Confidence-weighted Testing as an Impactful Education Intervention within a Pediatric Sepsis Quality Improvement Initiative.

INTRODUCTION: Confidence-weighted testing assesses learners' beliefs about their knowledge and skills. As part of a hospital-wide quality improvement initiative to enhance care for pediatric patients with suspected sepsis, we developed a novel intervention using confidence-weighted testing to identify institutional areas of misinformation and knowledge gaps while also providing real-time feedback to individual learners. METHODS: We developed pediatric sepsis eLearning modules incorporating confidence-weighted testing. We distributed them to nurses, advanced practitioners, and physicians in emergency departments and acute care/non-intensive care unit inpatient settings in our hospital system. We analyzed completion and response data over 2 years following module distribution. Our outcomes included completion, confidently held misinformation (CHM; when a learner answers a question confidently but incorrectly), struggle (when a learner repeatedly answers a question incorrectly or with low confidence), and mastery (when a learner initially answers a question correctly and confidently). RESULTS: Eighty-three percent of assigned learners completed the modules (1,463/1,754). Although nurses had significantly more misinformation and struggled more than physicians and advanced practitioners, learners of all roles achieved 100% mastery as part of module completion. The greatest CHM and struggle were found in serum lactate interpretation's nuances and the hemodynamic shock states commonly seen in sepsis. CONCLUSIONS: Our novel application of confidence-weighted testing enhanced learning by correcting learners' misinformation. It also identified systems issues and institutional knowledge gaps as targets for future improvement.

Benefits of Accumulating Versus Diminishing Cues in Recall.

Optimizing learning over multiple retrieval opportunities requires a joint consideration of both the probability and the mnemonic value of a successful retrieval. Previous research has addressed this trade-off by manipulating the schedule of practice trials, suggesting that a pattern of increasingly long lags-"expanding retrieval practice"-may keep retrievals successful while gradually increasing their mnemonic value (Landauer & Bjork, 1978). Here we explore the trade-off issue further using an analogous manipulation of cue informativeness. After being given an initial presentation of English-Iñupiaq word pairs, participants received practice trials across which letters of the target word were either accumulated (AC), diminished (DC), or always fully present. Diminishing cues yielded the highest performance on a final test of cued recall. Additional analyses suggest that AC practice promotes potent (effortful) retrieval at the cost of success, and DC practice promotes successful retrieval at the cost of potency. Experiment 2 revealed that the negative effects of AC practice can be partly ameliorated by providing feedback after each practice trial.