Use of online spaced education
to reinforce learning
Kitt Shaffer, MD PhD
Vice-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 nonrational 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