Buildup and release from proactive interference: The forward testing effect in children's spatial memory.

Previous work has indicated that testing can enhance memory for subsequently studied new information by reducing proactive interference from previously studied information. Here, we examined this forward testing effect in children's spatial memory. Kindergartners (5-6 years) and younger (7-8 years) and older (9-10 years) elementary school children studied four successively presented 3 × 3 arrays, each composed of the same 9 objects. The children were asked to memorize the locations of the objects that differed across the four arrays. Following presentation of each of the first three arrays, memory for the object locations of the respective array was tested (testing condition) or the array was re-presented for additional study (restudy condition). Results revealed that testing Arrays 1 to 3 enhanced children's object location memory for Array 4 relative to restudying. Moreover, children in the testing condition were less likely to confuse Array 4 locations with previous locations, suggesting that testing reduces the buildup of proactive interference. Both effects were found regardless of age. Thus, the current findings indicate that testing is an effective means to resolve proactive interference and, in this way, to enhance children's learning and remembering of spatial information even before the time of school entry.

Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study.

OBJECTIVE: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets. METHODS: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical. RESULTS: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05. CONCLUSIONS: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Application of test-enhanced learning (TEL) in obstetrics and gynecology: a prospective study.

OBJECTIVE: Clinical reasoning is an essential skill, the foundations of which should be acquired during medical school. Within the format of test-based learning, such examinations can also be used to support the long-term retention of procedural knowledge necessary for clinical reasoning. The aim was to investigate whether repeated exposure to clinical cases in obstetrics and gynecology (OBGYN) with built-in questions leads to higher learning outcome than pure reading cases and what influence the delay between the intervention and the final test has on the retention of the respective content. METHODS: In this non-randomised crossover study, 5th-year medical students (duration of the study is 6 years) taking a 1-week clinical attachment in OBGYN participated in computer-based case seminars in winter term 2020/2021, in which different case histories on gynecological-obstetric diseases were presented. Case content was identical for all groups, but the presentation format (cases with key feature questions vs read-only cases) of individual case vignettes changed weekly. The also intervention was repeated after 2 weeks for each group. Knowledge was assessed in an entry and an exit exam consisting of 40 short-answer questions. RESULTS: A total of 94 out of 118 eligible students participated in the study (response rate: 79.7%). Learning outcome was significantly higher for items presented in the key feature format compared to items presented as read-only cases (74.2 ± 8.6% vs. 71.0 ± 9.2%; p = 0.017). Furthermore, the analysis showed that the temporal distance of the intervention package from the final examination had no influence on retention. CONCLUSION: This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning in the subject of OGBYN. In this cross-over study, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing can thus improve learning outcomes for OBGYN.

Test-enhanced learning improves learner attendance during a laparoscopic box trainer simulation program.

BACKGROUND: Laparoscopy is the gold standard approach for many surgical procedures, but it is a complex skill to learn. Laparoscopic simulation training may help, but it is unclear how to best engage trainees in these programs. Test-enhanced learning (TEL) uses regular, well-defined assessments of performance throughout the training phase of learning. AIM: The aim of this study was to assess the effects of TEL on a laparoscopic simulation program involving a cohort of medical student volunteers. MATERIALS AND METHODS: A prospective cohort study was performed with a convenience sample of 40 medical students. Students were recruited to participate in a ten-week laparoscopic simulation program. Twenty students participated in a laparoscopic surgical program with TEL ('TEL group'), and 20 students participated in a standard laparoscopic simulation program ('control group'). RESULTS: Attendance in the TEL group was significantly higher than in the standard group (71 vs 51.5%, P = 0.03). There was no difference between groups in mean time scores. Four themes were identified in qualitative data drawn from student surveys - personal traits and motivators, training context, clear goals and feedback enabling understanding of one's own performance. CONCLUSION: Testing laparoscopic skills throughout a learning program, in conjunction with individualised feedback and tracking of learning trajectory, increases trainee attendance. Laparoscopic simulation training programs are encouraged to reflect on the pedagogic framework in which their procedural skills training operates.

Effectiveness of "OralDETECT": a Repetitive Test-enhanced, Corrective Feedback Method Competency Assessment Tool for Early Detection of Oral Cancer.

Early diagnosis of oral cancer results in less aggressive treatment and improves the quality of life and overall 5-year survival rate. Well-trained dental professionals can play a crucial role in the early detection of oral cancers. The present study aims to determine the effectiveness of the training program "OralDETECT", a spaced repetitive, test-enhanced learning tool with a corrective feedback mechanism for early detection of oral cancer. Thirty-two dentists and 259 dental students from three Malaysian dental schools were involved in this study. All participants were trained and calibrated to recognize oral potentially malignant disorders (OPMD) and oral cancer using "OralDETECT", which is comprised of a series of pre-test, lecture, post-tests and review sessions. The percentage of correct answers (scores) for each test given by the participants was calculated and analysed using a paired t test. It was found that the overall percentage of diagnostic accuracy for both dental professionals and student groups increased to above 80% from the pre-tests to the final post-tests. There was a significant improvement in overall scores between the pre-tests and all three post-tests for the dental professional groups and the student groups. The diagnostic accuracy for individual OPMD and lesions suspicious of oral cancer also increased to above 80% for both groups. The results of our study demonstrate that the "OralDETECT" is an efficient and effective competency tool which can be used to train dental professionals and students for the early detection of OPMD and oral cancer.

Twelve tips on guiding preparation for both high-stakes exams and long-term learning.

High-stakes exams including admissions, licensing, and maintenance of certification examinations are commonplace in health professions education. Although exam scores and performance can often serve gate-keeping purposes, the broader goal of health professions education is to foster deep, self-directed, meaningful, motivated learning. Establishing strong support structures that emphasize deep learning and understanding rather than exam scores can be beneficial to preparing learners who have the knowledge base to be excellent practitioners. This article offers guidance that can be used by academic support centres, medical educators, learning specialists, and faculty advisors, or even test-takers, to help learners to balance score achievement and knowledge development, while simultaneously cultivating more efficient and motivated studying and increasingly self-regulated learning. This series of tips details considerations for building academic success supports, fostering a growth mindset, planning efficient and effective studying efforts, utilizing test-enhanced learning strategies, exam-taking skills practice, and other support structures that can help strengthen learning experiences overall.

How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios.

BACKGROUND: The Choosing Wisely campaign highlights the importance of clinical reasoning abilities for competent and reflective physicians. The principles of this campaign should be addressed in undergraduate medical education. Recent research suggests that answering questions on important steps in patient management promotes knowledge retention. It is less clear whether increasing the authenticity of educational material by the inclusion of videos further enhances learning outcome. METHODS: In a prospective randomised controlled cross-over study, we assessed whether repeated video-based testing is more effective than repeated text-based testing in training students to choose appropriate diagnostic tests, arrive at correct diagnoses and identify advisable therapies. Following an entry exam, fourth-year undergraduate medical students attended 10 weekly computer-based seminars during which they studied patient case histories. Each case contained five key feature questions (items) on the diagnosis and treatment of the presented patient. Students were randomly allocated to read text cases (control condition) or watch videos (intervention), and assignment to either text or video was switched between groups every week. Using a within-subjects design, student performance on video-based and text-based items was assessed 13 weeks (exit exam) and 9 months (retention test) after the first day of term. The primary outcome was the within-subject difference in performance on video-based and text-based items in the exit exam. RESULTS: Of 125 eligible students, 93 provided data for all three exams (response rate 74.4%). Percent scores were significantly higher for video-based than for text-based items in the exit exam (76.2 ± 19.4% vs. 72.4 ± 19.1%, p = 0.026) but not the retention test (69.2 ± 20.2% vs. 66.4 ± 20.3%, p = 0.108). An additional Bayesian analysis of this retention test suggested that video-based training is marginally more effective than text-based training in the long term (Bayes factor 2.36). Regardless of presentation format, student responses revealed a high prevalence of erroneous beliefs that, if applied to the clinical context, could place patients at risk. CONCLUSION: Repeated video-based key feature testing produces superior short-term learning outcome compared to text-based testing. Given the high prevalence of misconceptions, efforts to improve clinical reasoning training in medical education are warranted. The Choosing Wisely campaign lends itself to being part of this process.

The pedagogical value of testing: how far does it extend?

Information is generally more memorable after it is studied and tested than when it is only studied. One must be cautious to use this phenomenon strategically, however, due to uncertainty about whether testing improves memorability for only tested material, facilitates learning of related non-tested content, or inhibits memory of non-tested material. 52 second-year Pharmacy students were asked to study therapeutic aspects of gastroesophageal reflux disease and peptic ulcer disease. One group was given 30 min to study. Another was given 20 min to study and 10 min to complete a 10-item test. Two weeks later a 40-item test was delivered to both groups that contained (a) the 10 learning phase questions, (b) 10 new questions drawn from the studied material, (c) 10 new questions about therapeutics in different disease states, and (d) 10 new questions drawn from more general pharmaceutical knowledge (e.g., basic physiology and drug characteristics). Moderate to large retrieval-enhanced learning effects were observed for both questions about material that was tested (22.9% difference in scores, p < 0.05, d = 0.60) and questions about material that was studied without being tested (18.9% difference, p < 0.05, d = 0.75). Such effects were not observed for questions that were not part of the study material: therapeutic questions that addressed different disease states (1.8% difference, p > 0.7, d = 0.08) or generic pharmaceutical questions (7.4% difference, p > 0.2, d = 0.32). Being tested made it more likely that students would report reviewing the material after the initial learning session, but such reports were not associated with better test performance. The benefit of mentally retrieving information from studied material appears to facilitate the retrieval of information that was studied without being tested. Such generalization of the benefit of testing can increase the flexibility of test-based pedagogic interventions.

Utility of intermittent online quizzes as an early warning for residents at risk of failing the pediatric board certification examination.

BACKGROUND: Traditionally, quizzes have been applied as a tool for summative assessment, though literature suggests their use as a formative assessment can improve motivation and content retention. With this premise, we implemented a series of intermittent, online quizzes known as the Board Examination Simulation Exercise (BESE). We sought to demonstrate an association between BESE participation and scores and performance on the American Board of Pediatrics (ABP) Certifying Examination (CE). METHODS: Residents were assigned online quizzes on a single topic at 2 week intervals that consisted of 20 multiple choice questions written by the study authors. This analysis includes graduates of 3 Pediatric and Internal Medicine-Pediatrics residency programs. RESULTS: Data were available for 329 residents. The overall BESE score weakly correlated with ABP CE score (n = 287; r = 0.39, p < 0.0001). ABP CE pass rates increased from 2009 to 2016 at all programs combined (p = 0.0001). A composite BESE score ≤ 11 had sensitivity of 54% and specificity of 80% for predicting ABP CE failure on the first attempt. There was no difference in ABP CE failure rates or scores by number of completed quizzes. CONCLUSION: Intermittent online quizzes implemented at three pediatric residency programs were associated with overall increasing ABP CE pass rates. BESE increased program emphasis on board preparation. Residents with lower BESE scores more often failed ABP CE. Though additional data are needed, BESE is a promising tool for pediatric resident learning and board preparation. It may also aid in earlier identification of residents at higher risk of failing the ABP CE and facilitate targeted interventions.

Effectiveness of Test-Enhanced Learning (TEL) in lectures for undergraduate medical students.

OBJECTIVE: To determine the effectiveness of Test-Enhanced learning as a learning tool in lectures for undergraduate medical students. METHOD: This quantitative, randomized controlled trial included eighty-four students of 4th year MBBS from Yusra Medical & Dental College, Islamabad. The duration of study was from March 2016 to August 2016. After obtaining the informed consent; participants were equally assigned to interventional and non-interventional study groups through stratified randomization. Single best answer MCQs of special pathology were used as data collection instrument after validation. A pre- and post-test was taken from both groups, before and after the intervention, respectively and their results were compared using SPSS version 21. RESULTS: There were 13 male (31%) and 29 female (69%) participants in each study group who showed an equivalent baseline performance on pre-test (p=0.95). Statistically significant difference was found among mean scores of interventional and non-interventional study groups at exit exam (p=0.00). Interventional group also showed a significant improvement in their post-test scores (mean: 17.17±1.59) as compared to pre-test scores (mean: 6.19±1.81). CONCLUSIONS: Test-enhanced learning has significant effect on improving the learning of course content delivered to undergraduate medical students through lectures.

Does test-enhanced learning transfer for triple associates?

Test-enhanced learning and transfer for triple-associate word stimuli was assessed in three experiments. In each experiment, training and final-test trials involved the presentation of two words per triple associate (triplet), with the third word having to be retrieved. In agreement with the prior literature on different stimuli, training through testing with feedback yielded markedly better final-test performance than did restudy. However, in contrast to the positive transfer reported for paired associate stimuli, minimal or no positive transfer was observed, relative to a restudy control, from a trained cue combination (e.g., A, B, ?) to other cue combinations from the same triplet that required a different response (e.g., B, C, ?). That result also held when two unique cue combinations per triplet were tested during training, and for triplets with low and high average associative strengths. Supplementary analyses provided insight into the overall transfer effect: An incorrect response during training appears to yield positive transfer relative to restudy, whereas a correct response appears to yield no, or even negative, transfer. Cross-experiment analyses indicated that test-enhanced learning is not diminished when two or three cue combinations are presented during training. Thus, even though learning through testing is highly specific, testing on all possible stimulus-response combinations remains the most efficient strategy for the learning of triple associates.

Strengthening concept learning by repeated testing.

The aim of this study was to examine whether repeated testing with feedback benefits learning compared to rereading of introductory psychology key-concepts in an educational context. The testing effect was examined immediately after practice, after 18 days, and at a five-week delay in a sample of undergraduate students (n = 83). The results revealed that repeated testing with feedback significantly enhanced learning compared to rereading at all delays, demonstrating that repeated retrieval enhances retention compared to repeated encoding in the short- and the long-term. In addition, the effect of repeated testing was beneficial for students irrespectively of working memory capacity. It is argued that teaching methods involving repeated retrieval are important to consider by the educational system.

Impact of frequency of spaced retrieval using repeat testing on asthma pharmacotherapy knowledge retention.

OBJECTIVE: "Test-enhanced learning" is a strategy utilized to impact knowledge retention. This study aimed to assess the effect of the frequency of spaced retrieval using repeat testing on knowledge depreciation in a Doctor of Pharmacy (PharmD) Program. METHODS: The study randomly assigned second-year pharmacy students to one of three retrieval practice groups: (1) two retrieval practice assessments (2 and 4 months after the course), (2) one retrieval practice assessment (4 months after the course), or (3) no retrieval practice. A final assessment was administered to all participants 6 months after the course. The retrieval assessments and final assessment consisted of five multiple-choice questions on asthma pharmacotherapy. RESULTS: In total, 94 participants were included in the study, with 32 in Group 1 and 31 in both Groups 2 and 3. All three groups performed similarly on the final assessment regardless of the frequency of spaced retrieval. While Group 1 scored numerically higher than Group 2 on the 4-month retrieval practice assessment and did not impact performance on the final assessment. In Group 1, final assessment scores were decreased compared to the two previous retrieval assessments. CONCLUSION: Regardless of the frequency of spaced retrieval following the academic course where asthma pharmacotherapy was initially learned, retrieval practice using multiple choice assessments, with the gap times of this study, did not impact asthma pharmacotherapy knowledge depreciation among second-year student pharmacists.

Nursing students' experiences with test-enhanced learning in teams: A cross-sectional study.

BACKGROUND: Many nursing students struggle with the disciplines of biosciences, particularly Anatomy, physiology, and biochemistry, which are introduced in the first year. Nursing students' motivation, prior knowledge, and academic performance matter, but teaching methods may also influence students' learning process. Retrieving knowledge through testing has previously proven to enhance learning to a greater extent than time spent on other classroom activities. OBJECTIVE: The aim of this study was to explore nursing students' experiences with test-enhanced learning as a way of enhancing learning in Anatomy, physiology, and biochemistry. DESIGN: The lectures in each topic were followed by testing five days later. The tests were typically multiple-choice tests with short reply-times. The effect was measured in terms of students' self-reported level of satisfaction with test-enhanced learning, and their performance on the final exam in Anatomy, physiology, and biochemistry. The tests were performed in teams to avoid stressful situations that could negatively affect the students' learning process. RESULTS: A key achievement from introducing test-enhanced learning in the Anatomy, physiology, and biochemistry course was a perceived higher learning outcome and increased engagement and motivation among the students, resulting in resulting in more students achieving the highest grades (A and B). However, the students' academic results from upper secondary school also seemed to matter for their achievements on the final exam. CONCLUSION: These results indicated that many students benefited from test-enhanced learning, suggesting that test-enhanced learning can be an important teaching strategy in nursing education, particularly for biosciences.

Formative key feature examinations as innovative teaching approach in dental education: A project report.

Introduction: Clinical reasoning ability is one of the core competencies of physicians. It should already be trained during undergraduate medical education. At University Medical Center Göttingen (UMG), medical students can participate in formative key feature examinations in which they work on virtual patient cases in order to apply and deepen the procedural knowledge acquired in lectures and seminars. Problem and objective: While this teaching format is already established in the medical curriculum at the UMG, it has not yet been implemented in the dental curriculum at the same institution. Therefore, the current project aimed to evaluate the feasibility of formative key feature examinations in dental education. Methods: In 2022, new key feature cases focusing on dental-surgical teaching content were created. For pilot testing, the new cases were worked on by two cohorts of dental students via an online learning platform in February 2023. The students were also asked to complete an anonymous online questionnaire in order to evaluate the new teaching format. Results: Overall, the formative key feature examinations were evaluated positively by the dental students, and they demanded for further dental key feature cases. However, descriptive analyses of item characteristics as well as students' comments in the questionnaire revealed some potential for improvements, so that a few cases were partly revised afterwards. Conclusion and outlook: This project shows that formative key feature examinations are feasible in dental education and that dental students can benefit from working on virtual case scenarios. Whether dental students' clinical reasoning competence can be improved by completing formative key feature examinations is being investigated in an ongoing study at the UMG.

Use of practice tests with immediate feedback in an undergraduate molecular biology course.

Multiple studies have shown that testing contributes to learning at all educational levels. In this observational classroom study, we report the use of a learning tool developed for a Genetics and Molecular Biology course at the college level. An interactive set of practice exams that included 136 multiple choice questions (MCQ) or matching queries was developed in the open-source Moodle platform. All MCQ questions contained four answer choices and configured for immediate feedback upon answering. Feedback consisted of providing the right answer and a short explanation of the learning objective examined. The interactive material was tested and refined for several semesters. Usefulness of this tool was assessed in two distinct settings: (1) during a face-to-face semester (Fall 2019) by comparing the grades in a final departmental exam between students who used the tool and those who did not, and (2) during an online semester (Fall 2020) by analyzing the grades in the first and last attempts on study sessions and students' performance in monthly exams. We found that when solving practice tests, students obtained a significantly higher scores in the last attempt compared with their first attempt, and that students who used the material performed better than those who did not. In all cases, answering the practice exams was optional, but students made full use of them preferentially during the online semester. This classroom research exemplifies the documented effectiveness of practice tests enhanced with feedback in biological sciences education through an open-source learning platform.

Judgments of Learning Following Retrieval Practice Produce Minimal Reactivity Effect on Learning of Education-Related Materials.

Testing (i.e., retrieval practice) is one of the most powerful strategies to boost learning. A recent study observed an incidental finding that making judgments of learning (JOLs) following retrieval practice further enhanced learning of education-related texts to a medium extent (Cohen's d = 0.44) by comparison with retrieval practice itself, suggesting that making JOLs may serve as an easy-to-implement educational intervention to improve the benefits of testing. Three experiments (one pre-registered) were conducted to test the replicability of Ariel et al.'s incidental finding and to further determine whether making JOLs following retrieval practice reactively enhances the benefits of testing for text learning. The three experiments consistently provided Bayesian evidence supporting no reactivity effect of JOLs following retrieval practice, regardless of whether the replication experiments were conducted in a laboratory (Experiment 1) or online (Experiments 2 and 3), whether the stimuli were presented in the same language (Experiments 2 and 3) or not (Experiment 1), and whether participants were recruited from the sample pool (Experiment 2) or not (Experiments 1 and 3) as in the original study. These null findings imply that making JOLs cannot be utilized as a practical strategy to enhance the benefits of testing for learning of educationally related materials. Possible explanations for the null reactivity effect of JOLs following retrieval practice are discussed.

A Curriculum Ignored? The Usage of Unofficial Commercial and Peer Learning Resources in Undergraduate Medical Education at a Canadian Medical School.

Medical students often seek educational resources outside of the formal curriculum to support their education. Commercial and student-developed educational resources are readily available, and may supplement or even replace aspects of the formal curriculum. Since this has the potential to impact what students learn and ultimately impact patient care, gaining a better understanding of the prevalence and patterns of use of these resources is of great interest. The purpose of this study, therefore, is to explore the use of non-traditional resources in undergraduate medical education. We surveyed University of Ottawa medical students to determine the usage, rationale, and perceived benefits and drawbacks of these educational resources. The response rate was 57/342 (17%). Of 57 respondents (first year = 21, second year = 34, MD/PhD = 2), 98.2% report using non-traditional resources, with Upper Year Notes, Student Developed Anki decks (a spaced repetition flashcard tool), and Student Developed Question Banks being most common. Although 75% of students reported using official lecture slides and practice tests, they reported spending more of their time (63%) using third-party resources compared to official curriculum offerings. Reported advantages of non-traditional resources listed were faster, more efficient, and easier to understand/search. Disadvantages were difficulty aligning unofficial resources with local exams, determining the level of detail required, and cost. These results suggest a need to examine curriculum design and delivery and further investigate the role of non-traditional resources developed by medical students and the role of medical students as peer educators. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01899-5.

Building a student learning-focused assessment and grading system in dental school: One school's experience.

PURPOSE/OBJECTIVES: As health professions education moves toward competency-based education, there has been increased focus on the structure of assessment systems that support student competency development and learning. This has been buoyed by a growing body of research supporting assessment for learning processes to promote student growth and learning rather than relying on assessment systems primarily to measure performance. This paper presents the rationale and evidence for moving to an assessment for learning system and the results of a quasi-experimental interrupted time series study using data from 2015 to 2022 to evaluate the impacts of these changes. METHODS: Columbia University College of Dental Medicine faculty voted to implement assessment for learning system changes beginning in 2017 with the graduating class of 2021. These changes included moving from using a grading system for didactic courses with Honors, Pass, and Fail as available grades to a grading system with only Pass and Fail as available grades, as well as creating synthesis and assessment weeks, weekly problem sets, post-exam review sessions, exam remediation opportunities, and formative progress exams throughout the curriculum. The revised assessment and grading system changes were communicated to residency program directors, and programmatic competency data about student performance across the curriculum were shared with programs in Dean's Letters. RESULTS: Once assessment system changes were implemented, it was found that student exam failure rates were lower, course exam scores were the same or higher, and performance on board exams improved compared to the national average. Students reported positive perceptions with regard to well-being and learning climate that they associated with the adoption of Pass/Fail grading. Match outcomes, including student satisfaction and program director ratings, have remained consistently positive. CONCLUSION: As dental educators, our goal is to nurture students to become life-long learners. Adopting a grading structure that is Pass/Fail and an assessment system that fosters learning allows students to shape learning practices that favor long-term retention and application of information, also enhancing the learning environment and student well-being. These system changes may also facilitate the inclusion and support of students whose backgrounds are underrepresented in dentistry.

Impact of test-enhanced learning as a study strategy: An exploratory study with first-year dental students.

PURPOSE: Research has demonstrated that learners who practice self-testing have superior long-term retention compared to those rereading the material alone, a phenomenon called test-enhanced learning. This testing effect can be leveraged by spacing out the testing practice over time, a technique called spaced repetition. In 2017, we provided dental students at the school with access to Osmosis, a web-based platform that supports test-enhanced learning and spaced repetition through flashcards. This exploratory study examined students' adoption of self-testing with flashcards and its impact on learning performance in basic sciences. METHODS: Participants were 143 first-year predoctoral students at a dental school in the US. The platform analytics revealed the number of flashcards students answered throughout the first academic year (2019-2020). Regression analyses examined how self-testing with flashcards impacted students' exam scores in basic sciences. Analysis of variance (ANOVA) tests examined the difference in students' exam performance among the non, minimal, occasional, and regular flashcard users who answered 0, 1-99, 100-499, and over 500 flashcards, respectively. RESULTS: Students answered 82,766 flashcards during the year. Additionally, they created 17,973 flashcards using the platform's flashcard authoring tool. Regression analyses showed that self-testing with flashcards correlated positively with students' exam performance in anatomy, biochemistry, nutrition, and physiology. ANOVA results revealed a statistically significant difference in students' exam performance in anatomy, biochemistry, and nutrition among the four groups. CONCLUSIONS: This study is the first in dental education to examine students' self-testing on the Osmosis platform. Results revealed that there was widespread adoption of self-testing with flashcards. The study provided additional evidence to support the value of self-testing for dental students. It has practical implications of how test-enhanced learning can be incorporated into dental education to support student learning. The study contributed to the test-enhanced learning literature in dental education, an area that has been underexplored.