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Using electronic flashcards to promote learning in medical students: retesting versus restudying

Authors

  • Ralf Schmidmaier,

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
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  • Rene Ebersbach,

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
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  • Miriam Schiller,

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
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  • Inga Hege,

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
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  • Matthias Holzer,

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
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  • Martin R Fischer

    1. Medical Education Unit, Medizinische Klinik Innenstadt, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
    2. School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Dr Ralf Schmidmaier, Schwerpunkt Medizindidaktik, Medizinische Klinik Innenstadt, Klinikum der Universität, Ludwig-Maximilians-Universität München, Ziemssenstrasse 1, Munich 80336, Germany. Tel: 00 49 89 5160 2111; Fax: 00 49 89 5160 4410; E-mail: ralf.schmidmaier@med.lmu.de

Abstract

Medical Education 2011: 45: 1101–1110

Context  The superiority of retesting over restudying in terms of knowledge retention and skills acquisition has been proven in both laboratory and classroom settings, as well as in doctors’ practice. However, it is still unclear how important retesting strategies are to the learning of relevant factual knowledge in undergraduate medical education.

Methods  Eighty students in Years 3–5 of medical school in Munich participated in a prospective, randomised, double-blinded, controlled study in which they were exposed to 30 electronic flashcards designed to help them memorise key factual knowledge in the domain of clinical nephrology. The flashcards were presented in four successive learning cycles, each consisting of a study period and a subsequent test period. Half of all participants were randomised to repetitive studying (restudy group) and half were randomised to repetitive testing (retest group) of successfully memorised flashcards. Knowledge retention was assessed after 1 week and 6 months. Additionally, personal data, self-reflection on the efficacy of the learning strategies and judgements of learning were obtained by questionnaires.

Results  Repetitive testing promoted better recall than repetitive studying after 1 week (p < 0.001). However, after 6 months general recall was poor and no difference between the restudy and retest groups was observed. Time on task and number of trials, in addition to sex, age, performance and psycho-social background, did not vary between the groups. Self-predictions of student performance did not correlate with actual performance.

Conclusions  In the context of using electronic flashcards, repetitive testing is a more potent learning strategy than repetitive studying for short-term but not long-term knowledge retention in clinical medical students. Although students use testing as a learning strategy, they seem to be unaware of its superiority in supporting short-term knowledge retention.

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