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Many students continue to study the same way they have for years, even with advances in technology. Students read and reread text, highlight text and information, and read again. While these strategies can help someone learn new knowledge, they may not allow students to learn and retain information in a way that can be applied long term.
Reading and rereading takes time and, in most cases, doesn’t result in retention of the information. Students are comfortable with this form of study though, as it instills in them a familiarity with the content that leads them to believe they are learning.
Retrieval learning — most simply defined as pulling information from memory to respond to questions — helps make the memory stronger. As faculty, we encourage students to practice test questions as part of their study routine without realizing this might be the most valuable study technique of all.
A new study by Uner and Roediger (2017) illustrates the key principles of retrieval learning. They studied students reading biology chapters and compared groups of students. One group read the chapter, another group reread the chapter, and a group read the chapter and responded to practice questions. The questions occurred after sections, at the end, or both. Practicing retrieval (responding to questions) resulted in greater recall in an exam administered two days later, more so than reading. Responding to questions while reading the chapter and after reading led to even better recall.
Think about the difference in responding to a question versus reading. Taking information from memory and responding to a high-level, well written question that encourages critical thinking is essentially helping to cement that information into knowledge that is readily retrievable in the future. It is easier to read and reread text, while it is more difficult and time consuming to ponder a high-level question, review all the potential responses (all of them seem plausible in a well written question), and then decipher the best response. In responding to a question, a student needs to pull multiple pieces of information or knowledge together, analyze the data, identify what the stem/question is really focusing on, and then select the best response.
This brain work is helping to cement a level of thinking beyond memorization and understanding — think of it as using all the tools in the tool box to create something new and special that is not easily forgotten.
The principles of retrieval learning described in the cognitive science literature is intriguing and something we should consider more frequently in nursing education. Instead of focusing on “how many NCLEX® examination-style questions should my students practice” to be ready for the NCLEX exam, let’s think about how we can encourage practice in retrieval learning and use questions in a variety of formats and activities. One of my favorite illustrations of this practice is the use of HESI Case Studies as homework, followed by faculty using item analysis to identify cohort weak areas, and then opening the HESI Case Studies up in class to debrief. Ask students about various responses and why they were selected — what is the rationale? Have students join in the discussion and share their rationales and thought process on their conclusions. Students can learn from each other. Lastly, try changing some of the content in the Case Studies with a twist using “what if” questions. Change the scenario or patient symptom or lab value to illustrate an important concept.
Using questions in a variety of activities and formats helps students retrieve and use the information and content they are learning, and gets them thinking more like a nurse in a clinical setting who needs to make a decision.
My last point on retrieval learning is that students, in general, are not interested in this type of learning. Ideally, many students want to be told in class what they need to know and be passive, not realizing that the effort yields benefits in retrieval learning. I don’t blame them. Responding to high-level questions is not an easy way to get through a course. But it is a good way to learn to think like a nurse and to retain key content and concepts. It takes more time and energy, but in the long run, students rate classes with low-stakes quizzing more favorably. Consider working as a faculty team on using the principles of retrieval learning more systematically and consistently in your program, so that retrieval learning becomes a method of learning that students embrace and value.
Agarwal, P.K., Roediger, H.L., McDaniel, M.A., and McDermott, K.B. (2017). How to Use Retrieval Practice to Improve Learning. Washington University in St. Louis. http://pdf.retrievalpractice.org/RetrievalPracticeGuide.pdf Last accessed October 12, 2017.
Brown, P.C., Roediger, H.L., and McDaniel, M.A. Make It Stick: The Science of Successful Learning. The Belknap Press of Harvard University Press, 2014.
Uner, O. and Roediger, H.L. (2017). The Effect of Question Placement on Learning from Textbook Chapters. Journal of Applied Research in Memory and Cognition. https://doi.org/10.1016/j.jarmac.2017.09.002.
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