Test-enhanced learning of clinical reasoning: a crossover randomised trial

Area of Science:

• Medical Education
• Cognitive Science

Background:

• Clinical reasoning is a critical skill for medical professionals, developed during undergraduate training.
• Key feature examinations can assess clinical reasoning and enhance knowledge retention through test-enhanced learning.

Purpose of the Study:

• To compare the effectiveness of repeated testing with key feature questions versus repeated case-based learning in improving clinical reasoning.
• To evaluate the impact of these methods on long-term retention of procedural knowledge.

Main Methods:

• A randomized crossover trial involving 87 Year 4 medical students over 10 weeks.
• Students experienced both long case narratives (control) and case presentations augmented with key feature questions (intervention).
• Performance was assessed at 13 weeks and 9 months post-intervention.

Main Results:

• Students scored significantly higher on intervention items (key feature questions) than control items in the 9-month retention test (56.0% vs. 48.8%, p < 0.001).
• Results remained significant after adjusting for exposure time, sex, and general academic performance.
• This is the first study to show test-enhanced learning's positive effect on clinical reasoning assessed by key feature questions.

Conclusions:

• Repeated testing using key feature questions is more effective than case-based learning alone for enhancing clinical reasoning.
• Integrating longitudinal key feature testing into medical curricula can significantly improve student learning outcomes in clinical medicine.