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PCRF Research Alert: Retrieval Practice for Higher-Order Learning

This ongoing series from the Prehospital Care Research Forum combs the literature to identify recent studies relevant to EMS education practices.

Agarwal PK. Retrieval practice & Bloom’s taxonomy: Do students need fact knowledge before higher order learning? J Educ Psych, 2018; 111(2): 189–209.

Retrieval practice is a learning strategy where a student recalls or “retrieves” information rather than simply rereading or restudying content. It’s an evidence-based strategy for enhancing fact knowledge, retention, and transfer of knowledge (application to a different context) that emphasizes pulling information out of the learner rather than putting it in.

The positive effects of retrieval practice have been demonstrated across a wide variety of student populations and environments. Recent evidence suggests engaging in complex retrieval practice is more beneficial than starting with basic factual knowledge and definitions.

Pooja Agarwal, PhD, a cognitive scientist and founder of the online resource, examined the common assumption that factual knowledge is a prerequisite for higher-order learning. She devised three experiments to address the research objective; two took place in a college setting, and one in a middle school classroom. This research questions the foundation of factual knowledge theory. Educators might recognize this theory, since it’s represented by the original Bloom’s taxonomy, the pyramid of educational outcomes that suggests a hierarchy of learning in which a student must achieve basic learning outcomes in order to reach “higher-order” or critical-thinking outcomes.

The Experiments

All three experiments tested reading comprehension by having students first read one of eight complex passages on a variety of topics within a discipline and then engage in either restudying the passages or retrieval-based activities such as formative quizzing (fact or higher-order quizzes). The outcome measure was delayed test scores two days later on two test types (a fact quiz and higher-order quiz).

In experiment #1, 48 college psychology students were placed into four retrieval conditions (study once, study twice, study once and take a fact quiz, study once and take a higher-order quiz). After two days the students then completed a fact quiz and a higher-order quiz (the outcome). Experiment #2 took place in the same university psychology department, but with a different group of 48 psychology students, and used this same “4x2 within subjects” design, but this time engaging in four retrieval practice conditions (one higher-order quiz; two higher-order quizzes; two mixed quizzes; two fact quizzes). Once again delayed test outcomes were measured after two days.

The results from these two experiments confirmed that retrieval practice is superior to studying and that retrieval practice with higher-order or mixed-level questions improved delayed fact quiz and higher-order quiz scores. Fact quizzing only enhanced fact-based delayed test outcomes but did not enhance higher-order test performance.

Next Agarwal studied the outcomes in 88 middle school students who read one of eight complex passages on a variety of topics in a history class. Parental consent was obtained prior to initiating the study. This time the study conditions included three retrieval practice conditions (higher-order quizzes, mixed quizzes, and no quiz) and again measured delayed test performance two days later on a fact quiz and higher-order quiz. Mixed-quiz retrieval practice produced the greatest level of performance on fact and higher-order final tests. Retrieval practice increased learning for middle school students compared with no quizzes, supporting a large volume of research on the benefits of retrieval practice. Mixed quizzing benefited both fact and higher-order learning. Overall the author concluded that building a factual base via retrieval practice did not enhance students’ higher-order learning.


This research has clear implications for EMS education and teacher training programs, particularly since national certification exams emphasize higher-order test items and accreditation standards require paramedic programs to use test item analysis to ensure an accurate assessment of cognitive competency. This study supports the use of mixed test item types and levels of difficulty (knowledge, application, and problem-solving) to support critical thinking and retention.

There are many potential avenues for research in EMS education. Do higher-level retrieval practice and cognitive testing translate into better critical thinking skills in simulation, clinical, and field settings? What are the effects of formative high-level cognitive retrieval practice on longer-term retention, say six months to one year later?

Discuss these questions and more with other educators and researchers on the monthly PCRF-NAEMSE Education Research Podcast or listen to the recorded podcast aired on March 22, 2019.

Megan Corry, EdD, EMT-P, is the program director and full-time faculty for the City College of San Francisco paramedic program and on the board of advisors of the UCLA Prehospital Care Research Forum. 



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