The effect of test-enhanced spaced learning on the otolaryngology board and annual examination results: A quasi-experimental study

Introduction: In the test-enhanced spaced learning, educationalcontents are presented in small packages of well-developedtest questions with a defined frequency to the learners. It is notclear that applying this educational style might have a positiveimpact on the summative assessment. Therefore, in this studywe assessed the effect of the test-enhanced spaced learning onthe otolaryngology board and annual examinations of residencytraining.Methods: In a quasi-experimental study with consecutivesampling, all forty-four residents of otolaryngology in four levelsof training in 2016 at Tehran University of Medical Sciences(TUMS) received daily-standardized multiple-choice questionswith a twice-repeated frequency of 10 days. Individual feedbackaccording to one’s response to each test was provided. The resultsof national board and annual exam were compared with the sameresults of all residents of other universities and previous yearTUMS’ residents for whom spaced learning were not applied andthey were considered as the control groups. The board exam hadtwo parts, multiple-choice questions, and computer-based clinicalexamination. The annual exam format was multiple-choicequestions. The total score for each one was 150. Student’s t-testand Mann-Whitney U test were used for comparative analyses. Results: The mean of the board exam results showed statisticallysignificant improvement compared to other medical schools(113.6±10.7 vs. 102.9±13.4 in multiple-choice questions,p=0.048, 118.7±12.5 vs. 54.1±60.0 in the computer-based clinicalexamination, p<0.001), while similar comparison results in theprevious year did not show any significant difference.Conclusion: Spaced learning with testing effect may be useful inthe clinical education setting to improve the learning outcomes.