Long-Term Forgetting Rates Vary by Bloom's Taxonomy Levels but Not Initial Learning in DPT Education

Abstract

Importance: Health professions education programs emphasize learning specialized knowledge that will be needed by the health care provider long after the initial exposure. Most laboratory investigations into memory have little applicability to the material learned in health professions education, and evidence is mixed on which material is retained and for how long.

Objective: The objective was to describe the retention levels of health professions education material among Doctor of Physical Therapy (DPT) learners over an extended interval and determine if retention varies by the level of knowledge assessed or the performance level of the learner.

Design: Learners completed 6 multiple-choice examinations as part of their standard curriculum. Each exam was integrated to include content covered across all instructional areas. Seventy-two items were selected from these 6 exams and re-administered in 2 retention tests occurring at approximately 5 and 15 months. The retention test items were dichotomized into high-level and low-level according to Bloom's taxonomy. We also compared the forgetting rates between learners in the top and bottom quartile, based on their initial exam performance.

Setting: Learners were enrolled in a residential DPT training program.

Participants: Ninety-four DPT learners participated.

Intervention(s) or exposure(s): This was a retrospective analysis of standard curriculum assessments administered without any interventions.

Main outcome(s) and measure(s): The main outcome was the learners' level of retention at the retention tests.

Results: Overall, retention decreased at the 5 and 15-month intervals. Initial performance was significantly lower on high-level Bloom's items, however, these items showed less forgetting over time compared to low-level items. Learners forgot 9% of the high-level Bloom's items compared to 17.5% of the low-level items. The forgetting rates overall and for each Bloom's level did not significantly differ across top and bottom quartile learners.

Conclusions: This study compared retention across levels of Bloom's taxonomy and compared high and low performing learners. An overall decrease in retention was found, that was attenuated by high-level Bloom's learning as compared to low-level learning.

Relevance: The attenuation of forgetting for high-level Bloom's questions and the stable rates of forgetting across high and low performers have implications for how programs might structure examinations to promote long-term retention. Future work should examine retention over extended intervals and investigate the effect of clinical experiences on the retention of material learned in the classroom.

Keywords: Bloom’s Taxonomy; Forgetting; Health Professions Education; Individual differences in learning; Long-term Retention; Physical Therapy Education.