Test-enhanced learning may be a gender-related phenomenon explained by changes in cortisol level

Abstract

CONTEXT Testing increases memory of a topic studied more than additional study or training. The mechanisms by which this occurs are not clearly understood. Testing can be stressful and studies suggest that the stress hormone cortisol has modulating effects on memory, predominantly in men. The aim of this study was to investigate whether cardiopulmonary resuscitation (CPR) skills testing induce a cortisol increase, whether the cortisol increase enhances retention of CPR skills, and how this relates to gender. METHODSWe randomised a convenience sample of medical students attending a mandatory course to one intervention and one control group. Students received a 4-hour course on CPR skills. During the final half-hour of the intervention course, participants were tested in CPR scenarios, whereas the control group underwent additional training. We assessed learning outcomes 2 weeks later by rating student performance in a CPR scenario using a checklist and a single blinded assessor. We measured salivary cortisol pre-course, half an hour before the end of the course and postcourse, and compared learning outcomes and cortisol responses between groups and genders.RESULTS In total, 146 of 202 (72%) students completed the study. We found a significant difference in learning outcome between the intervention and control groups for both genders (mean ± standard deviation, 5.0 ± 3.5; p = 0.006). We found a significant effect of increase in cortisol on learning outcome in men. The correlation between learning outcome and cortisol increase was medium to large for men (r = 0.38), but not for women (r = ) 0.05).CONCLUSIONS Cardiopulmonary resuscitation skills testing induces a rise in cortisol in men, which is related to the better retention of skills in men. Cortisol modulates test-enhanced learning in men.

Test-enhanced learning of clinical reasoning: a crossover randomised trial

“…Previous studies on the effectiveness of test‐enhanced learning in medical education differ with regard to study design (observational or randomised), study population (medical, dental and nursing students), career level (from incoming students to residents), sample size (21 to 138), learning objectives (from factual knowledge to clinical applications), testing format (from multiple‐choice questions to essays and simulated patient encounters), number of interventions (one, three or four), and length of follow‐up (1 week to 6 months). Although this huge variation limits the extent to which our results can be compared with those of earlier studies, there are some similarities between the present study and recent reports by Larsen and colleagues, who studied test‐enhanced learning in neurology.…”

Student‐Generated Pre‐Exam Questions is an Effective Tool for Participatory Learning: A Case Study from Ecology of Waterborne Pathogens Course

“…Furthermore, it involves either an elaboration of the memorized material (Mcdaniel and Fisher ) or requires a certain level of “desirable difficulty” (a condition that initially slows down knowledge acquisition, but improves long‐term retention and transfer of knowledge), which can be achieved when the recall activities are reasonably complicated (Bjork and others ). Therefore, the aim of this study was to test whether student's generation of multiple‐choice questions could result in robust learning gains that are similar to those observed in studies of the testing effect and without the undesirable effects of anxiety and biases observed in previous studies (Kromann and others ; Bjork and others ; Nguyen and McDaniel ) This activity required not only a simple recall of information, but a thorough understanding of the tested material and additional information.…”

Predictable chaos: a review of the effects of emotions on attention, memory and decision making

“…In medical students, positive emotions have been linked to increased creativity, decreased cognitive biases, and more thorough approaches to diagnostic reasoning problems (Estrada et al 1994(Estrada et al , 1997Isen et al 1991). In a variety of health professionals, anxiety and stress have been linked with impaired working memory and immediate recall, subtle alterations in clinical reasoning, and impaired technical and clinical performance (Arora et al 2010a, b;Cheung and Au 2011;Harvey et al 2010Harvey et al , 2012LeBlanc 2009;Pottier et al 2013), but also with increased memory consolidation (DeMaria et al 2010;Kromann et al 2011).…”

“…Some support for this comes from literature on enhanced memory consolidation and learning following stressful events (DeMaria et al 2010;Kromann et al 2011;LeBlanc 2009). However, it is important to note that while memory forms an important part of learning, it is one of many components.…”