The retrospective pre-post: A practical method to evaluate learning from an education program

Objectives: Program evaluation remains a critical but underutilized step in medical education. This study compared traditional and retrospective pre-post self-assessment methods to objective learning measures to assess which correlated better to actual learning.

Methods: Forty-seven medical students participated in a 4-hour pediatric resuscitation course. They completed pre and post self-assessments on pediatric resuscitation and two distracter topics. Postcourse, students also retrospectively rated their understanding as it was precourse (the “retrospective pre” instrument). Changes in traditional and retrospective pre- to postcourse self-assessment measures were compared to an objectives-based multiple-choice exam.

Results: The traditional pre to post self-assessment means showed an increase from 1.9 of 5 to 3.7 of 5 (p < 0.001); the retrospective pre to post scores also increased from 1.9 of 5 to 3.7 of 5 (p < 0.001). Although the group means were the same, individual participants demonstrated a response shift by either increasing or decreasing their traditional pre to retrospective pre scores. Scores on the 22-item objective multiple choice test also increased, from a median score of 13.0 to 18.0 (p < 0.001). There was no correlation between the change in self-assessments and objective measures as demonstrated by a Spearman correlation of -0.02 and -0.13 for the traditional and retrospective pre-post methods, respectively. Students reported fewer changes on the two distracters using the retrospective pre-post versus the traditional method (11 vs. 29).

Conclusions: Students were able to accurately identify, but not quantify, learning using either traditional or retrospective pre-post “self-assessment” measures. Retrospective pre-post self-assessment was more accurate in excluding perceived change in understanding of subject matter that was not taught.