The Retrospective Pre–Post: A Practical Method to Evaluate Learning from an Educational Program

ACADEMIC EMERGENCY MEDICINE 2012; 19:189–194 © 2012 by the Society for Academic Emergency Medicine Abstract 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.