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J Med Internet Res. 2016 Nov 21;18(11):e299.

Test-Enhanced E-Learning Strategies in Postgraduate Medical Education: A Randomized Cohort Study.

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Division of Critical Care Medicine, Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.
Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.
Department of Anesthesia, Harvard Medical School, Boston, MA, United States.



The optimal design of pedagogical strategies for e-learning in graduate and postgraduate medical education remains to be determined. Video-based e-learning use is increasing, with initial research suggesting that taking short breaks while watching videos (independent of answering test questions) may improve learning by focusing attention on the content presented. Interspersed test questions may also improve knowledge acquisition and retention.


To examine the effect of interspersed test questions and periodic breaks on immediate knowledge acquisition and retention at 6 months by pediatric residents engaged in video-based e-learning.


First- and second-year pediatric residents were randomized to 1 of the following 3 groups: viewing the complete video uninterrupted (full video), viewing the video interrupted with unrelated logic puzzles (logic puzzles), or viewing the video interrupted with brief comprehension test questions (short answer questions). Residents answered pre- and post-tests before and after video viewing, followed by a retention test at 6 months. Primary outcome included comparison of the change in test scores between groups.


A total of 49 residents completed the initial testing session. All 3 learning groups had comparable mean increases in immediate knowledge gain, but with no significant differences between groups (F2,46=0.35, P=.71). Thirty-five residents completed retention testing with comparable degrees of knowledge retention in the full video and short answer test questions groups (P<.001), but no significant change in the logic puzzles group (F1,32=2.44, P=.13).


Improved knowledge gain was not demonstrated among residents answering interspersed questions or completing logic puzzles during interrupted online video viewing when compared with residents viewing uninterrupted video content. However, residents who either participated in uninterrupted video viewing or answered interspersed questions during interrupted video viewing demonstrated significant knowledge retention at 6 months.


computer-assisted instruction; distance learning; educational measurement; medical education; retention

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