Document Type: Original Article


1 Department of Otolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of E-Learning in Medical Education, Virtual School, Tehran University of Medical Sciences, Tehran, Iran


Introduction: In the test-enhanced spaced learning, educational contents are presented in small packages of well-developed test questions with a defined frequency to the learners. It is not clear that applying this educational style might have a positive impact on the summative assessment. Therefore, in this study we assessed the effect of the test-enhanced spaced learning on the otolaryngology board and annual examinations of residency training.
Methods: In a quasi-experimental study with consecutive sampling, all forty-four residents of otolaryngology in four levels of training in 2016 at Tehran University of Medical Sciences
(TUMS) received daily-standardized multiple-choice questions with a twice-repeated frequency of 10 days. Individual feedback according to one’s response to each test was provided. The results of national board and annual exam were compared with the same results of all residents of other universities and previous year TUMS’ residents for whom spaced learning were not applied and they were considered as the control groups. The board exam had two parts, multiple-choice questions, and computer-based clinical examination. The annual exam format was multiple-choice questions. The total score for each one was 150. Student’s t-test and Mann-Whitney U test were used for comparative analyses.
Results: The mean of the board exam results showed statistically significant 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 clinical examination, p<0.001), while similar comparison results in the previous year did not show any significant difference.
Conclusion: Spaced learning with testing effect may be useful in the clinical education setting to improve the learning outcomes. 


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