LEARNING VERSUS PERFORMANCE
Training in the medical field is expensive. Therefore, finding effective and efficient training methods that can result in cost savings is a legitimate and important motive for many researchers. An intuitive approach might be to compare different practice methods in terms of the time needed by participants to reach a predefined level of performance.9,10 Such an approach has significant shortcomings, however. It can only demonstrate how performance is influenced by
certain training methods, which may, or may not, have anything to do with how much was learned.
Learning is typically defined as a relatively permanent change in a person’s capability to perform a skill.
Therefore, researchers use retention or transfer tests (the latter involve a variation of what was practised)
that are performed after a certain time interval (i.e. at least 1 day, but sometimes several days or even weeks).
The purpose of this interval is to allow any temporary performance-enhancing effects (such as caused by greater guidance) or performance-degrading effects (such as caused by increased fatigue) that certain practice conditions may have created to dissipate, leaving only the relatively permanent, or learning, effects. Another important aspect of retention or transfer tests is that all groups perform under the same conditions (e.g. without feedback or demonstrations).
Only then can the performance of different groups be compared on a level playing field, so that conclusions can be drawn about the effectiveness of different practice methods for learning.
Thus, one cannot infer that the most rapid change in performance, or achievement of criterion performance – under practice conditions in which feedback, modelling or other interventions are still present – constitutes true learning in the sense of retained or general is able skill or knowledge. Clearly,
as in other areas, the goal of training in the medical field is not to facilitate performance during practice, but to enhance the learning and transfer ability of clinical skills. In the following sections, we review variables that have been shown to affect learning