End of course testing vs. continuous assessment (EIT #643): Systematic Review

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ILCOR staff

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This Review is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final Review will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none applicable

The following Task Force members and other authors declared an intellectual conflict of interest: none to declare.

CoSTR Citation

Breckwoldt J, Beck S, Beckers SK, Bhanji F, Bigham BL, Bray JE, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma M, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn J, Greif R. - on behalf of the International Liaison Committee on Resuscitation Task Force Education, implementation and Teams.

‘End of course testing vs. continuous assessment’ Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Task Force Education, Implementation and Teams, 2020, Jan 3th. Available from: http://ilcor.org

Methodological Preamble

The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review (PROSPERO submission Dec 3rd, 2019 ) conducted by Gosteli M (Information specialist, University of Zurich) and Breckwoldt J, Beck S, Beckers SK (clinical content experts). Evidence was sought and considered by the Task Force EIT. These data were taken into account when formulating the Consensus of Science and Treatment Recommendations.

The databases CINAHL, MEDLINE, PsycINFO, EMBASE, and Cochrane were searched from inception up to Nov 23rd 2019. A total of 2,159 titles were identified and screened leading to 51 abstracts and subsequently to 10 articles which were retrieved for full text analysis.


Population: Among participants undergoing BLS/ALS courses

Intervention: does end of course testing

Comparison: compared to continuous assessment and feedback

Outcomes: improve cognitive knowledge and/or skill performance at course conclusion, skill performance at time between course conclusion and 1 year, skill performance at 1 year, skill performance in actual resuscitations, increase survival rates.

Study Designs: All comparative, human studies (prospective and retrospective) examining the use of pre-course preparation for advanced life support training and reporting knowledge/skills outcomes. Also, patient outcomes and performance in actual resuscitation situations.

Timeframe: All years and all languages were included as long as there was an English abstract; unpublished studies (e.g., conference abstracts, trial protocols) were excluded. Literature search updated to November 28, 2019.

PROSPERO submission: Dec 3rd 2019

Consensus on Science

No studies were found that addressed the PICOST question.

We identified 3 studies {Kromann 2010 395; Kromann 2009 21; Kromann 2011 192} that analyzed the educational effect of end-of-course testing (without comparing it to continuous assessment).

Treatment Recommendations

Given that no evidence was identified, we are unable to make a recommendation.

Justification and Evidence to Decision Framework Highlights

This topic was prioritized by the EIT Task Force based on the ongoing discussion of developing more appropriate assessment methods in resuscitation courses. There are reported to be positive educational effects of end-of course testing.

Knowledge Gaps

Evidence is needed for the most appropriate way of to assess competence of candidates attending resuscitation courses (eg. continuous assessment versus end-of-course testing).


Kromann CB, Bohnstedt C, Jensen ML, Ringsted C. The testing effect on skills learning might last 6 months. Adv Health Sci Educ Theory Pract. 2010;15:395-401.

Kromann CB, Jensen ML, Ringsted C. The effect of testing on skills learning. Med Educ. 2009;43:21-7.

Kromann CB, Jensen ML, Ringsted C. Test-enhanced learning may be a gender-related phenomenon explained by changes in cortisol level. Med Educ. 2011;45:192-9.


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