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      The impact of feedback during formative testing on study behaviour and performance of (bio)medical students: a randomised controlled study

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          A potential concern of formative testing using web-based applications (“apps”) is provision of limited feedback. Adopting a randomised controlled trial in 463 first year (bio) medical students, we explored if providing immediate, detailed feedback during “app”-based formative testing can further improve study behaviour and study performance of (bio)medical students.


          Students had access to a formative testing “app”, which involved 7 formative test modules throughout the 4-week course. In a randomised order, subjects received the “app” with ( n = 231, intervention) or without ( n = 232, control) detailed feedback during the formative test modules.


          No differences in app-use was found between groups ( P = 0.15), whereas the intervention group more frequently reviewed information compared to controls ( P = 0.007). Exam scores differed between non−/moderate−/intensive- users of the “app” ( P < 0.001). No differences in exam scores were found between intervention (6.6 ± 1.1) versus control (6.6 ± 1.1, P = 0.18). Time spent studying was significantly higher compared to previous courses in moderate- and intensive-users ( P = 0.006 and < 0.001, respectively), but not in non-users ( P = 0.55). Time spent studying did not differ between groups ( P > 0.05).


          Providing detailed feedback did not further enhance the effect of a web-based application of formative testing on study behaviour or study performance in (bio)medical students, possibly because of a ceiling-effect.

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          Test-enhanced learning: taking memory tests improves long-term retention.

          Taking a memory test not only assesses what one knows, but also enhances later retention, a phenomenon known as the testing effect. We studied this effect with educationally relevant materials and investigated whether testing facilitates learning only because tests offer an opportunity to restudy material. In two experiments, students studied prose passages and took one or three immediate free-recall tests, without feedback, or restudied the material the same number of times as the students who received tests. Students then took a final retention test 5 min, 2 days, or 1 week later. When the final test was given after 5 min, repeated studying improved recall relative to repeated testing. However, on the delayed tests, prior testing produced substantially greater retention than studying, even though repeated studying increased students' confidence in their ability to remember the material. Testing is a powerful means of improving learning, not just assessing it.
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            Test-enhanced learning in medical education.

            In education, tests are primarily used for assessment, thus permitting teachers to assess the efficacy of their curriculum and to assign grades. However, research in cognitive psychology has shown that tests can also directly affect learning by promoting better retention of information, a phenomenon known as the testing effect. Cognitive psychology laboratory studies show that repeated testing of information produces superior retention relative to repeated study, especially when testing is spaced out over time. Tests that require effortful retrieval of information, such as short-answer tests, promote better retention than tests that require recognition, such as multiple-choice tests. The mnemonic benefits of testing are further enhanced by feedback, which helps students to correct errors and confirm correct answers. Medical educational research has focused extensively on assessment issues. Such assessment research permits the conclusion that clinical expertise is founded on a broad fund of knowledge and effective memory networks that allow easy access to that knowledge. Test-enhanced learning can potentially strengthen clinical knowledge that will lead to improved expertise. Tests should be given often and spaced out in time to promote better retention of information. Questions that require effortful recall produce the greatest gains in memory. Feedback is crucial to learning from tests. Test-enhanced learning may be an effective tool for medical educators to use in promoting retention of clinical knowledge.
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              The influence of retrieval on retention


                Author and article information

                +312436134209 ,
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                3 April 2019
                3 April 2019
                : 19
                [1 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Radboud Institute for Molecular Life Sciences, , Radboud University Medical Center, ; Nijmegen, The Netherlands
                [2 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Physiology (392), Radboud Institute for Health Sciences, , Radboud University Medical Center, ; PO box 9101, 6500 HB Nijmegen, The Netherlands
                [3 ]ISNI 0000 0004 0368 0654, GRID grid.4425.7, Research Institute for Sport and Exercise Sciences, , Liverpool John Moores University, ; Liverpool, UK
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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                feedback, formative testing, e-learning, medical education, blended learning


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