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Background  Spaced-repetition and test-enhanced learning are two methodologies that boost knowledge retention. ALERT STUDENT is a platform that allows creation and distribution of Learning Objects named  flashcards , and provides insight into student judgments-of-learning through a metric called ‘recall accuracy‘. This study aims to understand how the spaced-repetition and test-enhanced learning features provided by the platform affect recall accuracy, and to characterize the effect that students,  flashcards  and repetitions exert on this measurement.    Methods  Three spaced laboratory sessions (s0, s1 and s2), were conducted with n=96 medical students. The intervention employed a study task, and a quiz task that consisted in mentally answering open-ended questions about each  flashcard  and grading recall accuracy. Students were randomized into study-quiz and quiz groups. On s0 both groups performed the quiz task. On s1 and s2, the study-quiz group performed the study task followed by the quiz task, whereas the quiz group only performed the quiz task. We measured differences in recall accuracy between groups/sessions, its variance components, and the G-coefficients for the  flashcard  component.    Results  At s0 there were no differences in recall accuracy between groups. The experiment group achieved a significant increase in recall accuracy that was superior to the quiz group in s1 and s2. In the study-quiz group, increases in recall accuracy were mainly due to the session, followed by  flashcard  factors and student factors. In the quiz group, increases in recall accuracy were mainly accounted by  flashcard  factors, followed by student and session factors. The  flashcard  G-coefficient indicated an agreement on recall accuracy of 91% in the quiz group, and of 47% in the study-quiz group.    Conclusions  Recall accuracy is an easily collectible measurement that increases the educational value of Learning Objects and open-ended questions. This metric seems to vary in a way consistent with knowledge retention, but further investigation is necessary to ascertain the nature of such relationship. Recall accuracy has educational implications to students and educators, and may contribute to deliver tailored learning experiences, assess the effectiveness of instruction, and facilitate research comparing blended-learning interventions.    Electronic supplementary material  The online version of this article (doi:10.1186/s12909-014-0275-0) contains supplementary material, which is available to authorized users.

Characterization of medical students recall of factual knowledge using learning objects and repeated testing in a novel e-learning system