Student-directed retrieval practice is a predictor of medical licensing examination performance

Abstract

IntroductionA large body of evidence indicates that retrieval practice (test-enhanced learning) and spaced repetition increase long-term information retention. Implementation of these strategies in medical curricula is unfortunately limited. However, students may choose to apply them autonomously when preparing for high-stakes, cumulative assessments, such as the United States Medical Licensing Examination Step 1. We examined the prevalence of specific self-directed methods of testing, with or without spaced repetition, among preclinical students and assessed the relationship between these methods and licensing examination performance.MethodsSeventy-two medical students at one institution completed a survey concerning their use of user-generated (Anki) or commercially-available (Firecracker) flashcards intended for spaced repetition and of boards-style multiple-choice questions (MCQs). Other information collected included Step 1 score, past academic performance (Medical College Admission Test [MCAT] score, preclinical grades), and psychological factors that may have affected exam preparation or performance (feelings of depression, burnout, and test anxiety).ResultsAll students reported using practice MCQs (mean 3870, SD 1472). Anki and Firecracker users comprised 31 and 49 % of respondents, respectively. In a multivariate regression model, significant independent predictors of Step 1 score included MCQs completed (unstandardized beta coefficient [B] = 2.2 × 10− 3, p < 0.001), unique Anki flashcards seen (B = 5.9 × 10− 4, p = 0.024), second-year honours (B = 1.198, p = 0.002), and MCAT score (B = 1.078, p = 0.003). Test anxiety was a significant negative predictor (B= − 1.986, p < 0.001). Unique Firecracker flashcards seen did not predict Step 1 score. Each additional 445 boards-style practice questions or 1700 unique Anki flashcards was associated with an additional point on Step 1 when controlling for other academic and psychological factors.ConclusionsMedical students engage extensively in self-initiated retrieval practice, often with spaced repetition. These practices are associated with superior performance on a medical licensing examination and should be considered for formal support by educators.

Conceptualising spaced learning in health professions education: A scoping review

“…This table only shows the terms with definitions (21 total). Terms identified without definitions were: Dispersed learning; Distributed learning; Repeated retrieval practice; Spaced instruction; Spaced training; Spaced retrieval practice; Spaced studying, and Spaced testing …”

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

“…Evidence suggests that current health care students are becoming increasingly more conscious of the role of empathy in their training (Burgess et al, ; Deng et al, ; Palmen et al, ; Hulbert and Anderson, ), and want guidance to systematically inculcate these skills in client management (Hew and Lo, ; Hickman et al, ). Moreover, providing a warm and empathetic learning environment has been reported to encourage conceptualized help‐seeking (Karpicke and Bauernschmidt, ; Dassel et al, ; Hill et al, ) and reduce test anxiety in students (Ahrweiler et al, ; Jordan and Foster, ; Riley, ).…”

“…They are optimistic (Wilkinson et al, 2014), collaborative (Si, 2018), team-oriented (Cianciolo et al, 2016), and are heavily reliant on technology (Rogers and Tutty, 2016;Desy et al, 2018). This is the first native online generation, and hence is globally oriented (Deng et al, 2015;Hulbert and Anderson, 2018), culturally diverse (Palmen et al, 2015), and constantly connected worldwide (Puertas et al, 2013;Shatto and Erwin, 2017;Rowland and Kumagai, 2018).…”

Study tips for medical students

“…You can also use practice questions, papers, or quizzes, checking that your answers are correct. This is also an effective way to incorporate retrieval practice into your revision 1011…”