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Abstract
Background: Cognitive psychology studies demonstrate that subjects who attempt to recall information show better learning, retention, and transfer than subjects who spend the same time studying the same material (test-enhanced learning, TEL). We systematically reviewed TEL interventions in health professions education.
Methods: We searched 13 databases, 14 medical education journals, and reference lists. Inclusion criteria included controlled studies of TEL that compared TEL to studying the same material or to a different TEL strategy. Two raters screened articles for inclusion, abstracted information, determined quality scores, and calculated the standardized mean difference (SMD) for the learning outcomes.
Results: Inter-rater agreement was excellent for all comparisons. The 19 included studies reported 41 outcomes with data sufficient to determine a SMD. TEL interventions included short answer questions, multiple choice questions, simulation, and standardized patients. Five of six immediate learning outcomes (SMD 0.09–0.44), 21 of 23 retention outcomes (SMD 0.12–2.5), and all seven transfer outcomes (SMD 0.33–1.1) favored TEL over studying.
Conclusions: TEL demonstrates robust effects across health professions, learners, TEL formats, and learning outcomes. The effectiveness of TEL extends beyond knowledge assessed by examinations to clinical applications. Educators should include TEL in health professions curricula to enhance recall, retention, and transfer.
Disclosure statement
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Additional information
Notes on contributors
Michael L. Green
Michael L. Green, MD, ScM, is professor of medicine and director of student assessment at the Teaching and Learning Center at Yale School of Medicine.
Jeremy J. Moeller
Jeremy J. Moeller, MD, MSc, is assistant professor, program director, and associate vice-chair for education in the Department of Neurology at Yale School of Medicine.
Judy M. Spak
Judy M. Spak, MLS, is assistant director of research and education services at the Cushing-Whitney Medical Library at Yale School of Medicine.