Making long-term memories in minutes: a spaced learning pattern from memory research in education

The impact of spaced learning within physics lessons in secondary schools

Spaced learning (SL) involves distributed learning with timed distraction breaks unrelated to the learning input. These breaks are thought to facilitate consolidation of novel information in long-term memory by accommodating post-activation neural recovery and biochemical changes in potentiation. Applications of SL have become commonplace across UK teaching and feature in government guidance, although there have been few research trials, especially within secondary schools, and none addressing physics independently. However, past research with 14-16-year-old students in England found that interspersing a fast-paced video input with ten-minute distraction breaks in a standard hour-long biology lesson yielded exam performance equivalent to regular teaching across many months. The present study adapted this regime to learning a novel physics topic, atomic structure, including radioactive decay, part of pre-16 compulsory science education in England. An in-class video covered all of the subject content in a single one-hour lesson, with three learning inputs, of length 11 - 14 minutes, interspersed with ten-minute distraction breaks. As well as 'business as usual' controls, the research included groups that only experienced the SL lesson, and those who were exposed to it prior to traditional teaching. Impact on learning was assessed using tests similar to state examinations taken at the end of a two-year physics course. Six non-selective state (non-fee charging) schools with varying demography were invited to join the study to ensure the sample was representative of the 93% of students who attend such schools in England. In total, 336 students completed all pre- and post-intervention (immediate and delayed) tests. Students studying combined sciences and separate physics were divided into groups cutting across conditions, with the former taking a shorter test. SL led to immediate benefits for separate physics students, but the SL only group showed no further gain at delayed post-test, with performance then equal to controls, as in past work. However, the SL plus group exhibited additional gains, 50% to 90% greater than the other groups at delayed post-test, following traditional teaching. Among combined science students, the SL plus group showed gains at delayed post-test 60% greater than controls. These effects were consistent across different schools. The implication is that SL provides a foundation for subsequent learning, often doubling its efficiency regardless of context, and that it does so with minimal additional input.

The role of NMDA receptors in memory and prediction in cultured neural networks

Objective. Memory has been extensively studied at the behavioural as well as the cellular level. Spike timing dependent plasticity is widely considered essential for long-term memory and is associated with activation of N-methyl-D-aspartate (NMDA) receptors. This suggests that NMDA receptor activation plays a crucial role in enabling long-term memory. However, experimental evidence remains sparse, probably due to the complex combination of cellular and functional readouts required.Approach. Recent work showed thatin-vitrocortical networks memorize and predict inputs. The initial dependency of prediction on short-term memory decreased during the formation of long-term memory traces. Here, we stimulated networks of dissociated cortical neurons that were grown on multi electrode arrays to investigate memory and prediction under control conditions, or under NMDA block.Main results. The NMDA antagonist 2-amino-5-phosphonovaleric acid (APV) at the used concentration impeded long-term memory trace formation, but did not significantly reduce network excitability. In APV-treated cultures short-term memory of stimuli persisted and they were still able to predict. In contrast to control cultures, prediction remained fully dependent on short-term memory.Significance. This confirms that NMDA receptor activation is essential for the formation of long-term memory traces and supports the notion that, as control cultures learn to memorize the stimulus, long-term memory starts to contribute to their predictive capability.

The therapeutic potential of low-intensity focused ultrasound for treating substance use disorder

Substance use disorder (SUD) is a persistent public health issue that necessitates the exploration of novel therapeutic interventions. Low-intensity focused ultrasound (LIFU) is a promising modality for precise and invasive modulation of brain activity, capable of redefining the landscape of SUD treatment. The review overviews effective LIFU neuromodulatory parameters and molecular mechanisms, focusing on the modulation of reward pathways in key brain regions in animal and human models. Integration of LIFU with established therapeutics holds promise for augmenting treatment outcomes in SUD. The current research examines LIFU's efficacy in reducing cravings and withdrawal symptoms. LIFU shows promise for reducing cravings, modulating reward circuitry, and addressing interoceptive dysregulation and emotional distress. Selecting optimal parameters, encompassing frequency, burst patterns, and intensity, is pivotal for balancing therapeutic efficacy and safety. However, inconsistencies in empirical findings warrant further research on optimal treatment parameters, physiological action mechanisms, and long-term effects. Collaborative interdisciplinary investigations are imperative to fully realize LIFU's potential in revolutionizing SUD treatment paradigms and enhancing patient outcomes.

The effect of spaced learning method on the evaluation score and education quality in nursing students

INTRODUCTION

Spaced learning is a teaching method aiming to stabilize long-term memory. The present study aims to evaluate the effect of the spaced learning method on the evaluation scores and education quality in the practical course of principles and techniques of nursing.

MATERIALS AND METHODS

In this quasi-experimental study, 51 nursing students in four semesters were selected by convenience sampling and randomly divided into experimental and control groups. We used the demographic characteristics form, student scores, and students' evaluations of the educational quality questionnaire (SEEQ) for data gathering. In the next step, the classes of the experimental groups were held with the spaced learning method, and the traditional methods were used for the control groups. After the end of each semester, the SEEQ questionnaire was given to the students of both groups, and their evaluation scores were extracted. The collected data were analyzed using SPSS version 26 using descriptive and inferential statistics.

RESULTS

After ensuring the independence of the data, the results showed that the difference in the mean evaluation score of the students in the two groups is not statistically significant (p > 0.05). However, the mean score of total SSEQ in the experimental group was significantly higher than the control group. Furthermore, except for the dimension of examination assignments and group interaction, the mean score of other SSEQ dimensions in the experimental group was statistically higher than the control group (p < 0.05).

CONCLUSION

Spaced learning is an easy, low-cost, and fun learning method that affects the teaching method compared to evaluation results and effortlessly has the potential to become an appropriate alternative to traditional teaching methods.

The neuroscience of active learning and direct instruction

Throughout the educational system, students experiencing active learning pedagogy perform better and fail less than those taught through direct instruction. Can this be ascribed to differences in learning from a neuroscientific perspective? This review examines mechanistic, neuroscientific evidence that might explain differences in cognitive engagement contributing to learning outcomes between these instructional approaches. In classrooms, direct instruction comprehensively describes academic content, while active learning provides structured opportunities for learners to explore, apply, and manipulate content. Synaptic plasticity and its modulation by arousal or novelty are central to all learning and both approaches. As a form of social learning, direct instruction relies upon working memory. The reinforcement learning circuit, associated agency, curiosity, and peer-to-peer social interactions combine to enhance motivation, improve retention, and build higher-order-thinking skills in active learning environments. When working memory becomes overwhelmed, additionally engaging the reinforcement learning circuit improves retention, providing an explanation for the benefits of active learning. This analysis provides a mechanistic examination of how emerging neuroscience principles might inform pedagogical choices at all educational levels.

A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial

Background

Workplace mental health is an important global health concern.

objectives

This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app.

Methods

The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures.

Results

Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score.

Conclusions

The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population.

Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.

The effect of spaced learning on the learning outcome and retention of nurse anesthesia students: a randomized-controlled study

BACKGROUND

Poor learning and retention are common problems of students, which may be alleviated by optimization of widely used educational methods such as lectures. This study aimed to investigate the effect of spaced learning on the learning outcome and retention of nurse anesthesia students.

METHODS

This was a randomized controlled study with a pre-and post-test design on 64 nurse anesthesia students who were divided into two groups of spaced lecture (n = 32) and conventional lecture (n = 32). The spaced lectures included three 30-minute training sessions with 10-minute intervals while the conventional sessions including 90 min of continuous training. Students' knowledge was measured using one valid and reliable questionnaire developed by the research team. All students in both groups took a pre-test, and their level of knowledge acquisition was evaluated immediately after the training. Their level of knowledge retention was tested two and four weeks after the lecture.

RESULTS

There was no significant difference between the two groups regarding demographic characteristics (p > 0.05). In the pre-test, the mean score of knowledge in the intervention group was lower than that in the control group, there was no significant difference (p = 0.177). But after the intervention, the mean scores of learning outcome and retention in the intervention group were significantly higher than those in the control group (p < 0.001, eta = 0.576). Also, the results showed that learning outcome and retention across the three academic semesters in the two groups are significantly different, and students with a higher academic semester obtained a significantly higher mean score of knowledge and retention (p < 0.001, eta = 0.604).

CONCLUSION

Spaced learning improves nurse anesthesia students' knowledge and retention more than conventional method. Future studies focusing on spaced learning should specifically examine the impact of duration and number of intervals, as well as the time gap between training and measurement of learning retention.

Changing Surgical Culture Through Surgical Education: Introduction to the PACTS Trial

The Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum was developed to improve surgical resident cultural dexterity, with the goal of promoting health equity by developing cognitive skills to adapt to individual patients' needs to ensure personal, patient-centered surgical care through structured educational interventions for surgical residents. Funded by the National Institute of Health (NIH)'s National Institute on Minority Health and Health Disparities, PACTS addresses surgical disparities in patient care by incorporating varied educational interventions, with investigation of both traditional and nontraditional educational outcomes such as patient-reported and clinical outcomes, across multiple hospitals and regions. The unique attributes of this multicenter, multiphased research trial will not only impact future surgical education research, but hopefully improve how surgeons learn nontechnical skills that modernize surgical culture and surgical care. The present perspective piece serves as an introduction to this multifaceted surgical education trial, highlighting the rationale for the study and critical curricular components such as key stakeholders from multiple institutions, multimodal learning and feedback, and diverse educational outcomes.

Prediction in cultured cortical neural networks

Theory suggest that networks of neurons may predict their input. Prediction may underlie most aspects of information processing and is believed to be involved in motor and cognitive control and decision-making. Retinal cells have been shown to be capable of predicting visual stimuli, and there is some evidence for prediction of input in the visual cortex and hippocampus. However, there is no proof that the ability to predict is a generic feature of neural networks. We investigated whether random in vitro neuronal networks can predict stimulation, and how prediction is related to short- and long-term memory. To answer these questions, we applied two different stimulation modalities. Focal electrical stimulation has been shown to induce long-term memory traces, whereas global optogenetic stimulation did not. We used mutual information to quantify how much activity recorded from these networks reduces the uncertainty of upcoming stimuli (prediction) or recent past stimuli (short-term memory). Cortical neural networks did predict future stimuli, with the majority of all predictive information provided by the immediate network response to the stimulus. Interestingly, prediction strongly depended on short-term memory of recent sensory inputs during focal as well as global stimulation. However, prediction required less short-term memory during focal stimulation. Furthermore, the dependency on short-term memory decreased during 20 h of focal stimulation, when long-term connectivity changes were induced. These changes are fundamental for long-term memory formation, suggesting that besides short-term memory the formation of long-term memory traces may play a role in efficient prediction.

Teaching, learning and assessment methods for sustainability education on the land-sea interface

The Land-Sea Interface (LSI) is where land and sea meet, not only in physical terms, but also with regards to a large variety of ecological and societal aspects. The United Nations has proclaimed the period 2021-2030 the Ocean Decade, which entails striving for a sustainable use of the ocean and teaching and learning about ocean related issues. Teaching and learning about the LSI are also tightly connected with several Sustainable Development Goals (Global Goals) such as Life Below Water, Zero Hunger and Sustainable Cities and Communities. Teaching and learning about sustainability lacks a uniform pedagogy, and it is probably wise to maintain that apparently adaptive diversity. In this globally relevant methods overview, we present a wide range of relatively new and/or successful and mostly largely learner-centered methods. We also discuss how effective and popular they are, and give examples on how most of these methods are already used in LSI sustainability teaching. There will probably not be any successful "one size fits all" model developing for LSI teaching and learning, and each module, course and programme will have to develop its own recipe for successful teaching and learning, possibly with support from one or several methods discussed in this paper.

CREBB repression of protein synthesis in mushroom body gates long-term memory formation in Drosophila

Learned experiences are not necessarily consolidated into long-term memory (LTM) unless they are periodic and meaningful. LTM depends on de novo protein synthesis mediated by cyclic AMP response element-binding protein (CREB) activity. In Drosophila, two creb genes (crebA, crebB) and multiple CREB isoforms have reported influences on aversive olfactory LTM in response to multiple cycles of spaced conditioning. How CREB isoforms regulate LTM effector genes in various neural elements of the memory circuit is unclear, especially in the mushroom body (MB), a prominent associative center in the fly brain that has been shown to participate in LTM formation. Here, we report that i) spaced training induces crebB expression in MB α-lobe neurons and ii) elevating specific CREBB isoform levels in the early α/β subpopulation of MB neurons enhances LTM formation. By contrast, learning from weak training iii) induces 5-HT1A serotonin receptor synthesis, iv) activates 5-HT1A in early α/β neurons, and v) inhibits LTM formation. vi) LTM is enhanced when this inhibitory effect is relieved by down-regulating 5-HT1A or overexpressing CREBB. Our findings show that spaced training-induced CREBB antagonizes learning-induced 5-HT1A in early α/β MB neurons to modulate LTM consolidation.

Harnessing the power of spaced repetition learning and active recall for trainee education in otolaryngology

Medical education is rapidly evolving. The historical reliance on textbook reading is being increasingly replaced by trainees in favor of using non-traditional platforms such as podcasts, videos, and app-based learning. Neuroscience research on human learning has demonstrated superior long-term retention when the synergistic principles of spaced repetition and active recall are employed. Spaced repetition entails the repeated exposure to learned material over successive iterations, whereas active recall involves the intentional reconstructive process of retrieving previously learned material, often through prompting (e.g., answering open-ended questions without multiple choice answers), rather than passively reviewing previously learned information (e.g., re-reading a textbook chapter). These concepts have revolutionized medical student education, with use of open-source spaced repetition platforms, such as Anki, and question banks becoming ubiquitous. Paralleling educational platforms within otolaryngology are emerging. Headmirror's OtoRecall app provides a free, peer-reviewed, open-access option for otolaryngology trainees to harness the power of these learning principles.

Evaluating the Effectiveness of an Educational Module for the Bush-Francis Catatonia Rating Scale

OBJECTIVE

Catatonia is widely underdiagnosed, in large part due to inaccurate recognition of its specific features. This study aimed to evaluate the effectiveness of an online educational module to improve theoretical and practical knowledge of the Bush-Francis Catatonia Rating Scale (BFCRS) across a broad range of clinicians and medical students.

METHOD

A 1-h online module, including a training manual and videos, was disseminated to medical students, psychiatry residents and fellows, and psychiatrists through national Listservs and through the Academy of Consultation-Liaison Psychiatry. Participants completed pre- and post-module testing consisting of a 50-question multiple-choice test and a 3-min standardized patient video scored using the 23-item BFCRS. Participants accessed the module from October 1, 2020, to April 4, 2021. Immediate improvement and 3-month knowledge retention were assessed using quantitative and qualitative analyses.

RESULTS

Study enrollment was high with moderate dropout (pre-testing: n = 482; post-testing: n = 236; 3-month testing: n = 105). Adjusting for demographics, large pre-post improvements were found in performance (multiple-choice: 11.3 points; standardized patient scoring: 4.2 points; both p < 0.001) and for nearly all individual BFCRS items. Knowledge attrition was modest, and improvements persisted at 3 months.

CONCLUSIONS

This educational resource provides descriptive and demonstrative reference standards of the items on the BFCRS. This curriculum improved identification of catatonia's features on both multiple choice and standardized patient scoring across all ages and training levels with good overall knowledge retention.

Evidence of the Spacing Effect and Influences on Perceptions of Learning and Science Curricula

The conventional science curricula generally favour educational practices that yield high scores on immediate examination, though it may not accurately predict students’ long-term academic achievement. In view of the pre-exam cramming phenomenon, this article shows the evidence of spacing effect in science education and probes into its theoretical mechanisms, effectiveness in experimental settings, and current applications in science learning. In brief, spacing works by repeatedly presenting the learning material across various temporal intervals. This paper suggests that spacing could significantly result in greater memory strength by alleviating multiple neurocognitive and behavioural properties of learning that are hampered by cramming. Together with the analysis of its relevance in science education, the spacing effect may further provide leverages for promoting long-term conceptual understanding and reflective skill development. However, there are many reasons that students and teachers may not be aware of or fully appreciate its benefits. Finally, this article discusses systemic barriers to why spaced repetition is underutilized in science curricula.

Proof of Concept: Game-Based Mobile Learning-The First Experience With the App Actionbound as Case-Based Geocaching in Education of Veterinary Neurology

Case-based learning is a valuable tool to impart various problem-solving skills in veterinary education and stimulate active learning. Students can solve imaginary cases without the need for contact with real patients. Case-based teaching can be well performed as asynchronous remote-online class. In time of the COVID-19-pandemic, many courses in veterinary education are provided online. Therefore, students report certain fatigue when it comes to desk-based online learning. The app “Actionbound” provides a platform to design digitally interactive scavenger hunts based on global positioning system (GPS)—called “bounds” —in which the teacher can create a case study with an authentic patient via narrative elements. This app was designed for multimedia-guided museum or city tours initially. The app offers the opportunity to send the students to different geographic localizations for example in a park or locations on the University campus, like geocaching. In this way, students can walk outdoors while solving the case study. The present article describes the first experience with Actionbound as a tool for mobile game-based and case-orientated learning in veterinary education. Three veterinary neurology cases were designed as bounds for undergraduate students. In the summer term 2020, 42 students from the second to the fourth year of the University of Veterinary Medicine Hannover worked on these three cases, which were solved 88 times in total: Cases 1 and 2 were each played 30 times, and case 3 was played 28 times. Forty-seven bounds were solved from students walking through the forest with GPS, and 41 were managed indoors. After each bound, students evaluated the app and the course via a 6-point numerical Likert rating scale (1 = excellent to 6 = unsatisfactory). Students playing the bounds outdoors performed significantly better than students solving the corresponding bound at home in two of the three cases (p = 0.01). The large majority of the students rated the course as excellent to good (median 1.35, range 1–4) and would recommend the course to friends (median 1.26, range 1–3). Summarizing, in teaching veterinary neurology Actionbound's game-based character in the context of outdoor activity motivates students, might improve learning, and is highly suitable for case-based learning.

Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in Children-A Retrospective Quality Improvement Report

BACKGROUND

Many children attend Emergency Departments (ED) and Out of Hours (OoH) frequently for acute asthma. Follow up care is often suboptimal leaving these children at risk of a future attacks. We report on the development, implementation and evaluation of a safe asthma discharge care pathway (SADCP).

METHODS

This is a retrospective report on the development, implementation and evaluation of outcomes of a SADCP. The pathway was based on the Teach-to-goal educational methodology that supported the mastery correct inhaler technique and ability to action the personalized asthma action plan (PAAP). Children with frequent asthma attacks were entered as they were discharged from the Emergency Department or ward. The first training session occurred within 1-3 weeks of the index asthma attack with 2 further sessions in the following 8 weeks. Children exiting the pathway were discharged either back to primary care or to a hospital clinic.

RESULTS

81 children entered the pathway (median age 5 years) with 72 discharged from the ED and 9 from the medical wards of the Royal Belfast Hospital for Sick Children. At pathway entry 13% had correct inhaler technique, 10% had a Personalized Asthma Action Plan (PAAP), and 5% had >80% (45% >50%) repeat refill evidence of adherence to inhaled corticosteroid over the previous 12 months. On pathway exit all children demonstrated correct inhaler technique and were able to action their PAAP. One year later 51% and 95% had refill evidence of >80% and >50% adherence. Comparisons of the 12 months before and 12 months after exit from the pathway the median number of emergency ED or OoH asthma attendances and courses of oral corticosteroids reduced to zero with >75% having no attacks requiring this level of attention. Similar findings resulted when the SADCP was implemented in a district general hospital pediatric unit.

CONCLUSION

Implementing an asthma care pathway, using Teach-to-Goal skill training methods and frequent early reviews after an index asthma attack can reduce the future risk of asthma attacks in the next 6 to 12 months.

Longitudinal assessment: A strategy to improve continuing professional certification

Healthcare certification organizations carefully balance a commitment to bring value to their membership through programs that support lifelong learning and professional growth, while protecting the public by ensuring competent certified practitioners. These certifying bodies are challenged with remaining current with their maintenance of certification programs while keeping pace with the growing breadth of knowledge, industry standards and guidelines, innovative advances, and rapid technological gains in testing and assessment. Within the context of process innovation, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) evaluated the current landscape of Longitudinal Assessment (LA) as a potential strategy for the assessment of core knowledge as part of their Continued Professional Certification Program for Certified Registered Nurse Anesthetists. This manuscript details the evaluation of LA using a Logic Model as the tool to scaffold inquiry, a review of LA literature, an environmental scan of current LA programs with identification of LA program elements available, and the results of a LA feasibility study. The findings substantiate that continued professional certification which incorporates a LA strategy can augment lifelong learning, but is not an assessment strategy that can be implemented without thoughtful planning, customization and continuous maintenance.

Concept analysis of longitudinal assessment for professional continued certification

BACKGROUND

This concept analysis presents a scholarly epistemological approach to defining the attributes, empirical referents, antecedents, and consequences of a knowledge maintenance approach-known as longitudinal assessment-to professional certification.

AIM

The analysis reports on the efforts of the National Board of Certification and Recertification for Nurse Anesthetists to explore this educational method as an approach to meet requirements for continued professional certification.

METHOD

Using the classical approach to concept analysis, the authors explore the structure and function of longitudinal assessment and define the characteristics of the concept in a way that is meaningful to the continued certification of nursing and medical professionals.

CONCLUSION

This analysis establishes a link between the goal and outcome of the continued certification process, including continuing education in nursing and medical practice, and the desirable characteristics of longitudinal assessment, which include proven principles of educational psychology. Through exploring model and borderline cases, the authors seek to demonstrate that longitudinal assessment is the best approach to foster lifelong learning of continuously evolving scientific, theoretical, and clinical knowledge in support of safe care for patients.

Residents' Perceptions of Effective Features of Educational Podcasts

INTRODUCTION

Educational podcasts are used by emergency medicine (EM) trainees to supplement clinical learning and to foster a sense of connection to broader physician communities. Yet residents report difficulties remembering what they learned from listening, and the features of podcasts that residents find most effective for learning remain poorly understood. Therefore, we sought to explore residents' perceptions of the design features of educational podcasts that they felt most effectively promoted learning.

METHODS

We used a qualitative approach to explore EM trainees' experiences with educational podcasts, focusing on design features that they found beneficial to their learning. We conducted 16 semi-structured interviews with residents from three institutions from March 2016-August 2017. Interview transcripts were analyzed line-by-line using constant comparison and organized into focused codes, conceptual categories, and then key themes.

RESULTS

The five canons of classical rhetoric provided a framework for thematically grouping the disparate features of podcasts that residents reported enhanced their learning. Specifically, they reported valuing the following: 1) Invention: clinically relevant material presented from multiple perspectives with explicit learning points; 2) Arrangement: efficient communication; 3) Style: narrative incorporating humor and storytelling; 4) Memory: repetition of key content; and 5) Delivery: short episodes with good production quality.

CONCLUSION

This exploratory study describes features that residents perceived as effective for learning from educational podcasts and provides foundational guidance for ongoing research into the most effective ways to structure medical education podcasts.

EEG Correlates of Learning From Speech Presented in Environmental Noise

How the human brain retains relevant vocal information while suppressing irrelevant sounds is one of the ongoing challenges in cognitive neuroscience. Knowledge of the underlying mechanisms of this ability can be used to identify whether a person is distracted during listening to a target speech, especially in a learning context. This paper investigates the neural correlates of learning from the speech presented in a noisy environment using an ecologically valid learning context and electroencephalography (EEG). To this end, the following listening tasks were performed while 64-channel EEG signals were recorded: (1) attentive listening to the lectures in background sound, (2) attentive listening to the background sound presented alone, and (3) inattentive listening to the background sound. For the first task, 13 lectures of 5 min in length embedded in different types of realistic background noise were presented to participants who were asked to focus on the lectures. As background noise, multi-talker babble, continuous highway, and fluctuating traffic sounds were used. After the second task, a written exam was taken to quantify the amount of information that participants have acquired and retained from the lectures. In addition to various power spectrum-based EEG features in different frequency bands, the peak frequency and long-range temporal correlations (LRTC) of alpha-band activity were estimated. To reduce these dimensions, a principal component analysis (PCA) was applied to the different listening conditions resulting in the feature combinations that discriminate most between listening conditions and persons. Linear mixed-effect modeling was used to explain the origin of extracted principal components, showing their dependence on listening condition and type of background sound. Following this unsupervised step, a supervised analysis was performed to explain the link between the exam results and the EEG principal component scores using both linear fixed and mixed-effect modeling. Results suggest that the ability to learn from the speech presented in environmental noise can be predicted by the several components over the specific brain regions better than by knowing the background noise type. These components were linked to deterioration in attention, speech envelope following, decreased focusing during listening, cognitive prediction error, and specific inhibition mechanisms.

Simulation-Based Arthroscopic Skills Using a Spaced Retraining Schedule Reduces Short-Term Task Completion Time and Camera Path Length

PURPOSE

To investigate whether acquiring basic knee arthroscopic skills via a spaced retraining schedule could prevent skills deterioration and achieve further skills improvement.

METHODS

In the learning phase, 16 residents with no previous hands-on experience in practicing arthroscopic skills were asked to perform basic arthroscopic tasks on a simulator until they attained perfect scores in each task. Immediately after completing the learning phase, a pretest was performed to assess their performance. Next, they were randomly assigned into 2 groups. The spaced retraining group, which undertook a spaced repetitive training phase with a fixed-time interval, returned on days 2, 4 and 6 to repeat the same tasks for 20 minutes per day, whereas the control group did nothing. On day 7, all participants performed a posttest. A 2 × 2 mixed analysis of variance model was used for statistical analysis.

RESULTS

Significant differences between the 2 groups were found in task completion time (P = .003) and camera path length (P = .043) but not cartilage injury (P = .186). Residents in the spaced retraining group decreased their task completion time (163.2 ± 23.9 seconds) whereas the task time in the control group increased (351.3 ± 25.5 seconds). The same pattern was found with the camera path length.

CONCLUSIONS

Implementing a spaced retraining schedule in 1 week resulted in a reduced task completion time and camera path length but no significant reduction in cartilage injury. It appears that introducing a spaced retraining schedule to retain arthroscopic skills acquired through massed learning may be advantageous.

CLINICAL RELEVANCE

In consideration of the training time available to residents and the trend toward massed learning, this spaced retraining schedule may offer a cost-effective and convenient way for residents to maintain and improve their basic arthroscopic skills with no significant increase in time invested.

Making a Lecture Stick: the Effect of Spaced Instruction on Knowledge Retention in Medical Education

INTRODUCTION

Poor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures. Guided by neuroscientific literature, we designed a spaced learning lecture in which the educator repeats the to-be-learned information using short temporal intervals. We investigated if this modified instructional design could enhance students' retention.

MATERIALS AND METHODS

Second-year medical students (n = 148) were randomly allocated to either the spaced lecture or the traditional lecture. The spaced lecture consisted of three 15-min instructional periods, separated by 5-min intervals. A short summary of the preceding information was provided after each interval. The traditional lecture encompassed the same information including the summary in the massed format, thus without the intervals. All students performed a baseline knowledge test 2 weeks prior to the lectures and students' knowledge retention was assessed 8 days after the lectures.

RESULTS

The average score on the retention test (α = 0.74) was not significantly different between the spaced lecture group (33.8% ± 13.6%) and the traditional lecture group (31.8% ± 12.9%) after controlling for students' baseline-test performance (F(1,104) = 0.566, p = 0.458). Students' narrative comments showed that the spaced lecture format was well-received and subjectively benefitted their attention-span and cognitive engagement.

DISCUSSION AND CONCLUSION

We were unable to show increased knowledge retention after the spaced lecture compared with the traditional lecture. Based on these findings, we provide recommendations for further research. Ultimately, we aim for optimized spaced learning designs to facilitate learning in the medical curriculum and to help educate health professionals with a solid knowledge base.

Optimization and validation of a modified radial-arm water maze protocol using a murine model of mild closed head traumatic brain injury

Cognitive impairments can be a significant problem after a traumatic brain injury (TBI), which affects millions worldwide each year. There is a need for establish reproducible cognitive assays in rodents to better understand disease mechanisms and to develop therapeutic interventions towards treating TBI-induced impairments. Our goal was to validate and standardize the radial arm water maze (RAWM) test as an assay to screen for cognitive impairments caused by TBI. RAWM is a visuo-spatial learning test, originally designed for use with rats, and later adapted for mice. The present study investigates whether test procedures, such us the presence of extra-maze cues influences learning and memory performance. C57BL/6 mice were tested in an 8-arm RAWM using a four-day protocol. We demonstrated that two days of training, exposing the mice to extra-maze cues and a visible platform, influenced learning and memory performance. Mice that did not receive training performed poorer compared to mice trained. To further validate our RAWM protocol, we used scopolamine. We, also, demonstrated that a single mild closed head injury (CHI) caused deficits in this task at two weeks post-CHI. Our data supported the use of 7 trials per day and a spaced training protocol as key factor to unmask memory impairment following CHI. Here, we provide a detailed standard operating procedure for RAWM test, which can be applied to a variety of mouse models including neurodegenerative diseases and pathology, as well as when pharmacological approaches are used.

Dental education: Lecture versus flipped and spaced learning

BACKGROUND

Even though there are diverse varieties of teaching methods to motivate and educate students, not many are used in dental institutions, where most rely only on traditional lectures. Hence, the objective of this study was to compare traditional lectures with newer teaching methods, specifically the flipped classroom and spaced learning method.

MATERIALS AND METHODS

In this prospective cohort study Students were randomized to one of the teaching methods, and their short-term (immediately after teaching) and long-term (i.e., 6 months later) knowledge retention was assessed through multiple choice questions, followed by students feedback which was obtained using Trierer Inventar zur Lehrevaluation questionnaire. P ≤ 0.05 was considered statistically significant.

RESULTS

For short-term learning gains, spaced learning group (165.85) showed highest mean scores, followed by the traditional lecture group (163.70) and flipped classroom group (153.25). P value acquired through the Kruskal-Wallis ANOVA was statistically significant (0.003). For long-term knowledge retention, traditional lecture group has highest mean scores (147.50), followed by spaced learning group (146.90) and flipped classroom group (145.05) with no significant difference (P = 0.657).

CONCLUSION

Spaced learning methodology was better than the traditional lecture method and the flipped classroom concerning knowledge gains when measured immediately after the application of learning method. For long-term knowledge retention, both the flipped classroom and spaced learning teaching methods were comparable to the traditional lecture method.

Annual Research Review: Educational neuroscience: progress and prospects

Educational neuroscience is an interdisciplinary research field that seeks to translate research findings on neural mechanisms of learning to educational practice and policy and to understand the effects of education on the brain. Neuroscience and education can interact directly, by virtue of considering the brain as a biological organ that needs to be in the optimal condition to learn ('brain health'); or indirectly, as neuroscience shapes psychological theory and psychology influences education. In this article, we trace the origins of educational neuroscience, its main areas of research activity and the principal challenges it faces as a translational field. We consider how a pure psychology approach that ignores neuroscience is at risk of being misleading for educators. We address the major criticisms of the field comprising, respectively, a priori arguments against the relevance of neuroscience to education, reservations with the current practical operation of the field, and doubts about the viability of neuroscience methods for diagnosing disorders or predicting individual differences. We consider future prospects of the field and ethical issues it raises. Finally, we discuss the challenge of responding to the (welcome) desire of education policymakers to include neuroscience evidence in their policymaking, while ensuring recommendations do not exceed the limitations of current basic science.

Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis

BACKGROUND

We aimed to systematically review the effectiveness of healthcare behavioral and education interventions for gout patients on clinical outcomes.

METHODS

We searched multiple databases to identify trials or observational studies of educational or behavioral interventions in gout. Risk of bias was assessed with the Cochrane tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale for observational studies. We estimated odds ratios (ORs) for categorical and standardized mean difference (SMD) for continuous measures using a random-effects model.

RESULTS

Overall, eight (five RCTs and three observational) studies met the inclusion criteria and examined pharmacist-led interventions (n = 3), nurse-led interventions (n = 3) and primary care provider interventions (n = 2). Compared with the control intervention (usual care in most cases), a higher proportion of those in the educational/behavioral intervention arm achieved serum urate (SU) levels <6 mg/dl, 47.2% versus 23.8%, the OR was 4.86 [95% confidence interval (CI), 1.48, 15.97; 4 RCTs] with moderate quality evidence. Compared with the control intervention, a higher proportion of those in the educational/behavioral intervention arm were adherent to allopurinol, achieved at least a 2 mg/dl decrease in SU, achieved an SU < 5 mg/dl, had a reduction in the presence of tophi at 2 years, had improved quality of life as assessed with SF-36 physical component scores, had a higher knowledge about gout and higher patient satisfaction (moderate-low quality evidence).

CONCLUSION

Educational and behavioral interventions can improve gout outcomes in the short-intermediate term. Randomized trials are needed to assess its impact on long-term gout outcomes.

A rapid introduction to neurological biochemistry using Drosophila melanogaster

Short, cost-effective teaching activities are a useful way of providing an integrated view on biological processes. Here we describe a brief, hands-on workshop that allows pre-university students to explore their understanding of a neurological pathway from its chemical bases to phenotype. The workshop effectively introduces the students to data collection and analysis in an enjoyable way and at an appropriate level, determined by an end of session feedback survey. The design of the workshop can be adapted and scaled to generate diverse sessions such as university teaching practicals or summer school training workshops.

Making Memories: Why Time Matters

In the last decade advances in human neuroscience have identified the critical importance of time in creating long-term memories. Circadian neuroscience has established biological time functions via cellular clocks regulated by photosensitive retinal ganglion cells and the suprachiasmatic nuclei. Individuals have different circadian clocks depending on their chronotypes that vary with genetic, age, and sex. In contrast, social time is determined by time zones, daylight savings time, and education and employment hours. Social time and circadian time differences can lead to circadian desynchronization, sleep deprivation, health problems, and poor cognitive performance. Synchronizing social time to circadian biology leads to better health and learning, as demonstrated in adolescent education. In-day making memories of complex bodies of structured information in education is organized in social time and uses many different learning techniques. Research in the neuroscience of long-term memory (LTM) has demonstrated in-day time spaced learning patterns of three repetitions of information separated by two rest periods are effective in making memories in mammals and humans. This time pattern is based on the intracellular processes required in synaptic plasticity. Circadian desynchronization, sleep deprivation, and memory consolidation in sleep are less well-understood, though there has been considerable progress in neuroscience research in the last decade. The interplay of circadian, in-day and sleep neuroscience research are creating an understanding of making memories in the first 24-h that has already led to interventions that can improve health and learning.

Short-Term Dosage Regimen for Stimulation-Induced Long-Lasting Desynchronization

In this paper, we computationally generate hypotheses for dose-finding studies in the context of desynchronizing neuromodulation techniques. Abnormally strong neuronal synchronization is a hallmark of several brain disorders. Coordinated Reset (CR) stimulation is a spatio-temporally patterned stimulation technique that specifically aims at disrupting abnormal neuronal synchrony. In networks with spike-timing-dependent plasticity CR stimulation may ultimately cause an anti-kindling, i.e., an unlearning of abnormal synaptic connectivity and neuronal synchrony. This long-lasting desynchronization was theoretically predicted and verified in several pre-clinical and clinical studies. We have shown that CR stimulation with rapidly varying sequences (RVS) robustly induces an anti-kindling at low intensities e.g., if the CR stimulation frequency (i.e., stimulus pattern repetition rate) is in the range of the frequency of the neuronal oscillation. In contrast, CR stimulation with slowly varying sequences (SVS) turned out to induce an anti-kindling more strongly, but less robustly with respect to variations of the CR stimulation frequency. Motivated by clinical constraints and inspired by the spacing principle of learning theory, in this computational study we propose a short-term dosage regimen that enables a robust anti-kindling effect of both RVS and SVS CR stimulation, also for those parameter values where RVS and SVS CR stimulation previously turned out to be ineffective. Intriguingly, for the vast majority of parameter values tested, spaced multishot CR stimulation with demand-controlled variation of stimulation frequency and intensity caused a robust and pronounced anti-kindling. In contrast, spaced CR stimulation with fixed stimulation parameters as well as singleshot CR stimulation of equal integral duration failed to improve the stimulation outcome. In the model network under consideration, our short-term dosage regimen enables to robustly induce long-term desynchronization at comparably short stimulation duration and low integral stimulation duration. Currently, clinical proof of concept is available for deep brain CR stimulation for Parkinson's therapy and acoustic CR stimulation for tinnitus therapy. Promising first in human data is available for vibrotactile CR stimulation for Parkinson's treatment. For the clinical development of these treatments it is mandatory to perform dose-finding studies to reveal optimal stimulation parameters and dosage regimens. Our findings can straightforwardly be tested in human dose-finding studies.

How Can We Improve Disease Education in People with Gout?

PURPOSE OF REVIEW

Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts.

RECENT FINDINGS

Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education. An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

The spaced learning concept significantly improves training for laparoscopic suturing: a pilot randomized controlled study

BACKGROUND

Spaced learning has been shown to be effective in various areas like traditional knowledge or motor skill acquisition. To evaluate the impact of implementation of the spaced learning concept in laparoscopic training was the aim of this study.

METHODS

To evaluate the effectiveness of spaced learning, subjects were asked to perform four surgeon's square knots on a bowel model prior and post 3 h of hands-on training. All subjects were medical students and novice in laparoscopic suturing. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan score), and laparoscopic performance (Munz checklist) were assessed. Moreover, motivation was accessed using Questionnaire on Current Motivation.

RESULTS

Twenty students were included in the study; after simple randomization, ten were trained using "spaced learning" concept and ten conservatively. Both groups had comparable baseline characteristics and improved after training significantly regarding all aspects assessed in this study. Subjects that trained via spaced learning were superior in terms of suture performance, knot quality, and suture strength. Ultimately, spaced learning significantly decreased anxiety and impression of challenge compared to controls.

CONCLUSION

The spaced learning concept is very suitable for complex motor skill acquisition like laparoscopic suturing and knot tying. It significantly improves laparoscopic performance and knot quality as shown by the knot score and suture strength. Thus, we recommend to incorporate spaced learning into training courses and surgical programs.

Pilot study of a multidisciplinary gout patient education and monitoring program

OBJECTIVE

Gout patient self-management knowledge and adherence to treatment regimens are poor. Our objective was to assess the feasibility and acceptability of a multidisciplinary team-based pilot program for the education and monitoring of gout patients.

METHODS

Subjects completed a gout self-management knowledge exam, along with gout flare history and compliance questionnaires, at enrollment and at 6 and 12 months. Each exam was followed by a nursing educational intervention via a structured gout curriculum. Structured monthly follow-up calls from pharmacists emphasized adherence to management programs. Primary outcomes were subject and provider program evaluation questionnaires at 6 and 12 months, program retention rate and success in reaching patients via monthly calls.

RESULTS

Overall, 40/45 subjects remained in the study at 12 months. At 12 months, on a scale of 1 (most) to 5 (least), ratings of 3 or better were given by 84.6% of subjects evaluating the usefulness of the overall program in understanding and managing their gout, 81.0% of subjects evaluating the helpfulness of the nursing education program, and 50.0% of subjects evaluating the helpfulness of the calls from the pharmacists. Knowledge exam questions that were most frequently answered incorrectly on repeat testing concerned bridge therapy, the possibility of being flare-free, and the genetic component of gout.

CONCLUSIONS

Our multidisciplinary program of gout patient education and monitoring demonstrates feasibility and acceptability. We identified variability in patient preference for components of the program and persistent patient knowledge gaps.

Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency

OBJECTIVE

To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency.

DESIGN

A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program.

SETTING

Urban tertiary academic medical center.

PARTICIPANTS

General surgery residents, faculty, and medical students.

RESULTS

An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation.

CONCLUSION

An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members.

The spacing principle for unlearning abnormal neuronal synchrony

Desynchronizing stimulation techniques were developed to specifically counteract abnormal neuronal synchronization relevant to several neurological and psychiatric disorders. The goal of our approach is to achieve an anti-kindling, where the affected neural networks unlearn abnormal synaptic connectivity and, hence, abnormal neuronal synchrony, by means of desynchronizing stimulation, in particular, Coordinated Reset (CR) stimulation. As known from neuroscience, psychology and education, learning effects can be enhanced by means of the spacing principle, i.e. by delivering repeated stimuli spaced by pauses as opposed to delivering a massed stimulus (in a single long stimulation session). To illustrate that the spacing principle may boost the anti-kindling effect of CR neuromodulation, in this computational study we carry this approach to extremes. To this end, we deliver spaced CR neuromodulation at particularly weak intensities which render permanently delivered CR neuromodulation ineffective. Intriguingly, spaced CR neuromodulation at these particularly weak intensities effectively induces an anti-kindling. In fact, the spacing principle enables the neuronal population to successively hop from one attractor to another one, finally approaching attractors characterized by down-regulated synaptic connectivity and synchrony. Our computational results might open up novel opportunities to effectively induce sustained desynchronization at particularly weak stimulation intensities, thereby avoiding side effects, e.g., in the case of deep brain stimulation.