Use of online spaced education to reinforce learning

Kitt Shaffer, MD PhDVice-Chair of Radiology for Education

Boston Medical Center

what is the spacing effect?

• information that is delivered multiple times, with some length of time in between repetitions, is retained better than information delivered once

do we make use of the spacing effect in medical education?

• yes and no• for some courses, detailed information is

given in one large bolus (1st year Anatomy)• however, material may be revisited in later

courses (systems-based courses may review anatomy pertinent to each organ system in 2nd yr, clinical courses review anatomy in 3-4th yr)

• this is probably too LONG for real spacing effect to be seen

Custers EJ. Long-term retention of basic science knowledge: a review study. Adv Health Sci Educ Theory Pract 2008;Feb 15.

what is the research to support the spacing effect?

Kerfoot BP, DeWolf WC et al. Spaced education improves the retention of clinical knowledge by medical students: a randomized controlled trial. Med Educ 2007;41(1):23-31.

what is the testing effect?

• material that is tested is retained• this is separate from the student and faculty

tendency to ‘teach to the test’, or the question ‘will this be on the test?’

• facts which a learner has had to RECALL for a test will be retained better than other facts

what is the research to support the testing effect?

• college students were either quizzed weekly on material or given additional reading assignments

• quizzing led to significantly higher scores on final exam

• fill-in format quizzes led to higher scores than MCQ format quizzes

McDanier MA, Anderson JL et al, Testing the testing effect in the classroom. Eur J Cog Psych 19:494-513;2007.

do we make use of the testing effect in medical education?

• yes and no• obviously, we test students on material• we may select what to test on based on non-

rational choices (what type of material lends itself to testing, what type of material is easy to formulate as an MCQ?)

is there another way to make use of both the spacing and testing effects?• SpacedEd– a website that provides infrastructure to design

online courses that offer various testing formats as well as customizable spacing intervals

– use the website to enter questions and explanations

– invite learners to join course– select spacing interval, other parameters

what do course participants see?

• emails in their inbox “Your SpacedEd questions for today…”

• upon opening email, link takes them to the website

• question is displayed, may include images, video, text, diagrams

• participant answers, gets feedback• same question is sent again after appropriate

spacing interval

demonstration--user

what does the course designer see?

• http://www.spaceded.com• tools available to set up a course on any topic– type in questions, explanations– upload image files, diagrams, movies– set parameters for participants• how often to repeat (spacing interval)

demonstration--teacher

Conclusions

• Repetition is key to retention for learners– even a single repetition at an appropriate interval

(2-6 weeks) can dramatically improve retention• Testing itself improves retention– effect is most pronounced for fill-in questions

• SpacedEd is a site that allows design of courses that take advantage of both the spacing effect and the testing effect– CT Anatomy review is in the top 15 courses on site