Three Easy Activities for Retrieval Practice in Nursing Education

Retrieval practice is an essential skill for a learner to master. It involves reconstructing information you learned in the past and bringing it in a new form to the present moment. 

For nursing students, this is a vital skill to bridge the academic-practice gap and allow students to bring what they learn in theory to clinical.

Research suggests that when a memory is retrieved, our minds alter it. Every time it is retrieved, it becomes more flexible and durable, allowing it to be used as a reference for future situations. In addition, if a memory or retrieved information is tied to an emotion, it becomes even more lasting.

In one study, researchers put students into two groups. One group read and re-read text about the pathophysiology of the respiratory system. The other group read the identical text but then typed what they could remember into a virtual notebook (a type of retrieval practice). One week later, students who practiced retrieval (reading and then writing) performed better on the short exam. 

In addition, they could also answer questions about respiratory diseases, such as polio, even though it was not covered in the text. Retrieval practice allowed them to apply the information they had learned about the respiratory system muscles to a new situation.

While we can offer a variety of assessment types in our courses, there is simply no way around the fact that to be a nurse, you will need to take a high-stakes exam. 

But just like you would not register for a marathon and only train on a bike, we cannot expect students to perform on an exam and never “train” for the event. Research suggests that when the pressure to perform well on a test increases, the learning benefits from retrieval can decrease.

Instead, consider offering frequent low-stakes or no-stakes quizzes. Just as runners cross-train, exposing students to various forms of test-taking can increase their ability to perform. And research has shown that frequent quizzing in the classroom can reduce test anxiety. A win all around!

⚡Put it into action: Add a few low-stakes questions to the end of theory or clinical sessions. Bonus points if you can offer alternative format questions.

Have you ever struggled to start a task from a blank page? It seems that even the most basic outline can help the brain categorize and organize information. Using a concept map outline and providing a framework for note-taking can also help students practice retrieval.

When assigning a short lecture section or asking students to read a textbook section before class, offer a partially completed concept map or a diagram to connect and scaffold the information. It can look something like this:

Flashcards can be a great way to learn and recall basic definitions. And repetition is a great way to practice the foundational topics of Bloom’s taxonomy - remembering and understanding. With a simple modification to flashcards, you can help students use this tool to access higher application and analysis levels.

Create two stacks of flashcards.

1. The first stack is TRADITIONAL of cards used for remembering and understanding. For example, using the COPD example lesson, you would include COPD interventions or beta-agonists for the pharmacology section.
2. Then, the second stack is the CONCEPT SET and includes instructions for application exercises. These could include:

• Compare/Contrast
  Pick two traditional cards and describe how they are related or different.

• Real-Life
  Choose one traditional card and think of a real-life example

• Teach It Out Loud
  Choose one traditional card and explain it as if you’re teaching a first-semester nursing student.
• Clinical Prioritization
  Choose two traditional cards and decide which one would be the priority in a patient scenario — explain why.
• Patient Education Translation
  Choose one traditional card and explain it in plain language to a patient with a 6th-grade reading level.
• Complication Connection
  Choose one traditional card and describe a potential complication related to it.
• Medication-to-Condition Link
  Pick one pharmacology traditional card and connect it to the pathophysiology it treats. Explain the mechanism of action.
• What If Scenario
  Choose one traditional card and create a “what if” variation (e.g., What if the patient also has heart failure? What if they are elderly?).
• Assessment Tie-In
  Choose one intervention traditional card and identify what assessment findings would indicate it is effective.
• NCLEX-Style Question Creation
  Pick one traditional card and write a one-sentence NCLEX-style question stem related to it.
• Error Spotting
  Choose one traditional card and describe a common mistake students or new nurses might make related to this concept.
• Sequence It
  Choose three traditional cards and arrange them in the correct clinical order or priority sequence.
• Red Flag Identification
  Pick one traditional card and describe a finding that would require immediate intervention.
• Documentation Practice
  Choose one traditional card and write a brief nursing documentation note that reflects its application in practice.
• Interdisciplinary Lens
  Pick one traditional card and explain how another member of the healthcare team (respiratory therapist, pharmacist, physical therapist, etc.) would be involved.
• Opposite Scenario
  Choose one traditional card and describe what could happen if this intervention is delayed or performed incorrectly.
• Patient Story Builder
  Draw three random traditional cards and create a short patient scenario that incorporates all three.

This simple modification can help students access higher levels of thinking and get extra retrieval practice from a set of flashcards.

⚡Put it into action: Teach students how to create a set of basic flashcards as well as modified flashcards.

Retrieval practice can feel difficult or repetitive, and students may feel that these activities are not productive because they do not see immediate results. However, just like exercise, the results are expected over the long run rather than immediately. 

Nurse educators can use low stakes/no-stakes quizzing, scaffolding with concept maps and modified flashcards as active learning tools to practice retrieval. These types of activities ensure that our students are ready for the NCLEX exam and more importantly, clinical practice.