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Perspect Med Educ. 2015 Dec;4(6):308-313.

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

Author information

1
Washington University School of Medicine, Campus Box 8077, 660 S. Euclid Ave, 63110-1093, Saint Louis, MO, USA. francisdeng@wustl.edu.
2
Washington University School of Medicine, Campus Box 8077, 660 S. Euclid Ave, 63110-1093, Saint Louis, MO, USA.
3
Department of Neurology, Washington University School of Medicine, Saint Louis,, MO, USA.

Abstract

INTRODUCTION:

A 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.

METHODS:

Seventy-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).

RESULTS:

All 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.

CONCLUSIONS:

Medical 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.

KEYWORDS:

Licensing examinations; Self-directed learning; Spaced repetition; Test-enhanced learning

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