August 24, 2014

Stop Re-Reading … and Try Self-Testing!

by Amanda Schartel, Pharm.D., PGY2 Ambulatory Care Resident, University of Maryland School of Pharmacy

Take a minute and think back on the hundreds of quizzes, tests, and other assessments you have taken during your years in school.  Remember the countless hours and late nights you put in trying to learn everything in time?  Now think about how much of that information you actually remember days, weeks, months, and years later.  If you’re like me, you probably realize just how much of that information you have forgotten.  While you put in a lot of time and effort studying, the information learned was all too soon forgotten.  This is due, in part, to the ineffective and inefficient study strategies that most of us employ.  As students progress on to college and graduate school, poor study habits becomes a bigger problem as the material becomes increasing complex. This problem is particularly important for students training to become healthcare professionals given the fast pace at which medical information changes.1

Student Perceptions and Use of Study Strategies
In order to help our students succeed, we must first identify what study strategies they currently use and what perceptions they have about effective ways to learn.  A survey of undergraduate students at a top university found that repeated re-reading was the most common study strategy (83.6%) with more than half of the students ranking re-reading as their preferred study strategy.  One of the least common study strategies used was self-testing (10.7%).  And the majority of these students avoided self-testing if they could not go back to re-read the material.2

These findings are similar to a study conducted by Hagemeier and colleagues who surveyed pharmacy students about their study habits.  They found that only 11.6% of students would self-test if they did not have the option of going back to re-read the material.  Half of the students reported that if they self-tested, it was to see what they had learned.  Only a third of the students believed self-testing helped them learn more.  The majority of students stated that spreading out study sessions was beneficial, but only 17% scheduled study sessions in advance and 60.2% reported that they crammed for exams.  

The majority of students state that their study habits are NOT based on formal instruction on how to study.1 This suggests that most students have never been trained to study in effective ways.  Interventions by educators may give students the tools needed to succeed.

(In)Effective Study Strategies
We now know that many students use re-reading as their preferred study strategy. But is this actually an effective way to study? Are there other study strategies that are more effective?
While re-reading is common, it has only modest benefits on learning.3  Re-reading is most effective when there is a short delay between readings.  It is not effective when the material is re-read immediately following the initial reading.  Re-reading is most useful for recall-based tasks, and its effects on comprehension are questionable.  In head-to-head studies, re-reading has been found to be inferior to several other study strategies, including self-testing, elaborative interrogation, and self-explanation.3  Students may be under the false impression that re-reading is an effective strategy because they are committing a great amount of time when using this strategy.  But this may be a “labor-in-vain” phenomenon, whereby spending extra time memorizing information does not promote meaningful learning.2 In a comprehensive review of learning techniques by Dunlosky and colleagues, re-reading, summarization, highlighting/underlining, keyword mnemonic, and imagery for text were identified as a low utility learning strategies.3  This was based on research showing that these techniques do not increase performance, lead only to short-term retention of information, and are only helpful for some students and in some contexts.3

So if these commonly used learning strategies are ineffective, which strategies would be more effective for students to use?  Dunlosky and colleagues identified two high utility strategies:  self-testing and distributed practice.3  Both of these strategies benefit learners of different ages and abilities, as well as increase performance across many tasks and contexts.2

The literature has described the concept of the “testing effect” since the 1600s.  It suggests that the act of retrieving information from memory increases long-term retention.1  Also, it has been proposed that self-testing may improve performance by enhancing how students mentally organize and process information.2  The testing effect is not just limited to formal assessments, but can also be seen when students practice recall on their own (i.e. complete practice problems, use flashcards).  In a study of first-year medical students by West and colleagues, researchers found that self-testing was a significant predictor of first-semester final grades and practical examination averages.4

Distributed Practice
We know that many students typically pack their studying into a short period of time before an exam.  While this may lead to short-term retention of the material, it has been shown that spreading out study activities over time, or distributed practice, has greater benefits and leads to long-term retention.  This may be because distributed study sessions force students to repeatedly retrieve previous knowledge, which is known to reinforce memory and retention.  Furthermore, when study sessions are spaced out, it forces the student to work harder to retrieve the information from memory and allows them to more accurately assess their understanding.3 Similar to self-testing, West and colleagues found that time management—including maintaining a study schedule—was a significant predictor of first-semester final grades and written examination averages.4

Help Students Adopt Better Study Habits
Given that many students use study strategies that are less than optimal, educators should provide guidance to students about the value of alternative strategies such as self-testing and distributed practice.  Furthermore, structuring instruction to encourage students to use these strategies, such as creating practice problem sets for self-testing, can help the students to become successful lifelong learners.

  1. Hagemeier NE, Mason HL. Student pharmacists’ perceptions of testing and study strategies. Am J Pharm Educ. 2011;75:Article 35.
  2. Karpicke JD, Butler AC, Roediger HL. Metacognitive strategies in student learning: do students practise retrieval when they study on their own? Memory 2009;17:471-9.
  3. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students’ learning with effective learning techniques: promising directions from cognitive and educational psychology. Psychol Sci Public Interest 2013; 14:4-58.
  4. West C, Sadoski M. Do study strategies predict academic performance in medical school? Med Educ. 2011;45:696-703.