Testing Test-Enhanced Continuing Medical Education: A Randomized Controlled Trial

Purpose The authors investigated the impact of the use of an efficient multiple-choice question (MCQ) test-enhanced learning (TEL) intervention for continuing professional development (CPD) on knowledge retention as well as self-reported learning behaviors. Method The authors conducted a randomized controlled trial comparing knowledge retention among learners who registered for an annual CPD conference at the University of Toronto in April 2016. Participants were randomized to receive an online preworkshop stand-alone MCQ test (no feedback) and a postworkshop MCQ test (with feedback) after a 14-day delay. Controls received no pre-/posttesting. The primary outcome measure was performance on a clinical vignette-based retention and application test delivered to all participants four weeks post conference. Secondary outcomes included self-reported changes in learning behavior, satisfaction, and efficiency of TEL. Results Three hundred eight physicians from across Canada registered for the four-day conference; 186 physicians consented to participate in the study and were randomized to receive TEL or to the control group in 1 of 15 workshops, with 126 providing complete data. A random-effects meta-analysis demonstrated a pooled effect size indicating moderate effect of TEL (Hedges g of 0.46; 95% CI: 0.26–0.67). The majority of respondents (65%) reported improved CPD learning resulting from pretesting. Conclusions Testing for learning can be leveraged to efficiently and effectively improve outcomes for CPD. Testing remains an underused education intervention in CPD, and the use of formative assessment to enhance professional development should be a key target for research.