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Cited by 7Simulation-Based Education in HealthcareInnovations in Medical EducationCardiac Arrest and Resuscitation

The importance of combined use of spacing and testing effects for complex skills training: a quasi-experimental study.

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Soares, Renata Vicente, Pedrosa, Rafaela Batista dos Santos, Sandars, John, Cecilio-Fernandes, Dario·2025·Medical Teacher
DOI 10.1080/0142159x.2024.2427735
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Abstract

Introduction A major challenge is retention of complex clinical skills. Spacing training and testing have been demonstrated to increase knowledge and skill retention but the combination has not been previously investigated in complex clinical skills. The aim of our study was to compare the effectiveness of combined spacing and testing for Basic Life Support (BLS) and Advance Life Support (ALS) simulation training in one group (intervention group), with combined spacing and testing, and another group (control) that received simulation training in a single-session simulation training without testing.Methods A quasi-experimental study.Results Thirteen nursing students were in the intervention group and 18 in the control group. After three months, there was no significant reduction in retention of BLS knowledge (p > 0.05) or BLS skills (p < 0.05) in the intervention group, but there was a significant reduction in both (p < 0.05) in the control group. We found no significant reduction in retention of ALS knowledge in the control group (p > 0.05), but there was a significant reduction in the intervention group (p < 0.05). There was no significant decay of ALS skills in both groups (p < 0.05).Discussion This is the first study to demonstrate that combined spacing and testing could be highly effective for complex skills simulation training to increase retention after three months.

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  • The combined application of spacing and testing effects significantly improved 3-month retention of both basic and advanced life support skills, whereas learners receiving a single simulation session exhibited substantial skill decay.

    “Soares et al. demonstrated that the combined application of spacing and testing effects significantly improved 3-month retention of both basic and advanced life support skills, whereas learners receiving a single simulation session exhibited substantial skill decay (5).”

    From Application effect of Miller’s pyramid teaching method based on HeartCode BLS in basic life support training for nursing students (2026) · cites this paper as [5]

    The Results (page unavailable) report that the combined intervention maintained BLS skills after three months, while the single-session control group showed BLS skill decay. They do not support the same claim for ALS skills: performance did not differ significantly between groups or across the three time points, and neither group showed significant ALS skill decay. (LLM, conf=0.92)

    Experimental — accuracy not yet measured

  • BLS knowledge and psychomotor skills decay rapidly, often within months.

    “both knowledge and psychomotor skills decay rapidly, often within months (5, 6)”

    From Application effect of Miller’s pyramid teaching method based on HeartCode BLS in basic life support training for nursing students (2026) · cites this paper as [5]

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Cited by

Sorted by citations

Authors
Soares, R. V., Pedrosa, R. B. D. S., Sandars, J., & Cecilio-Fernandes, D.
Affiliations
  • Universidade Estadual de Campinas (UNICAMP) (BR)
  • Edge Hill University (GB)
  • School of Medical Sciences, University of Campinas
ORCID
Venue
Medical Teacher
Publisher
Informa UK Limited
Published
2024-11-13
Volume
47
Issue
8
Pages
1296-1303
ISSN
  • 0142-159X (ISSN-L)
  • 1466-187X
DOI
10.1080/0142159x.2024.2427735
OpenAlex
W4404318476
Cited by
7
References
4
Citations by year
2026: 4 · 2025: 2 · 2024: 1
FWCI
1.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Teacher (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, cc-by-nc-nd)
Funders
FAPESP – São Paulo Research Foundation (2018/15642-1)
Topics
  • Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords
spacing effect, testing effect, skill retention, simulation-based training, basic life support, advanced life support, nursing students, skill decay, knowledge retention
MeSH terms
Simulation Training, Adult, Clinical Competence, Educational Measurement, Female, Humans, Male, Retention, Psychology, Students, Nursing, Young Adult

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