Distributed retrieval practice promotes superior recall of anatomy information

Enhancing students' agency in learning anatomy vocabulary with a formative intervention design

One of the major challenges for health science students is the rapid acquisition of a new vocabulary in anatomy comprising several hundred new words. Research has shown that vocabulary learning can be improved when students are directed to vocabulary strategies. This paper reported a study with a formative intervention design inspired by Vygotsky's method of double stimulation. In this design, the students were put in a structured situation that invited them to identify the challenges in learning anatomy and then provided them with active guidance and a range of anatomy vocabulary learning strategies that scaffolded them to work out a solution to the challenge and develop their individualized anatomy learning resources. The data were collected from surveys, pre and postquiz results, and group discussion transcripts. The results revealed students perceived one of the main challenges in learning anatomy was learning, memorizing, and remembering many new words. A key finding in our study was that the formative intervention enhanced students' agency in creating resources for learning anatomy vocabulary. In addition, the development of their understanding showed a recursive form: from concrete experiences to abstract concepts and then to concrete new practices.

Systematic review of distributed practice and retrieval practice in health professions education

To determine the effect of distributed practice (spacing out of study over time) and retrieval practice (recalling information from memory) on academic grades in health professions education and to summarise a range of interventional variables that may affect study outcomes. A systematic search of seven databases in November 2022 which were screened according to predefined inclusion criteria. The Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) were used to critically appraise eligible articles. A summary of interventional variables includes article content type, strategy type, assessment type and delay and statistical significance. Of 1818 records retrieved, 56 were eligible for inclusion and included a total of 63 experiments. Of these studies, 43 demonstrated significant benefits of distributed practice and/or retrieval practice over control and comparison groups. Included studies averaged 12.23 out of 18 on the MERSQI and averaged 4.55 out of 6 on the NOS-E. Study designs were heterogeneous with a variety of interventions, comparison groups and assessment types. Distributed practice and retrieval practice are effective at improving academic grades in health professions education. Future study quality can be improved by validating the assessment instruments, to demonstrate the reliability of outcome measures. Increasing the number of institutions included in future studies may improve the diversity of represented study participants and may enhance study quality. Future studies should consider measuring and reporting time on task which may clarify the effectiveness of distributed practice and retrieval practice. The stakes of the assessments, which may affect student motivation and therefore outcomes, should also be considered.

Evaluating knowledge loss over multiple retention intervals can identify deficiencies and inform curricular development

Nursing students struggle to retain enough anatomical knowledge to meet their entry to practice competencies, but what knowledge is missing and when this occurs has been previously unexplored. A cohort of 80 nursing students were given multiple choice quizzes to assess their anatomical knowledge on 11 different organ systems during their second, third, and fourth year. Results were analyzed in comparison to their first-year examination scores to determine knowledge loss. Results showed an overall knowledge loss of 33.5% in the second year, 31.8% in the third year, and 29.6% in the fourth year. There were significant differences in system specific results. Special senses (i.e., audition) had a 20.6% loss in the second year, increased in retention to a 17.3% loss in third year, and then decreased to a 37% loss in fourth year. The vascular system had a 46.1% knowledge loss at the second-year assessment, declined to 49% knowledge loss in the third year, but improved to 27.6% knowledge loss by the fourth year. A similar change was observed for the musculoskeletal system with second-year loss at 30.7%, third-year loss at 40.3%, and fourth-year loss at 26.6%. These data suggest there are significant differences in the amount of knowledge retained by nursing students depending on the system being tested and the year the test is taken. Identifying the areas and times where anatomical knowledge is lost and gained is valuable for instructors in any program so that specific topics can be targeted at different times with more effective educational strategies.

Using Evidence-Based Learning Strategies to Improve Medical Education

Medical education research has been adopting principles from psychology to improve student learning. Here is an overview and illustrative examples of six evidence-based learning strategies that have been thoroughly researched and validated in the psychology literature: spacing, interleaving, retrieval practice, elaboration, dual coding, and concrete examples. For each of these, their use within medical education and considerations that may influence efficacy are discussed. Medical education researchers should collaborate more with psychology researchers in transdisciplinary teams to better implement these strategies and more directly benefit from advances made in the psychology literature.

Prior anatomy experience among medical students: What difference does it make?

Prior research has reported that experience in undergraduate anatomy did not significantly affect students' grades in professional schools, yet students would still recommend anatomy experience prior to medical school. It has been further posited that this prior experience may have benefits that do not appear in grade outcomes, such as decreased stress levels or different study strategies. The present study investigated whether different study strategies in anatomy were reported between students with and without prior experience. The data were collected using surveys administered near the beginning and the end of the medical anatomy course. The surveys included questions about study strategies used for the course, basic demographics, and prior experience in anatomy and/or physiology. Results confirmed very few differences in course outcomes between students with and without prior experience in anatomy and/or physiology; however, differences were noted in the study strategies reported. Students with prior experience in anatomy were more likely to report use of a wider variety of strategies and less changes in strategies between the surveys. However, these differences were only noted with prior courses of a certain number and level. It is posited that students with prior experience may have already created a basic scaffold of information in their mind that they could then plug additional information into rather than creating an entirely new knowledge structure. While this did not largely change course outcomes, it is likely to have positive effects on students' perceptions of stress and feelings of being overwhelmed during the course.

Desirable Difficulty: Theory and application of intentionally challenging learning

CONTEXT

Health professions trainees must acquire a vast amount of clinical knowledge and skills, and a deliberate instructional design approach is needed to provide trainees with effective learning strategies. One powerful yet counterintuitive strategy that facilitates long-term learning is incorporating intentional difficulties during the learning process. Difficulties that require more effort from learners may impede short-term learning but are ultimately beneficial for long-term learning and are therefore termed Desirable Difficulties.

OBJECTIVES

In this cross-cutting edge paper, we describe the Desirable Difficulty effect from three theoretical perspectives originating in different fields, discuss common evidence-based Desirable Difficulty strategies used in Health Professions Education and explore emerging research that could further optimise Desirable Difficulty-enhanced learning for health professions trainees.

METHODS

We synthesise theory and research from psychology, cognitive science and Health Professions Education literatures to further the understanding and application of Desirable Difficulties. We introduce three theoretical perspectives that provide a comprehensive overview of the theoretical underpinnings of the Desirable Difficulty effect: the New Theory of Disuse, the Challenge Point Framework and Cognitive Load Theory. We then illustrate how three common Desirable Difficulty strategies in medical education research-retrieval practice, spaced practice and interleaved practice-can be understood through these theoretical lenses. Finally, we provide relevant examples from the literature and explore emerging research in this area.

CONCLUSIONS

This paper summarises the theory and empirical research on Desirable Difficulties during the learning process, from explaining what they are and why they may be effective to how they have been applied in different contexts. We argue that providing educators and trainees with a comprehensive theoretical and applied understanding of Desirable Difficulty will promote deliberate instructional design decisions and lead to more effective learning.

Using the study cycle model to support better student learning: a faculty guide

Despite years of varied school experiences, many college students do not have adaptable study methods that allow them to collect, organize, and reorganize information to critically assess what they know and what they need help with until after a poor exam performance. Faculty are frequently called on to help students become better learners. In addition, as the tasks and complexity of the material become more challenging, students will need to adopt new study habits and adapt them to each new learning opportunity to reach their goals. This article describes an evidence-based framework that teachers can share with students that will support better studying habits leading to deeper learning.NEW & NOTEWORTHY Many college students do not have adaptable methods habits that allow them to get the most out of in-class time and structure their out-of-class study time. As a result, faculty are frequently called on to help students become better learners. This article describes an evidence-based framework focusing on learning anatomy and physiology examples that faculty can share with students to support better studying habits leading to deeper learning.

Voluntary participation in flipped classroom application sessions has a negligible effect on assessment outcomes in an accelerated pass-fail course

Increasingly, basic science educators at medical and health science programs are faced with the challenge of delivering fundamental science content using evidence-based pedagogical approaches that build students' fund of knowledge while also supporting their development as self-regulated learners. This has led to an increased use of active learning-based pedagogies such as flipped classroom teaching. However, there are many open questions about the conditions necessary for successful flipped classroom sessions. In particular, the role of student compliance (i.e., participation, engagement, attendance) in mediating performance needs to be evaluated. This is especially important in accelerated curricula where multiple basic science disciplines are integrated together in pass-fail courses, presenting challenges to both students' time and cognitive load. Data on prematriculation performance, in-class participation, weekly quiz performance, and summative assessment performance from three cohorts of medical students (n = 146) at a new medical school were collected and analyzed. We found that historically high-performing students more readily participated in flipped classroom application sessions compared with historically lower-performing students. Correlational analysis of performance on weekly formative quizzes and the summative course exam was not related to in-class participation. However, performance on weekly formative quizzes played the most significant role in students' performance on summative exams. Efforts to understand the benefits of in-class participation beyond short-term assessment performance, such as long-term knowledge retention or development of noncognitive skills, should be undertaken to justify using such time- and human resource-intensive pedagogies.NEW & NOTEWORTHY This study explores the use of flipped classroom teaching in a voluntary and accelerated medical school course. We found that historically high-performing students attend class, whereas historically low-performing students do not attend class as readily. Formative assessment performance appears to be more important than participation in determining the final grade. Correlation of high performance (>90%) with participation may differentiate students who excel in our curriculum from those who simply pass with superficial knowledge.

Solidity Meets Surprise: Cerebral and Behavioral Effects of Learning from Episodic Prediction Errors

How susceptible a memory is to later modification might depend on how stable the episode has been encoded. This stability was proposed to increase when retrieving information more (vs. less) often and in a spaced (vs. massed) practice. Using fMRI, we examined the effects of these different pre-fMRI retrieval protocols on the subsequent propensity to learn from episodic prediction errors. After encoding a set of different action stories, participants came back for two pre-fMRI retrieval sessions in which they encountered original episodes either 2 or 8 times in either a spaced or a massed retrieval protocol. One week later, we cued episodic retrieval during the fMRI session by using original or modified videos of encoded action stories. Recurrent experience of modified episodes was associated with increasing activity in the episodic memory network including hippocampal and cortical areas, when leading to false memories in a post-fMRI memory test. While this observation clearly demonstrated learning from episodic prediction errors, we found no evidence for a modulatory effect of the different retrieval protocols. As expected, the benefit of retrieving an episode more often was reflected in better memory for originally encoded episodes. In addition, frontal activity increased for episodic prediction errors when episodes had been less frequently retrieved pre-fMRI. A history of spaced versus massed retrieval was associated with increased activation throughout the episodic memory network, with no significant effect on behavioral performance. Our findings show that episodic prediction errors led to false memories. The history of different retrieval protocols was reflected in memory performance and brain responses to episodic prediction errors, but did not interact with the brain's episodic learning response.

Support for learning under naturalistic conditions

Educational opportunities occur through naturalistic everyday life experiences (e.g., reading a newspaper, listening to a podcast, or visiting a museum). Research primarily examines learning under controlled conditions, such as in a classroom or laboratory. There is relatively little known about the extent to which adults extract semantic content, beyond factual recall, from naturalistic educational experiences. In the present work, we focused on virtual museum exhibits. The materials were sourced directly from an art history museum. The naturalistic nature of this work stems from the type of content used though an important component of naturalistic learning—motivational processes—was not measured. In each of three experiments, we assessed adult learners’ performance on tests of factual recall, inferential reasoning, and self-derivation through memory integration from naturalistic virtual museum exhibits. In anticipation of the potential challenge associated with learning outcomes under naturalistic conditions, we administered a yoked protocol under which participants had opportunities to engage in retrieval practice (Experiment 2a) or restudy (Experiment 2b) as explicit mechanisms of support for the three tests of learning. In all experiments, participants performed successfully on all three tests of learning; factual recall was the most accessible of the three learning outcomes. There was no difference in performance at the group level across experiments, but there was at the individual level, such that idea units generated during retrieval practice predicted learning outcomes, whereas restudy of those exact idea units did not. The current work provides novel insight into mechanisms underlying adult learning from naturalistic educational opportunities.

Combining desirable difficulty learning strategies to address the amount-to-learn vs. time-to-learn imbalance in residency training

PURPOSE

Residents have limited time and much to learn. Mounting evidence shows that Desirable Difficulty (DD) learning strategies can ease that imbalance, but few studies have specifically studied combinations of these strategies.

METHODS

We tested two different combinations of DD strategies: a double combination of distributed practice and retrieval practice and a triple combination additionally including interleaved practice. We compared residents' annual In-Training Exam (ITE) scores and graduates' board certification performance between both DD curricula and a historical baseline.

RESULTS

Average ITE scores rose from 149.06 in the historical baseline to 160.04 under the combined DD curricula (p < 0.001). Average ITE scores fell from 162.50 under the double combination to 155.11 under the triple combination (p = 0.03). There were no significant changes in graduates' board performance between any of the curricula.

CONCLUSIONS

These results add to the evidence that DD strategies can enhance residents' learning. The drop in ITE scores under the triple DD combination may suggest that it pushed learners past beneficial desirable difficulty into detrimental overwhelming difficulty. Further research should apply this framework in larger and more diverse settings to clarify how these DD strategies can be optimally used to enhance residents' learning.

Self-reported Learning and Study Strategies in First and Second Year Medical Students

Medical school presents a unique challenge to the average learner as the instructional strategies used in medical curricula are often different than what the student has experienced prior. The large volume of information taught in medical school is delivered with a variety of techniques. After the educational material has been delivered, it is the student's responsibility to study and learn the information for future exams and for their future patients. The current study aims to explore what learning activities and teaching strategies first (M1) and second year (M2) medical students use and prefer. Additionally, the study aims to determine if there are cohort differences in classroom and study habits. A group of 95 M1 students and 109 M2 students were recruited to participate in this online survey study. The analyses indicated statistical differences between M1 and M2 student cohorts with M1 students preferring group work and small group discussions more than M2 students. Classic didactic lecturing was preferred by 71.6% of students surveyed. M1 students reported a greater tendency for self-testing and group study versus M2 students. GPA and study technique preference were not correlated. These findings indicate that medical students are not using research-based learning and study strategies at the possible detriment of long-term knowledge retention. Modeling of research-based learning and study strategies by medical educators is one possible solution to encourage medical students to change their study practice. Future work should focus on how medical student learning preferences change as they progress through medical school.

Twelve tips for optimising medical student retention of anatomy

Concern that many graduate medical students do not know sufficient anatomy to safely and effectively assess and treat patients is a frequent complaint by clinicians. Although downgrading of anatomy relative to newer basic sciences is often blamed, there is evidence students rapidly forget anatomy. However, there are a number of ways instructors can foster long-term retention of anatomy, the most powerful involving intertwining clinical and anatomical information and assessing in-depth processing. Assisting this process is 'triaging' the curriculum so it contains only clinically engaged anatomy. Students are far more likely to remember information which they consider to be relevant to their future vocation. Therefore, teaching only anatomy which is likely to be useful in a clinical context tends to improve long-term retention of anatomy by medical students. Other helpful techniques include incorporating surface and radiological anatomy in a vertically integrated curriculum, reciprocal peer teaching and employing clinically qualified instructors.

Pedagogical Strategies for the Enhancement of Medical Education

Clearly, memory and learning are essential to medical education. To make memory and learning more robust and long-term, educators should turn to the advances in neuroscience and cognitive science to direct their efforts. This paper describes the memory pathways and stages with emphasis leading to long-term memory storage. Particular stress is placed on this storage as a construct known as schema. Leading from this background, several pedagogical strategies are described: cognitive load, dual encoding, spiral syllabus, bridging and chunking, sleep consolidation, and retrieval practice.

Front-loading of anatomy content has no effect on long-term anatomy knowledge retention among physical therapy students: a prospective cohort study

BACKGROUND

Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. The research hypothesis was that students receiving spaced instruction would have significantly better anatomy knowledge retention than students receiving massed instruction.

METHODS

Participants consisted of two cohorts of DPT students that both received 45 contact hours of anatomy lecture and 90 contact hours of anatomy lab. The LONG cohort experienced anatomy through a lecture and lab taught over a 30-week, 2 semester period as separate courses. In contrast, the SHORT cohort took their anatomy lecture and lab concurrently over one 10-week semester. A pre-test was administered on the first day of their anatomy lecture course, and a post-test was administered to each cohort 18 months after completion of their last anatomy exam.

RESULTS

After controlling for age-related differences in the two groups, no significant differences in mean pre-test, post-test, or percentage improvement were found between cohorts (p = 0.516; 0.203; and 0.152, respectively).

CONCLUSION

These findings refute the hypothesis and show that both spaced and massed instruction in these cohorts resulted in the same level of long-term anatomy knowledge retention.

Anatomy Terminology Performance is Improved by Combining Jigsaws, Retrieval Practice, and Cumulative Quizzing

Science courses containing English-language terminology are a common implement in "English as a foreign language" (EFL) countries across the globe. In many of these countries, licensing examinations place added significance on terminology competence by requiring health science graduates to demonstrate mastery of English-language anatomy terms. In recent years, a wealth of research has shown active learning can offer many benefits over lecture-based, didactic approaches. Despite this work, very little has been done to test the potential of active learning in improving medical terminology performance. The present study explores this potential in two human gross anatomy lecture courses in South Korea, collecting performance and survey data from 399 undergraduates over a period of four years. Jigsaws, retrieval practice, and regular cumulative quizzing were used to mitigate three learning challenges specific to the study context: high vocabulary volume, low feelings of control over learning, and difficulties with exam preparation. The results show the reforms significantly improved both performance and learning attitudes, with students overwhelmingly favoring the use of new methods over lecture when taught using a mixture of both. Given that science learning often resembles the process of learning a foreign language, this study offers broad potential for improving terminology competence across disciplines, even for non-EFL students.

The Learning Styles Neuromyth Is Still Thriving in Medical Education

Learning Styles theory promises improved academic performance based on the identification of a personal, sensory preference for informational processing. This promise is not supported by evidence, and is in contrast to our current understanding of the neuroscience of learning. Despite this lack of evidence, prior research shows that that belief in the Learning Styles “neuromyth” remains high amongst educators of all levels, around the world. This perspective article is a follow up on prior research aimed at understanding why belief in the neuromyth of Learning Styles remains so high. We evaluated current research papers from the field of health professions education, to characterize the perspective that an educator would be given, should they search for evidence on Learning Styles. As in earlier research on Higher Education, we found that the use of Learning Style frameworks persist in education research for the health professions; 91% of 112 recent research papers published on Learning Styles are based upon the premise that Learning Styles are a useful approach to education. This is in sharp contrast to the fundamental principle of evidence-based practice within these professions. Thus any educator who sought out the research evidence on Learning Styles would be given a consistent but inaccurate endorsement of the value of a teaching technique that is not evidence based, possibly then propagating the belief in Learning Styles. Here we offer perspectives from both research and student about this apparent mismatch between educational practice and clinical practice, along with recommendations and considerations for the future.

Retrieval Practice for Improving Long-Term Retention in Anatomical Education: A Quasi-Experimental Study

It is generally assumed by students that learning takes place during repeated episodes of rereading and rote memorization of course materials. Over the past few decades, however, research has increasingly indicated that the said notion can and should be enhanced with learning paradigms such as retrieval practice (RP). RP occurs when students practice retrieving their consolidated semantic memories by informally testing themselves. This strategy results in the re-encoding and re-consolidation of existing semantic memories, thus strengthening their schemas. The purpose of this quasi-experimental design was to assess the effects of the implementation of RP on student performance on the final exam in a large, undergraduate Gross Anatomy course. It was hypothesized that student participation in RP during class would improve their performance on the final exam in the course. The participants (N = 248) were mainly in Life Sciences, Kinesiology, and Physical Education programs. They answered RP questions using TopHat©, an online educational software platform. The results of this study indicated that student performance on the final exam was enhanced when students engaged in RP. It was concluded that the use of RP effectively enhances learning and long-term retention of semantic memory. In addition to the traditional testing 'of' learning, teachers are encouraged to implement testing, in the form of RP, in their classrooms 'for' learning.

Spacing and Interleaving Effects Require Distinct Theoretical Bases: a Systematic Review Testing the Cognitive Load and Discriminative-Contrast Hypotheses

Spaced and interleaved practices have been identified as effective learning strategies which sometimes are conflated as a single strategy and at other times treated as distinct. Learning sessions in which studying information or practicing problems are spaced in time with rest-from-deliberate-learning periods between sessions generally result in better learning outcomes than massed practice without rest-from-deliberate-learning periods. Interleaved practice also consists of spaced sessions, but by interleaving topics rather than having rest-from-deliberate-learning periods. Interleaving is usually contrasted with blocking in which each learning topic is taught in a single block that provides an example of massed practice. The general finding that interleaved practice is more effective for learning than blocked practice is sometimes attributed to spacing. In the current paper, the presence of rest-from-deliberate-learning periods is used to distinguish between spaced and interleaved practice. We suggest that spaced practice is a cognitive load effect that can be explained by working memory resource depletion during cognitive effort with recovery during rest-from-deliberate-learning, while interleaved practice can be explained by the discriminative-contrast hypothesis positing that interleaving assists learners to discriminate between topic areas. A systematic review of the literature provides evidence for this suggestion.

Changing Study Strategies with Revised Anatomy Curricula: a Move for Better or Worse?

Investigations into medical student study strategies have seen an increase in recent years, but we have also seen a move to more integrated medical curricula during this time. This manuscript endeavors to assess the changes in study plans and students' reported study strategies that are associated with a move from a traditional stand-alone anatomy curriculum to an integrated, standardized curriculum. Previously validated study strategy surveys were given to medical students at the beginning of their anatomy course and again at the end of the course. These responses were then correlated with basic demographic information and outcomes in anatomy. Results indicate that this change in curriculum does correlate with changes to students' study plans and reported study strategies. In particular, the plans for and use of web-based resources appear higher in the new curriculum while the use of self-quizzing and attendance appear lower, with potentially negative implications for understanding and long-term retention. Differences were also seen between genders and student ages. Finally, a few associations with outcomes are also noted for increased use of web-based resources and student confidence going into the exam.

Positive Impact of Multiple-Choice Question Authoring and Regular Quiz Participation on Student Learning

We previously developed an online multiple-choice question authoring, learning, and self-assessment tool that we termed Quizzical. Here we report statistical analyses over two consecutive years of Quizzical use in a large sophomore-level introductory molecular biology course. Students were required to author two questions during the term and were also afforded opportunities to earn marks for quiz participation. We found that students whose final grade was "A," "B," or "C" exhibited similar patterns of Quizzical engagement. The degree to which students participated was positively associated with performance on formal exams, even if prior academic performance was considered as a covariable. During both terms investigated, students whose Quizzical engagement increased from one exam to the next earned statistically significant higher scores on the subsequent exam, and students who attempted Quizzical questions from earlier in the term scored higher, on average, on the cumulative portion of the final exam. We conclude that the structure and value of the assignment, and the utility of Quizzical as a discipline-independent active-learning and self-assessment tool, enabled students to better master course topics.

Academic coaching for learners in medical education: Twelve tips for the learning specialist

As medical education moves toward a competency-based model of teaching and learning, the need for individual academic coaching has increased. However, coaching for improving academic performance is underexplored relative to coaching for the improvement of technical skills. This manuscript introduces 12 tips for developing academic coaching skills (in the context of one-on-one coaching encounters as well as that of the broader learning and teaching environment) that promote lifelong learning habits. These tips were developed by drawing upon relevant literature from coaching (across disciplines), educational linguistics, the learning sciences, and my experiences as a medical education learning specialist. Key considerations for impactful academic coaching include critical self-reflection (for both the learner and learning specialist), dialogic interpersonal communication, collaborating with student leaders and faculty, and facilitating the development of self-regulated, lifelong learning skills.

Second-Year Nursing Students' Retention of Gross Anatomical Knowledge

Human anatomy is a foundational course in nursing education, however, there is growing concern that students do not retain enough anatomical knowledge to successfully apply it in clinical settings. The aim of this study was to determine retention level of anatomy knowledge among second-year nursing students from their first-year anatomy class, and to determine if there is a difference in level of retention based on organ system. For each system, second-year students were asked to answer 9 to 11 multiple-choice questions (MCQs), and the scores from these quizzes were compared to matched test items from their first-year anatomy examinations. There was a significant decrease in the overall mean score from 83.05 ± 8.34 (±SD) in first year to 54.36 ±12.9 in second year (P = 0.0001). Retention levels were system specific. System-specific knowledge retention was highest for the gastrointestinal system (89.7%), respiratory system (88.5%), and genitourinary system (83.6%). This was followed by the integumentary system (80.1%), special senses (79.4%), nervous system (74.9%), and musculoskeletal system (69.3%). Retention was lowest for the lymphatic system (64.3%), cranial nerves (58.8%), vascular system (53.9%), and head and neck (42.6%). The present study shows that nursing students' anatomy knowledge retention was comparatively higher than rates reported by others in medical and allied-health students. The researchers are now investigating knowledge retention in third- and fourth-year nursing students. Further investigation into why retention is higher for specific systems and intervention strategies to improve knowledge acquisition and retention in nursing students is recommended.

Learning how to learn: can embedded discussion boards help first-year students discover new learning strategies?

Learning anatomy and physiology at university can be challenging, as students need to understand both the language of the discipline and complex topics, such as system integration. Yet learning strategies are rarely taught at university, making it difficult for students to adopt new strategies, if their approach to learning has not been effective or efficient. This study evaluated the use of small-group peer discussion boards as an avenue for sharing learning strategies between students in a first-year anatomy and physiology course. The majority of students (91%) identified strategies from the discussion board worth trying before they completed the midsemester exam. The most frequently reported type of strategy was transforming records. By the end of semester, 76% of students had adopted at least one new strategy; however, these students performed significantly worse on the exam compared with students who did not adopt new strategies. The students who adopted new strategies learned about them from peers (33%), the discussion board (32%), or through self-discovery (32%). The majority of students (83%) found the discussion boards to be useful as a source of new learning strategies and for insight into how others learn. Although the discussion boards provided an avenue for students to learn about new strategies from each other, further guidance from instructors may be required to help students evaluate the effectiveness of these learning strategies.

Conceptualising spaced learning in health professions education: A scoping review

OBJECTIVES

To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education.

METHOD

The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods.

RESULTS

Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching.

CONCLUSIONS

Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education.

Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology

Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.

Retrieval practice and judgements of learning enhance transfer of physiology information

It is well-documented that retrieval practice enhances the recall of simple and complex information (Karpicke and Aue in Educ Psychol Rev 27(2):317-326, 2015). Evidence is also accumulating that retrieval practice can enhance other cognitive processes such as the ability to critically evaluate research articles (Dobson et al. in Med Educ 52(5):513-525, 2018) and transfer of learning (Butler in J Exp Psychol Learn Mem Cogn 36(5):1118, 2010). One aim of this investigation was to explore the effects of retrieval practice on transfer of learning with physiology information. A second aim was to compare recall and transfer of physiology information following retrieval practice versus a judgment of learning task (JOL) that is potentially less time consuming for students to use. Participants were randomly assigned to learn three physiology texts using each of the following strategies: (1) studying a text four times (S-S-S-S), (2) studying and then retrieving a text two times (S-R-S-R), and (3) studying a text four times while completing multiple JOL during the second and fourth repetitions (S-S/J-S-S/J). Recall and accuracy on transfer questions were assessed 1 week after the learning phase, and the results were analyzed using repeated measures ANOVAs. The S-R-S-R strategy (21.35 ± 1.08%) produced significantly greater recall than the S-S-S-S strategy (17.35 ± 0.86%), and both the S-R-S-R (44.60 ± 2.55%) and S-S/J-S-S/J (41.79 ± 2.63%) strategies lead to significantly greater transfer than the S-S-S-S strategy (36.07 ± 2.40%). These results provide evidence that retrieval practice enhances recall and transfer of physiology information and that a JOL task can also prove to be beneficial but to a lesser degree.

Using online game-based platforms to improve student performance and engagement in histology teaching

BACKGROUND

Human morphology is a critical component of dental and medical graduate training. Innovations in basic science teaching methods are needed to keep up with an ever-changing landscape of technology. The purpose of this study was to investigate whether students in a medical and dental histology course would have better grades if they used gaming software Kahoot® and whether gamification effects on learning and enjoyment.

METHODS

In an effort to both evoke students' interest and expand their skill retention, an online competition using Kahoot® was implemented for first-year students in 2018 (n = 215) at the University of Eastern Finland. Additionally, closed (160/215) or open-ended (41/215) feedback questions were collected and analyzed.

RESULTS

The Kahoot® gamification program was successful and resulted in learning gains. The overall participant satisfaction using Kahoot® was high, with students (124/160) indicating that gamification increased their motivation to learn. The gaming approach seemed to enable the students to overcome individual difficulties (139/160) and to set up collaboration (107/160); furthermore, gamification promoted interest (109/160), and the respondents found the immediate feedback from senior professionals to be positive (146/160). In the open-ended survey, the students (23/41) viewed collaborative team- and gamification-based learning positively.

CONCLUSION

This study lends support to the use of gamification in the teaching of histology and may provide a foundation for designing a gamification-integrated curriculum across healthcare disciplines.

Generative retrieval results in positive academic emotions and long-term retention of cardiovascular anatomy using transthoracic echocardiography

With increasing medical knowledge, procedural, and diagnostic skills to learn, it is vital for educators to make the limited amount of teaching time available to students effective and efficient. Generative retrieval is an effective and efficient learning tool, improving long-term retention through the practice of retrieval from memory. Forty medical students were randomized to learn normal cardiovascular anatomy using transthoracic echocardiography video clips in a generative retrieval (GR) or standard practice (SP) group. GR participants were required to verbally identify each unlabeled cardiovascular structure after viewing the video. After answering, participants viewed the correctly labeled video. SP participants viewed the same video clips labeled with the correct cardiovascular structure for the same amount of total time without verbally generating an answer. All participants were tested for intermediate (1-wk), late (1-mo), and long-term (6- to 9-mo) retention of cardiovascular anatomy. Additionally, a three-question survey was incorporated to assess perceptions of the learning method. There was no difference in pretest scores. The GR group demonstrated a trend toward improvement in recall at 1 wk [GR = 74.3 (SD 12.3); SP = 65.4 (SD 16.7); P = 0.10] and 1 mo [GR = 69.9 (SD15.6); SP = 64.3 (SD 15.4); P = 0.33]. At the 6- to 9-mo time point, there was a statistically significant difference in scores [GR = 74.3 (SD 9.9); SP = 65.0 (SD 14.1); P = 0.042]. At nearly every time point, learners had a statistically significantly higher perception of effectiveness, enjoyment, and satisfaction with GR. In addition to improved recall, GR is associated with increased perceptions of effectiveness, enjoyment, and satisfaction, which may lead to increased engagement, time spent studying, and improved retention.

Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology

Applied memory research in the field of cognitive and educational psychology has generated a large body of data to support the use of spacing and testing to promote long-term or durable memory. Despite the consensus of this scientific community, most learners, including radiology residents, do not utilize these tools for learning new information. We present a discussion of these parallel and synergistic learning techniques and their incorporation into a software platform, called Spaced Radiology, which we created for teaching radiology residents. Specifically, this software uses these evidence-based strategies to teach pediatric radiology through a flashcard deck system.

Another Nail in the Coffin for Learning Styles? Disparities among Undergraduate Anatomy Students' Study Strategies, Class Performance, and Reported VARK Learning Styles

The concept and existence of learning styles has been fraught with controversy, and recent studies have thrown their existence into doubt. Yet, many students still hold to the conventional wisdom that learning styles are legitimate, and may adapt their outside of class study strategies to match these learning styles. Thus, this study aims to assess if undergraduate anatomy students are more likely to utilize study strategies that align with their hypothetical learning styles (using the VARK analysis from Fleming and Mills, , Improve Acad. 11:137-155) and, if so, does this alignment correlate with their outcome in an anatomy course. Relatedly, this study examines whether students' VARK learning styles are correlated with course outcomes regardless of the students' study strategies, and whether any study strategies are correlated with course outcomes, regardless of student-specific VARK results. A total of 426 anatomy students from the 2015 and 2016 Fall semesters completed a study strategies survey and an online VARK questionnaire. Results demonstrated that most students did not report study strategies that correlated with their VARK assessment, and that student performance in anatomy was not correlated with their score in any VARK categories. Rather, some specific study strategies (irrespective of VARK results), such as use of the virtual microscope, were found to be positively correlated with final class grade. However, the alignment of these study strategies with VARK results had no correlation with anatomy course outcomes. Thus, this research provides further evidence that the conventional wisdom about learning styles should be rejected by educators and students alike. Anat Sci Educ. © 2018 American Association of Anatomists.

Retrieval practice in the form of online homework improved information retention more when spaced 5 days rather than 1 day after class in two physiology courses

Studies have shown that practicing temporally spaced retrieval of previously learned information via formal assessments increases student retention of the information. Our objective was to determine the impact of online homework administered as a first retrieval practice 1 or 5 days after introduction of physiology topics on long-term information retention. Students in two undergraduate courses, Anatomy and Physiology (ASCI 240) and Animal Physiological Systems (ASCI 340), were presented with information on a specific physiological system during each weekly laboratory and then completed an online homework assignment either 1 or 5 days later. Information retention was assessed via an in-class quiz the following week and by a comprehensive final exam at semester's end (4-13 wk later). Performance on homework assignments was generally similar between groups for both courses. Information retention at 1 wk did not differ due to timing of homework in either course. In both courses, however, students who received homework 5 days after class performed better on final exam questions relevant to that week's topic compared with their day 1 counterparts. These findings indicate that the longer period between introducing physiology information in class and assigning the first retrieval practice was more beneficial to long-term information retention than the shorter period, despite seemingly equivalent benefits in the shorter term. Since information is typically forgotten over time, we speculate that the longer interval necessitates greater retrieval effort in much the same way as built-in desirable difficulties, thus allowing for stronger conceptual connections and deeper comprehension.

Retrieval practice enhances the ability to evaluate complex physiology information

OBJECTIVE

Many investigations have shown that retrieval practice enhances the recall of different types of information, including both medical and physiological, but the effects of the strategy on higher-order thinking, such as evaluation, are less clear. The primary aim of this study was to compare how effectively retrieval practice and repeated studying (i.e. reading) strategies facilitated the evaluation of two research articles that advocated dissimilar conclusions. A secondary aim was to determine if that comparison was affected by using those same strategies to first learn important contextual information about the articles.

METHODS

Participants were randomly assigned to learn three texts that provided background information about the research articles either by studying them four consecutive times (Text-S) or by studying and then retrieving them two consecutive times (Text-R). Half of both the Text-S and Text-R groups were then randomly assigned to learn two physiology research articles by studying them four consecutive times (Article-S) and the other half learned them by studying and then retrieving them two consecutive times (Article-R). Participants then completed two assessments: the first tested their ability to critique the research articles and the second tested their recall of the background texts.

RESULTS

On the article critique assessment, the Article-R groups' mean scores of 33.7 ± 4.7% and 35.4 ± 4.5% (Text-R then Article-R group and Text-S then Article-R group, respectively) were both significantly (p < 0.05) higher than the two Article-S mean scores of 19.5 ± 4.4% and 21.7 ± 2.9% (Text-S then Article-S group and Text-R then Article-S group, respectively). There was no difference between the two Article-R groups on the article critique assessment, indicating those scores weren't affected by the different contextual learning strategies.

CONCLUSION

Retrieval practice promoted superior critical evaluation of the research articles, and the results also indicated the strategy enhanced the recall of background information.