The effect of testing on skills learning
Article first published online: 17 DEC 2008
© Blackwell Publishing Ltd 2009
Volume 43, Issue 1, pages 21–27, January 2009
How to Cite
Kromann, C. B., Jensen, M. L. and Ringsted, C. (2009), The effect of testing on skills learning. Medical Education, 43: 21–27. doi: 10.1111/j.1365-2923.2008.03245.x
- Issue published online: 17 DEC 2008
- Article first published online: 17 DEC 2008
- Received 14 April 2008; editorial comments to authors 3 June 2008; accepted for publication 15 July 2008
- clinical competence/*standards;
- randomised controlled trial;
- prospective studies;
- pilot projects;
- comparative study [publication type];
- *education, medical, undergraduate;
Objectives In addition to the extrinsic effects of assessment and examinations on students’ study habits, testing can have an intrinsic effect on the memory of studied material. Whether this testing effect also applies to skills learning is not known. However, this is especially interesting in view of the need to maximise learning outcomes from costly simulation-based courses. This study was conducted to determine whether testing as the final activity in a skills course increases learning outcome compared with an equal amount of time spent practising the skill.
Methods We carried out a prospective, controlled, randomised, single-blind, post-test-only intervention study, preceded by a similar pre- and post-test pilot study in order to make a power calculation. A total of 140 medical students participating in a mandatory 4-hour in-hospital resuscitation course in the seventh semester were randomised to either the intervention or control group and were invited to participate in an assessment of learning outcome. The intervention course included 3.5 hours of instruction and training followed by 30 minutes of testing. The control course included 4 hours of instruction and training. Participant learning outcomes were assessed 2 weeks after the course in a simulated scenario using a checklist. Total assessment scores were compared between the two groups.
Results Overall, 81 of the 140 students volunteered to participate. Learning outcomes were significantly higher in the intervention group (n = 41; mean score 82.8%, 95% confidence interval [CI] 79.4–86.2) compared with the control group (n = 40; mean score 73.3%, 95% CI 70.5–76.1) (P < 0.001). Effect size was 0.93.
Conclusions Testing as a final activity in a resuscitation skills course for medical students increases learning outcome compared with spending an equal amount of time practising the skills.