Dr Nielsen’s work concerns making websites more user-friendly; what separates him from many others in his field is the quality and originality of his research. However, in this article, he cites work by Karpicke and Blunt which found that “retrieval” (by taking tests) trumps repeated study and concept mapping, the latter being a popular strategy among educators to aid students’ retention (memory):
Retrieval practice produced the best learning, better than elaborative studying with concept mapping, which itself was not significantly better than spending additional time reading.
Overall, 101 out of 120 students (84%) performed better on the final test after practicing retrieval than after elaborative studying with concept mapping. … Ninety out of 120 students (75%) believed that elaborative concept mapping would be just as effective or even more effective than practicing retrieval.
The same research was also summarized in the New York Times article “To Really Learn, Quit Studying and Take a Test” by Pam Belluck.
The study was interesting for another reason – the students’ metacognition (process of thinking about thinking) was found to be extremely poor:
Students’ judgments of learning were solicited after students had experienced each text in the initial learning phase. In general, students erroneously predicted that elaborative concept mapping would produce better long-term learning than retrieval practice.
I suspect the latter finding had a lot to do with belief perseverance, or confirmation bias if you like – a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true.
So how is all this practically relevant to passing the CPHQ exam?
People who are gearing up for the CPHQ exam have to remember a lot of things – the practice of healthcare quality covers a broad range of disciplines.
Almost everyone will be required to do some reading (“studying”) before the exam. The problem is that most people are working professionals too busy to find the time needed to study everything thoroughly.
The research conducted by Karpicke and Blunt supports my hypothesis (and our preliminary data on CPHQ test takers) that “studying” (i.e. reading) alone is not an effective way of learning and/or preparing for the exam.
For several months now, we have been evaluating the effects of frequent testing in the form of microquizzes among CPHQ candidates.
The feedback we got was that people generally don’t like reading but they want to assimilate the relevant information to help them pass the exam. At the same time, we don’t want to publish material that is of limited utility to people – that’s wasting their time and ours.
Through an iterative process, we’ve figured out, to some extent, what works and what doesn’t.
We know that the regular microquizzes that we publish almost every day help people remember pertinent points – this is strongly supported by the research described in Karpicke and Blunt’s paper – and perhaps more importantly, help people to prepare for the CPHQ exam efficiently. By taking the quizzes online, we believe encoding (implanting into memory) is facilitated through a few ways:
- Retrieval and reconstruction (as described above).
- Hawthorne effect or something similar – by repeatedly returning to the site for “testing”, it is our hypothesis that our members improve their underlying performance by this process, independent of other effects. This phenomenon is similar to how people shed weight and keep it off by joining weight management sites.
- Coupling questions with relevant material. As described several times in the past, we give detailed explanations of the answers to our questions. In recent weeks, we have taken this to a new level – whenever possible, the explanations have become mini articles. Alternatively, we have linked questions with relevant articles in close time proximity. The idea behind this move is that (we believe) users’ attention is primed for encoding and subsequent storage, retention and recall immediately after attempting a quiz. In other words, users have the potential to learn significantly more in the immediate post-test period. An analogy to this phenomenon is the improved rate of success of smoking cessation interventions in the period immediately after a myocardial infarction (heart attack); this period is a precious and unique window of opportunity to affect behavior change.
Our CPHQ trainees and members, most of whom have gone on to pass the CPHQ exam, can attest to this method of learning. We realize it is not conventional, but it is highly effective.
Frequent testing with quizzes is not something that CPHQ candidates will buy into easily for several reasons:
- Many people still shy away from being tested. This could be a psychological defense mechanism – to “protect” the individual from facing the harsh reality of how much he/she might not know. Sometimes the truth is hard to swallow.
- Belief preservation. As alluded to above, people tend to favor information that confirms their preconceptions, independent of whether the information is true.
- Some people prefer the perceived security of owning physical books as opposed to accessing information online.
We are constantly on the lookout for new ways to deliver relevant content and evaluating their effectiveness. Particularly on the back of the research above, we are confident that our quizzes, though cannot be used exclusively at this stage, help candidates to significantly improve their CPHQ exam scores.
It’s no wonder then that many CPHQs have reported our quizzes helped them in their exam preparation.
Like the rest of our work in quality, the fruit is in the pudding.
September 3, 2020 Update
Our membership site dedicated to CPHQ exam preparation is now called CPHQ Tutor. We have also consolidated our microquizzes (usually consisting of only one or two questions, published daily) to quizzes, usually consisting of 25–35 questions each, published about every three days.