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Background Eating disorder (ED) education during medical training is lacking. Few medical trainees feel comfortable managing EDs, and an alarming 78% of healthcare providers report feeling insecure in treating EDs. Recognizing EDs early is crucial as the standardized mortality ratio for patients with anorexia nervosa is more than five times higher than that of the general population. Retrieval practice is a powerful tool in producing meaningful learning of complex concepts in education. We investigated the effectiveness of retrieval practice in ED education among medical trainees to improve recognition, diagnosis, and treatment of EDs among adolescent patients. Methods This exploratory, prospective, cluster-randomized trial enrolled residents and medical students over 14, four-week blocks. Participants were randomized by block to either the conventional lecture-based format (control group) or the retrieval-based educational format (intervention group). The control group received case-based lectures. The intervention group received education via 21 case-based quiz questions over the block with immediate feedback. Groups completed nine-item, multiple choice pre (T1)- and post (T2)-rotation knowledge tests, covering recognizing, diagnosing, and treating EDs. All participants also completed pre- and post-rotation surveys designed to measure self-perceived comfort, confidence in training, knowledge, and skills on the topic of EDs. Results The study's primary outcome was the difference between T1 and T2 scores between study groups. The intervention group showed greater improvement from T1 to T2 (5.8 to 7.4, respectively) than the control group (5.1 to 6.0, respectively). The difference between mean T1 and T2 scores in the control group versus the intervention group was significant (p=0.020). Despite the control group reporting improvements in confidence regarding training on EDs, this increased confidence was inversely correlated with scores on T2 (r=-0.502, p=0.011). Conclusions Trainees benefit from retrieval practice to improve knowledge acquisition regarding EDs. Standard lectures may confer false confidence to learners, which may not accurately align with actual knowledge acquisition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Guy N. Brock, PhD declare(s) a grant from National Institutes of Health, National Center for Advancing Translational Sciences. GNB was supported in part by the National Institutes of Health, National Center for Advancing Translational Sciences grant UL1TR002733. Maria Ash, MD, MA(Ed) declare(s) a grant from Nationwide Children's Hospital. Maria was awarded with an Intramural Grant for trainees, award AWD00000731. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ash et al.)