Not forgetting what you learned – how we can do better in medical education.

This blog posting was inspired by a tweet by @ARJalali (website: Medical Educator 2.0).

Remember that 10th grade history test? No.

Or that psychology exam in first year university? Probably not.

This propensity to forget what we’re learning has carried through to medicine and it appears that our same study habits that we adopted early in our educational careers really don’t serve us well. Cramming doesn’t work. Well, it does to pass the test but as we move into a field where we need to remember things for more than just a day, we need to have ways to learn better. We need to adopt techniques and integrate within our curricula improved methods for trainees to retain knowledge. You could argue that memorizing is less important with any fact just a “google” keystroke away. I agree. But we still need to retain information as it makes us more efficient during clinical situations, in emergent situations we MUST remember and finally it makes it easier to teach others.

Wouldn't you like a method to remember better, than just a few post-it notes?

Wouldn’t you like a method to remember better, than just a few post-it notes?

Psychologists have been interested in these concepts for decades and several interesting ideas have emerged. “Spaced education” – the idea that educational encounters which are spaced over time and repeated result in improved and more efficient learning. Contrast this to everyone’s favorite “Bolus education” which is found at conferences when you sit down for a 1 hour lecture and you expect to actually remember something. Or sit in front of that textbook for hours before the exam then as soon as you walk out of the exam…surprise…you don’t remember a thing!

A study by a urologist published in 2007, randomized medical students to receive this “spaced education” endeavor. This occurred by regular emails with short clinically relevant questions/scenarios followed by MCQ and a summarized “take-home message”.  There were 4 core topics for the urology curriculum at this medical school and half of the participants received 2 topics by “spaced education” while the other participants received the other 2 topics by space education.

The results? Spaced educational emails significantly improved composite end of year tests. With greater benefit for those who received the emails over a longer period (6-12 months).

Another, similarly designed study found that this could be done with consultants and residents. There were statistically significant improvements across a range of topics when learning included a “spaced education” model followed by testing on a cyclical basis. Most importantly 84% of participants wanted to engage in additional programs!

Brilliant! I love this idea! This is a similar concept that is occurring now doing with Twitter and FOAMed (Free open access medical education). Though spaced education is more formalized and contains an evaluative piece. The concept is the same however…deliver short bits of information to the learner on a regular basis. This will improve retention and their ability to self-assess performance.

Educators can easily utilize Twitter or other forms of social media to deliver a regular stream of information to learners which then ideally integrates an evaluative component. This evaluation part is more than just finding out what the learner knows…it functions as an additional learning tool!

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