Test‐Enhanced Learning in Competence‐Based Predoctoral Orthodontics: A Four‐Year Study

Abstract

Dental educators intend to promote integration of knowledge, skills, and values toward professional competence. Studies report that retrieval, in the form of testing, results in better learning with retention than traditional studying. The aim of this study was to evaluate test-enhanced experiences on demonstrations of competence in diagnosis and management of malocclusion and skeletal problems. The study participants were all third-year dental students (2011 N=88, 2012 N=74, 2013 N=91, 2014 N=85) at New York University College of Dentistry. The 2013 and 2014 groups received the test-enhanced method emphasizing formative assessments with written and dialogic delayed feedback, while the 2011 and 2012 groups received the traditional approach emphasizing lectures and classroom exercises. The students received six two-hour sessions, spaced one week apart. At the final session, a summative assessment consisting of the same four cases was administered. Students constructed a problem list, treatment objectives, and a treatment plan for each case, scored according to the same criteria. Grades were based on the number of cases without critical errors: A=0 critical errors on four cases, A-=0 critical errors on three cases, B+=0 critical errors on two cases, B=0 critical errors on one case, F=critical errors on four cases. Performance grades were categorized as high quality (B+, A-, A) and low quality (F, B). The results showed that the test-enhanced groups demonstrated statistically significant benefits at 95% confidence intervals compared to the traditional groups when comparing low-and high-quality grades. These performance trends support the continued use of the test-enhanced approach.

Conceptualising spaced learning in health professions education: A scoping review

“…Spaced learning was also implemented in simulation settings (n = 24, 23%), generally used to disperse training sessions over time to stimulate clinical skill acquisition. In total 24 studies (23%) were conducted in classrooms and applied to various educational activities, ranging from repeated practice and testing of basic science mechanisms, to clinical scenarios and skill training.…”

“…Almost half of the empirical research articles (n = 48, 47%) did not explicitly mention a theoretical framework. In total, nine theoretical frameworks were mentioned in the remaining studies of which the Spacing effect (n = 40) and Testing effect (n = 31) were named most often. Other frameworks were Cognitive Load Theory (n = 4), Desirable Difficulties Theory (n = 2), Retrieval hypothesis (n = 2), Total‐time hypothesis (n = 2), Learning Theory (n = 1), Metacognitive Theory (n = 1) and Kolb's Experiential Learning Theory (n = 1).…”

Types of Feedback in Competency‐Based Predoctoral Orthodontics: Effects on Students’ Attitudes and Confidence

“…Although prior studies have suggested that test‐enhanced learning improves recall and may improve performance in summative competency assessments, 3 , 4 there may be undesirable side effects on students’ perceptions of instruction 13 . Through assessments, learners are made aware of errors, and this knowledge may threaten self‐efficacy.…”

“…In 2012, a test‐enhanced method of instruction based on formative assessments with feedback was introduced. When compared to a traditional classroom approach (presentations and in‐class exercises), the test‐enhanced method generally boosted performance (i.e., higher grades), while not demonstrably affecting pass rates 3 . Although test‐enhanced methods (in areas not related to competency‐based dental education) have been reported to improve performance, they also deflate students’ confidence compared to traditional studying 4 , 5 .…”

“…This study continues an investigation in which evidence‐based methods of assessment and instruction reported in the education and psychology literature are applied to a predoctoral dental course assessing competence in management of patients with malocclusion and skeletal problems 1 – 3 . In this course, assessment emulates the thinking activities of the practitioner: constructing problem lists, treatment objectives, and treatment plans based on patient records (radiographs, intraoral and facial photographs, and history).…”