The results reveal a strong positive correlation between the number of successful retrieval attempts in these tests that cover content from the course textbook, and long-term knowledge retention as demonstrated in a live, final, closed book, cumulative exam consisting of multiple choice, labeling, definitions, and open ended questions covering the content of both textbook readings and lectures.

The presented results suggest that online, open book tests designed using gamification principles, even when covering partial course content and one type of questions, are an effective strategy for using educational technology to motivate students to repeatedly engage in retrieval based learning activities and improve long-term knowledge retention, regardless of the course delivery mode.