Daily Text-Message Retrieval Practice for Pediatric Residents

Objective Residents have limited time and much to learn. This creates an inescapable time pressure, which encourages reliance on efficient and effective learning strategies. Retrieval practice - study strategies such as flashcards and practice questions that demand active recall of desired information - is an increasingly common learning strategy for medical trainees. Growing evidence has linked retrieval practice to improved learning outcomes, but it has primarily come from small, observational studies, and their methods have varied widely. The variability in the existing literature makes it difficult to synthesize the evidence and identify best practices. We designed a national, prospective study to test the effects of daily retrieval practice for pediatric residents. Methods We recruited a national sample of pediatric residents in the United States. We sent participating residents mass text messages every morning for a year, directing them to answer one exam-style, multiple-choice, retrieval practice question. We then compared residents' scores on national standardized exams at the beginning and end of the study period, and we compared scores between participating residents and a control group of residents not enrolled in the study. Results A total of 293 residents enrolled in the study. At baseline, their exam scores were no different from control residents' scores. The daily mass text messages did not successfully induce residents to answer practice questions; most participants answered very few, and many answered none at all. There was no significant difference between participating residents' and control residents' exam scores, and there was no significant correlation between the number of questions participants answered and the change in their exam scores. Conclusions Previous observational studies have shown that the more exam-style practice questions residents answer, the better they score on subsequent exams. Small studies have also found that text message reminders encouraged residents to answer more practice questions and boosted their exam performance. In this large, national, prospective study, however, we found that daily text messages were not effective, and we were therefore unable to test how answering practice questions might have impacted residents' annual standardized exam scores. Previous studies of text message retrieval practice may have missed or undervalued key elements of the text messaging programs that did not scale effectively to a national intervention. Future studies should explore effective strategies for increasing residents' engagement with practice questions and other forms of retrieval practice.