The Importance of Testing: Using Test-Enhanced Learning to Teach Point-of-Care Ultrasound

Background and Aim: An ongoing challenge in medical education is implementing teaching methods that promote the long-term retention of information. Research has shown that repeated testing improves acquisition and retention of information when compared to studying, a phenomenon known as test-enhanced learning (TEL). While TEL has been shown to facilitate knowledge retention, few studies have examined how it applies to the acquisition of procedural skills. Therefore, we investigated how TEL influences the acquisition of point-of-care ultrasound (PoCUS) skills, specifically ultrasound image generation and interpretation, in a cohort of internal medicine residents. Materials and Methods: This study took part in three phases. Phase I involved a teaching session with hands-on practice of six PoCUS skills. One month later, Phase II allowed residents to practice the six skills taught in Phase I through objective structured clinical examination (OSCE)-style scenarios. Using a counterbalanced design, three of the skills were practiced with sonographers’ guidance (control condition), whereas the remaining three skills were practiced as sonographers assessed the residents’ abilities using a series of rating scales (testing condition). Two months later, Phase III had a final OSCE-style session where residents were formally assessed on all six skills. Results: Our results indicated no significant differences in final OSCE scores for PoCUS skills that were practiced with facilitator guidance (control condition) compared to those that were assessed (testing condition) ( P > 0.05). Conclusions: While the benefits of TEL are largely recognized within medical education, these null results suggest that the benefits of TEL may not apply to procedural skill development.