Struggling Prior to a Teaching Event Results in Superior Short-Term Skills Acquisition in Novice Learners

Objective: The act of generating an answer/solution before a learning episode has been shown to enhance performance, even if the learner produces incorrect answers/solutions. This phenomenon has been termed the pretesting effect. In essence, allowing a learner to struggle prior to instruction may be beneficial. The benefits of the pretesting effect have been demonstrated with declarative knowledge (i.e., facts). The objective of this study was to investigate whether the benefits of the pretesting effect extend to acquisition of procedural skill. Design: Prospective, randomized, pretest–posttest experiment. Participants and Setting: Forty-two first- and second-year medical students enrolled at the University of Texas Health Science Center at San Antonio completed this study. Interventions: Participants were randomly assigned to 1 of 2 instructional conditions. Participants in the teach-first (TF) condition watched a detailed instructional video of laparoscopic intracorporeal suturing and knot-tying (ICSKT) with auditory and text step-by-step instructions prior to attempting the exercise. In contrast, participants in the struggle-first (SF) condition attempted the ICSKT exercise prior to watching the instructional video. All participants completed 4 trials of ICSKT. The first trial was scored as the pretest and the final trial was the post-test. Results: Participants in the TF group had higher pretest scores than participants in the SF group, however these differences were not significant. Despite the pretest deficit, participants in the SF group had higher post-test scores compared to the TF group (p = 0.03). Conclusions: Allowing learners to struggle with a procedural skill prior to receiving instruction results in superior acquisition of psychomotor skills.