Timing's not everything: Immediate and delayed feedback are equally beneficial for performance in formative multiple-choice testing.

INTRODUCTION: Test-enhanced learning (TEL) is an impactful teaching and learning strategy that prioritises active learner engagement through the process of regular testing and reviewing. While it is clear that meaningful feedback optimises the effects of TEL, the ideal timing of this feedback (i.e. immediate or delayed) in a medical education setting is unclear. METHOD: Forty-one second-year medical students were recruited from the University of Melbourne. Participants were given a multiple-choice question test with a mix of immediate (i.e. post-item) and delayed (i.e. post-item-block) conceptual feedback. Students were then tested on near and far transfer items during an immediate post-test, and at a one-week follow-up. RESULTS: A logistic mixed effects model was used to predict the probability of successful near and far transfer. As expected, participants in our study tended to score lower on far transfer items than they did on near transfer items. In addition, correct initial response on a parent question predicted subsequent correct responding. Contrary to our hypotheses, the feedback timing effect was non-significant-there was no discernible difference between feedback delivered immediately versus delayed feedback. DISCUSSION: The findings of this study suggest that the timing of feedback delivery (post-item versus post-item-block) does not influence the efficacy of TEL in this medical education setting. We therefore suggest that educators may consider practical factors when determining appropriate TEL feedback timing in their setting.

Beyond right or wrong: More effective feedback for formative multiple-choice tests.

INTRODUCTION: The role of feedback in test-enhanced learning is an understudied area that has the potential to improve student learning. This study investigates the influence of different forms of post-test feedback on retention and transfer of biomedical knowledge within a test-enhanced learning framework. METHODS: 64 participants from a Canadian and an Australian medical school sat two single-best-answer formative multiple choice tests one week apart. We compared the effects of conceptually focused, response-oriented, and simple right/wrong feedback on a learner's ability to correctly answer new (transfer) questions. On the first test occasion, participants received parent items with feedback, and then attempted items closely related (near transfer) to and more distant (far transfer) from parent items. In a repeat test at 1 week, participants were given different near and far transfer versions of parent items. Feedback type, and near and far transfer items were randomized within and across participants. RESULTS: Analysis demonstrated that response-oriented and conceptually focused feedback were superior to traditional right/wrong feedback for both types of transfer tasks and in both immediate and final retention test performance. However, there was no statistically significant difference between response-orientated and conceptually focused groups on near or far transfer problems, nor any differences in performance between our initial test occasion and the retention test 1 week later. As with most studies of transfer, participants' far transfer scores were lower than for near transfer. DISCUSSION: Right/wrong feedback appears to have limited potential to augment test-enhanced learning. Our work suggests that item-level feedback and feedback that identifies and elaborates on key conceptual knowledge are two important areas for future research on learning, retention and transfer.