12 3How Residents Learn: An Update on Cognition Science
For residents to become excellent teachers, it is useful for them to understand the
current literature on cognition, as well as related theories on how people learn and
store information in memory. Numerous theories have been described. Until
recently, it has been assumed that learning is primarily facilitated from repetitive
exposure through studying and resulting encoding of information in memory [ 15 ].
However recent data has shown the benefit of test-enhanced learning in long-term
memory and retrieval.
Test-Enhanced Learning
Test-enhanced learning is a model that has been developed over the past decade; it
states that repeated retrieval of information through testing increases retention and
long-term memory [ 16 ]. Testing has long been thought to be a neutral event in the
process of memory and not a determinant of learning itself [ 15 , 16 ]. Yet, recent stud-
ies have redefined how testing affects the process of long-term memory acquisition
and how it produces results superior to studying over the long term.
Karpicke and Roediger in 2008 performed a study evaluating college students
and their ability to remember word pairs from a foreign language and their native
tongue as a function of whether they studied and/or were tested in the interval from
initial learning to evaluation of performance on a final delayed test [ 15 ]. The first
group of students was allowed to study and engaged in interval testing (ST). The
second group was simply tested (SNT), but did not study. The third group was
allowed to study, but was not tested (STN). Finally, the fourth group was not allowed
to study or test once they had initially learned the word pairs (SNTN). The results
demonstrated that students who were tested only performed just as well as students
who both studied and tested and students who studied but did not undergo interval
testing performed almost as poorly as those who neither studied nor tested (ST 80%
on final test, SNT 80%, STN 36%, SNTN 33%).
In other words, interval testing, and not the conventional studying, was the
important operative determinant of how well the students performed as reflected by
long-term recall. The process of repeated retrieval of the information (i.e., testing)
allowed the students to correctly recall approximately 80% of the foreign language
word pairs regardless of whether they studied or not, while the students who were
not repeatedly tested (even if engaged in study) recalled around 35%, similar to
those who engaged in neither studying nor testing in the interval from initial learn-
ing to final testing.
These results have been reproduced in numerous other studies. Larsen et al. in
2015 studied a group of neurologists that were participating in continuing medical
education (CME) courses. Groups were divided into no additional exposure after
the initial CME course, repeated study after the CME course, and repeated retrieval/
quizzing after the CME course. The results showed that neurologists that were
7 Teaching Residents to Teach: Why and How