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Updated: Jun 5, 2026

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Published on: June 14, 2019
Test-enhanced learning may be a gender-related phenomenon explained by changes in cortisol level.
Charles B Kromann1, Morten L Jensen, Charlotte Ringsted
1Centre for Clinical Education, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. charles.kromann@gmail.com
Cardiopulmonary resuscitation (CPR) skills testing increases cortisol levels in men, enhancing skill retention. This cortisol-induced improvement in learning was not observed in women.
Area of Science:
- Medical Education
- Physiology
- Psychology
Background:
- Testing enhances memory more than additional study.
- The stress hormone cortisol may influence memory, particularly in men.
- Mechanisms of test-enhanced learning are not fully understood.
Purpose of the Study:
- Investigate if cardiopulmonary resuscitation (CPR) skills testing increases cortisol.
- Determine if cortisol increase enhances CPR skill retention.
- Examine gender differences in these effects.
Main Methods:
- Randomized controlled trial with medical students.
- Intervention group: CPR skills testing; Control group: additional CPR training.
- Assessed CPR skill performance and salivary cortisol levels pre- and post-intervention.
Main Results:
- CPR skills testing significantly improved learning outcomes in both genders.
- Increased cortisol levels correlated with better learning outcomes in men (r = 0.38).
- No significant correlation between cortisol increase and learning outcomes was found in women (r = -0.05).
Conclusions:
- Cardiopulmonary resuscitation skills testing elevates cortisol levels in men.
- Cortisol increase is linked to improved CPR skill retention in men.
- Cortisol plays a role in test-enhanced learning, with gender-specific effects.
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