Division of Orthopedic Surgery, Department of Surgery, Western University, London, Ontario, Canada.
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
J Surg Educ. 2022 Sep-Oct;79(5):1308-1314. doi: 10.1016/j.jsurg.2022.05.001. Epub 2022 May 28.
Tests are shown to enhance learning: this is known as the "testing effect". The benefit of testing is theorized to be through "active retrieval", which is the effortful process of recalling stored knowledge. This differs from "passive studying", such as reading, which is a low effort process relying on recognition. The testing effect is commonly studied in random word list scenarios and is thought to disappear as complexity of material increases. Little is known about the testing effect in complex situations such as procedural learning. Therefore, we investigated if testing improves procedural learning of fracture fixation as compared to "passive studying".
DESIGN, SETTING, AND PARTICIPANTS: Fifty participants watched an instructional video of an open reduction internal fixation of a Sawbones™ femur. Participants then performed the procedure under guided supervision (pretest). After randomization, they either read the steps (passive studying group), or wrote down the steps from memory (active retrieval group) for a period of 15 minutes. After a washout period, all participants performed the procedure without guidance (posttest) and then once more, 1 week after the initial testing (retention test). The participants were assessed using the Objective Structured Assessment of Technical Skill. Each performance was video recorded for data analysis purposes.
Participants in the passive studying group had significantly higher Objective Structured Assessment of Technical Skill scores during immediate assessment compared to the active retrieval group (p = 0.001), especially with respect to remembering the correct order of the steps (p = 0.002). The percentage of information forgotten was significantly less in the active retrieval group (p = 0.02) at the retention test.
We demonstrated that, compared to passive studying, testing with active retrieval through writing resulted in better retention of fracture fixation knowledge (i.e., less forgetting). These findings can easily be applied and incorporated in existing curricula. Future studies are needed to determine the effects of different kinds of active retrieval methods such as verbal retrieval (e.g., dictating) in surgical practice.
测试被证明可以增强学习效果：这被称为“测试效应”。测试的好处被认为是通过“主动检索”实现的，这是一种费力地回忆存储知识的过程。这与“被动学习”不同，例如阅读，这是一种依赖于识别的低努力过程。测试效应通常在随机单词列表场景中进行研究，并且随着材料复杂性的增加而被认为会消失。在复杂情况下，如程序学习，对测试效应知之甚少。因此，我们研究了与“被动学习”相比，测试是否会提高骨折固定的程序学习效果。
设计、设置和参与者：50 名参与者观看了关于使用 Sawbones™股骨切开复位内固定的教学视频。参与者随后在指导监督下进行了该程序（预测试）。随机分组后，他们要么阅读步骤（被动学习组），要么凭记忆写下步骤（主动检索组），持续 15 分钟。在洗脱期后，所有参与者在无指导的情况下（后测试）进行了该程序，然后在初始测试（保留测试）后一周再次进行了该程序。参与者使用客观结构化评估技术技能进行评估。为了数据分析目的，每个表现都进行了视频记录。
在即时评估中，与主动检索组相比，被动学习组的客观结构化评估技术技能得分明显更高（p=0.001），尤其是在记住步骤的正确顺序方面（p=0.002）。在保留测试中，主动检索组的遗忘信息百分比明显较低（p=0.02）。
与被动学习相比，通过写作进行主动检索的测试导致骨折固定知识的保留更好（即遗忘较少）。这些发现可以很容易地应用和整合到现有的课程中。未来的研究需要确定不同类型的主动检索方法（例如口头检索（例如口述））在外科实践中的效果。
