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thought that delayed feedback that is fully processed by the learner leads to better
retrieval because it leads to an additional spaced exposure to the material. One limi-
tation to delayed feedback, experts point out, is that students may not be motivated
to review feedback in the delayed setting, not guaranteeing full processing of the
feedback material [ 28 ].
Summary
Test-enhanced learning allows for greater retrieval of information and retention in
long-term memory than study alone. To maximize the effect of testing, the literature
supports five principles that should be followed [ 16 ]:
- Tests should be developed from the educational objectives in the program’s
curriculum. - Questions should allow for the production of answers instead of simple recogni-
tion of answers. - Tests should allow for repeated retrieval practice.
- Repeated tests should be spaced and interleaved to necessitate effortful retrieval
of information. - Feedback should be given after each test.
Understanding these principles in regard to human learning and memory pro-
vides a critical foundation for exploring the specific strategies residents can employ
in the clinical setting to become more effective teachers.
Feedback in the Clinical Arena
Feedback is a critical component of all education, not only in the testing realm but
also in the clinical teaching and learning environment, and has a pronounced effect
on the success of surgical residents. Feedback incorporates an interaction between
the learner and teacher that provides accurate information on the learner’s perfor-
mance and behavior. This interaction is a learning opportunity to provide guidance
for future activities and performances [ 31 , 32 ]. It is important for feedback to be a
two-way conversation that allows the learners to self-reflect and assess their perfor-
mance [ 33 ].
Residents have rated feedback as exceedingly important in their overall training.
In prior studies, the process of giving feedback has been rated second only to the
clinical competence of the attending surgeon in describing the characteristics of
effective clinical teaching [ 34 ]. Feedback, positive or constructive, gives residents a
learning opportunity to reinforce good skills and abandon mistakes or undesirable
habits. If feedback is not given at regular intervals, habits that are deemed desirable
might be abandoned, and conversely, undesirable habits retained [ 35 ].
J. Feimster et al.