Online learning is still in its infancy, and many educators are trying to determine which methods work best. One HMS researcher has completed an award-winning randomized trial that shows promising results for a method of online learning based on the “spacing effect.”
The term spacing effect refers to the psychological principle that knowledge is more efficiently acquired and more readily retained when the information is repeated over spaced time intervals rather than given all at once. Relatively few studies, however, have examined the practical application of this principle.
In a recent study, B. Price Kerfoot, HMS assistant professor of surgery at the VA Boston Healthcare System, along with his colleagues, has demonstrated that a novel online methodology based on the spacing effect, called “spaced education,” improved urology residents’ ability to learn and retain clinical knowledge as they prepared for the American Urological Association (AUA) Urology In-service Examination. The study, which was sponsored by the AUA, won the 2007 William Campbell Felch/Wyeth Award for Research in Continuing Medical Education. It is given each year by the Continuing Medical Education Alliance and recognizes “the best completed research project in the area of continuing medical education.”
The randomized trial involved more than 500 urology residents in the United States and Canada. Approximately half (the bolus cohort) were e-mailed a PDF file of validated study questions in week one. The other half (the spaced-education cohort) were sent daily educational e-mails over 27 weeks, each of which contained one or two of these same study questions. The questions were repeated at spaced intervals during the 27-week period. Each spaced educational e-mail required approximately one to three minutes to read. To determine the “forgetting curves” for each cohort, participants completed a delayed online test at different points, anywhere from one to 14 weeks, after the completion of the intervention. Kerfoot, also a senior consultant at Harvard Medical International (HMI), and his colleagues then compared these scores to the participants’ scores on the AUA In-service Examination.
The spaced-education cohort demonstrated significantly greater online test scores than those in the bolus cohort. Analysis of the forgetting curves showed that residents in the spaced-education cohort retained the clinical knowledge longer. These learning gains did not generalize to higher scores on the In-service Examination, however, likely because the study materials represented only a small portion of this test. Ninety-five percent of the residents in the spaced-education cohort requested to participate in future spaced-education programs. The findings will appear in a paper in the April 2007 Journal of Urology.
Spaced education holds promise as an effective method of online CME delivery, since long-term retention is important in making meaningful improvements in clinical practice and patient outcomes. It could also be useful for a variety of student levels, from grade schoolers to adult learners. Kerfoot is currently working with the HMS Center for Educational Technology, HMI, and the AUA to develop and investigate further applications of this spaced-education methodology.
