gms | German Medical Science

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

25.09. - 27.09.2014, Hamburg

Predictive value of teaching format, assessment consequences and student motivation on retention of ECG interpretation skills


Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). Hamburg, 25.-27.09.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocV154

doi: 10.3205/14gma244, urn:nbn:de:0183-14gma2448

Veröffentlicht: 11. September 2014

© 2014 Raupach et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Introduction: Summative examinations create a powerful incentive to learn in undergraduate medical education. It has recently been shown that assessment consequences (summative versus formative) are stronger predictors of ECG interpretation skills than teaching intensity. This study addressed the impact of teaching format, assessment consequences and student motivation on medium-term retention of these skills.

Methods: A total of 493 fourth-year medical students participated in a six-group (2×3), partially randomised trial. Students received three levels of teaching intensity: self-directed learning (2 groups), lectures (2 groups) or small-group peer-teaching (2 groups). On each level of teaching intensity, end-of-course written ECG examinations (exit exam) were summative in one group and formative in the other. The primary outcome of this study was student performance in an unannounced written ECG retention test eight weeks after the exit exam.

Results: Compared to formative assessments, summative assessments were associated with a greater performance increase towards the exit exam and a greater decrease towards the retention test (see Figure 1 [Fig. 1]). In a linear regression analysis, summative (vs. formative) assessments predicted retention test scores (adjusted beta 4.06; 95% confidence interval 1.36-6.77). Higher overall performance levels and higher motivation to learn were also predictive of higher scores in the retention test. However, the decrease in ECG interpretation skills between the exit exam and the retention test was independent of these student characteristics (see Table 1 [Tab. 1]).

Discussion/conclusion: Although summative assessments increase medium-term retention of ECG interpretation skills, they cannot prevent a steep decrease in performance levels over an 8-week follow-up period. This decrease occurs in all students irrespective of their overall performance levels [1], [2], [3].


Raupach T, Brown J, Anders S, Hasenfuss G, Harendza S. Summative assessments are more powerful drivers of student learning than resource intensive teaching formats. BMC Med. 2013;11:61. DOI: 10.1186/1741-7015-11-61 Externer Link
Misch DA. Andragogy and medical education: are medical students internally motivated to learn? Adv Health Sci Educ Theory Pract. 2002;7:153-160.
Raupach T, Hanneforth N, Anders S, Pukrop T, Th J ten Cate O, Harendza S. Impact of teaching and assessment format on electrocardiogram interpretation skills. Med Educ. 2010;44(7):731-740. DOI: 10.1111/j.1365-2923.2010.03687.x Externer Link