. & Young, M.E. The benefits of testing for learning on later performance. Adv in Health Sci Educ 20, 305–320 (2015). https://doi.org/10.1007/s10459-014-9529-1

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  • DOI: https://doi.org/10.1007/s10459-014-9529-1

Keywords

  • Assessment
  • Learning
  • Medical education
  • Question format
  • Testing effect
  • Test-enhanced learning