Active Retrieval Improves Procedural Learning in Orthopedic Surgery

Silvio Ndoja; Charles-Antoine Dion; Ali Ahmadi Pirshahid; Brynn Petras Charron; Alexandra Durocher; Alexander McCarton; Marie-Eve LeBel

doi:10.1016/j.jsurg.2022.05.001

Active Retrieval Improves Procedural Learning in Orthopedic Surgery

J Surg Educ. 2022 Sep-Oct;79(5):1308-1314. doi: 10.1016/j.jsurg.2022.05.001. Epub 2022 May 28.

Authors

Silvio Ndoja¹, Charles-Antoine Dion¹, Ali Ahmadi Pirshahid², Brynn Petras Charron², Alexandra Durocher², Alexander McCarton³, Marie-Eve LeBel⁴

Affiliations

¹ Division of Orthopedic Surgery, Department of Surgery, Western University, London, Ontario, Canada.
² Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
³ Division of Orthopedic Surgery, Department of Surgery, Kingston Health Sciences, Kingston, Ontario, Canada.
⁴ Division of Orthopedic Surgery, Department of Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada. Electronic address: mlebel4@uwo.ca.

PMID: 35637140
DOI: 10.1016/j.jsurg.2022.05.001

Abstract

Objective: Tests are shown to enhance learning: this is known as the "testing effect". The benefit of testing is theorized to be through "active retrieval", which is the effortful process of recalling stored knowledge. This differs from "passive studying", such as reading, which is a low effort process relying on recognition. The testing effect is commonly studied in random word list scenarios and is thought to disappear as complexity of material increases. Little is known about the testing effect in complex situations such as procedural learning. Therefore, we investigated if testing improves procedural learning of fracture fixation as compared to "passive studying".

Design, setting, and participants: Fifty participants watched an instructional video of an open reduction internal fixation of a Sawbones™ femur. Participants then performed the procedure under guided supervision (pretest). After randomization, they either read the steps (passive studying group), or wrote down the steps from memory (active retrieval group) for a period of 15 minutes. After a washout period, all participants performed the procedure without guidance (posttest) and then once more, 1 week after the initial testing (retention test). The participants were assessed using the Objective Structured Assessment of Technical Skill. Each performance was video recorded for data analysis purposes.

Results: Participants in the passive studying group had significantly higher Objective Structured Assessment of Technical Skill scores during immediate assessment compared to the active retrieval group (p = 0.001), especially with respect to remembering the correct order of the steps (p = 0.002). The percentage of information forgotten was significantly less in the active retrieval group (p = 0.02) at the retention test.

Conclusion: We demonstrated that, compared to passive studying, testing with active retrieval through writing resulted in better retention of fracture fixation knowledge (i.e., less forgetting). These findings can easily be applied and incorporated in existing curricula. Future studies are needed to determine the effects of different kinds of active retrieval methods such as verbal retrieval (e.g., dictating) in surgical practice.

Keywords: active retrieval; forgetting; learning; medical education; surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Curriculum
Humans
Learning
Mental Recall*
Orthopedic Procedures*
Writing