Medical Council of Canada

Research in Clinical Assessment grant recipient (2011-2012) — Christina St-Onge

Research in Clinical Assessment grant recipient (2011-2012) — Christina St-Onge

Research in Clinical Assessment grant recipient (2011-2012) — Christina St-Onge

Testing one, two, three times: The longitudinal effect of test-enhanced learning and transferability to high-stakes settings


St-Onge, C.


Young, M.



Repeated testing has been shown to enhance memory retention, a phenomenon referred to as test-enhanced learning. Tests that require the production of a response (short-answer questions [SAQs]) show greater test-enhanced learning than those requiring recognition of correct responses (multiple-choice questions [MCQs]). Educators have begun implementing context-rich MCQs (clinical vignettes) that emphasize application of clinical knowledge, rather than recognition of medical ‘facts’. The impact of these context-rich MCQs on test-enhanced learning is not well understood, and so forms the basis of this proposal.

Research questions:

This study will address two main research questions: (1) Can repeated testing improve performance on a mock-PHELO examination? (2) How does question format (SAQs, context-free MCQs, and context-rich MCQs) influence test-enhanced learning effects?

Study design:

A mixed design will be used to investigate test-enhanced learning and transfer appropriate processing phenomena, and the influence of question format (SAQs, context-free MCQs and context-rich MCQs) on later performance. During four weeks, fourth-year medical students at Université de Sherbrooke and McGill University will complete weekly educational activities on public health, ethics, legal and organizational issues of medicine (PHELO). Educational activities will include reading study material or completing weekly quizzes that contain either: SAQs, context-free MCQs or context-rich MCQs. During the final week, students will complete a mock MCCQE PI exam on the topics and objectives previously studied or tested.

Expected outcomes:

Based on previous literature, we expect to find a benefit of testing, with the largest performance benefit found with material studied using context-rich MCQs and SAQs. Overall, the test-enhanced learning literature would predict best performance on material studied using SAQs. However, an alternative outcome is also possible. Because our final performance exam will consist solely of context-rich MCQs, transfer appropriate processing may ameliorate test-enhanced learning, thereby resulting in context-rich MCQs showing the largest performance benefit. Therefore, by examining performance on both SAQs and context-rich MCQs, we hope to tease apart influences of transfer appropriate processing on test-enhanced learning.


McConnell, M.M., St-Onge, C., Young, M.E. (2014). The benefits of testing for learning on later performance. Advances in Health Sciences Education. DOI: 10.1007/s10459-014-9529-1.