Spaced education in medical residents: An electronic intervention to improve competency and retention of medical knowledge

Abstract

BackgroundSpaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a “Clinical Pearls” format would improve knowledge retention in medical residents.MethodsThis study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes.ResultsOverall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36–0.42). Incorrect response rates varied by quiz (range 0.34–0.49; p = 0.02), but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08). Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83–1.22; p = 0.95), we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70–0.99, p = 0.04).ConclusionsOverall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of spaced education, however, was unique and readily reproducible suggesting its potential efficacy for intern education within a large residency program.

Conceptualising spaced learning in health professions education: A scoping review

“…Information or questions were distributed through online sources daily (n = 10), every 2 days (n = 8), every 3 days (n = 1) , weekly (n = 12), every 2 weeks (n = 1), or monthly (n = 2). In studies explicitly stating that material was not only spaced but also repeated, repetition delays ranged from various days (n = 2), to weeks (n = 24), to months (n = 12). Additionally, there were large variations in the number of repetitions and intervals between repetitions.…”

“…Approximately half of the empirical research articles (n = 51, 48%) applied spaced learning in an online setting, mostly through delivering learning sessions in e-mails distributed over time using electronic modules, eg, Qstream [19][20][21]23,[27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]47,[51][52][53][54][55]64,74,[78][79][80][81][82][83][84][85] (n = 38, 37%). Spaced learning was also implemented in simulation settings 46,48,53,56,65,67,68,75,76,[86][87][88]…”

“…Information or questions were distributed through online sources daily 22,[27][28][29][30]33,34,37,55,85 (n = 10), every 2 days 19,23,24,31,52,53,64,78 (n = 8), every 3 days 41 (n = 1), wee kly 20,35,36,39,40,43,44,71,80,[114][115][116] (n = 12), every 2 weeks 45 (n = 1), or monthly 43,79 (n = 2). In studies explicitly stating that material was not only spaced but also repeated, repetition delays ranged from various days 22,55 (n = 2), to weeks 19,23,24,[27][28][29][31][32][33][34][35][39][40][41][42]…”

Mobile app technology is associated with improved otolaryngology resident in‐service performance

“…22,26 In addition, spaced repetition, the order in which questions are visited and how often they are reviewed, remains highly important for memory retention and improved academic performance. 8,16,18,19,27 Specifically, this study utilized new and review questions that allowed users to be introduced to new content but also to review questions they had answered incorrectly more often than the questions they answered correctly. As such, review questions were critical for residents to solidify a concept or fact they had previously mistaken or learned for the first time.…”

“…15 It has also been demonstrated to be helpful in knowledge retention with medical students and residents when delivered via email or online. 8,10,[16][17][18][19] Hsueh et al showed support for utilizing digital media in otolaryngology residencies; however, it did not utilize spaced repetition, which could further enhance educational performance. Nevertheless, digital spaced repetition use has not been examined in an otolaryngology residency setting.…”