Retrieval Practice Improves Exam Performance as a Function of Review Question Number and Format

Introduction. Although retrieval practice is a well-established method of improving learning, it is unclear whether review question format matters or how many review questions are needed to maximize the effects of retrieval practice. Review of Literature. Inconsistent findings are reported regarding review question format, and no studies were conducted in physical therapy education programs. A positive relationship is reported between review question number and exam performance, but no studies estimate the number of review questions needed to maximize retention of specific learning objectives. Subjects. Eighty-eight second-year Doctor of Physical Therapy students (baseline cohort = 42 students, intervention cohort = 46 students). Methods. Exam questions were randomly assigned into different review categories. Some exam questions received no review, whereas other exam questions were reviewed with open-ended review questions or varying numbers of multiple-choice review questions. Performance on 160 multiple-choice exam questions was compared between review question categories using mixed-effects logistic regression models. Results. Both open-ended and multiple-choice review questions significantly improved exam question performance. Performance on exam questions improved most when more than one multiple-choice review question was provided. After controlling for exam question difficulty, multiple-choice review questions were superior to open-ended review questions. Discussion and Conclusion. On multiple-choice exams, multiple-choice review questions are at least as effective as open-ended review questions. Given their ease of implementation, multiple-choice review questions are an efficient means to improve multiple-choice exam question performance.