Retrieval practice and judgements of learning enhance transfer of physiology information

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.

Exploring the Role of Attentional Reorienting in the Reactive Effects of Judgments of Learning on Memory Performance

Making judgments of learning (JOLs) while studying related word pairs can enhance performance on tests that rely on cue-target associations (e.g., cued recall) compared to studying alone. One possible explanation for this positive JOL reactivity effect is that the prompt to make JOLs, which typically occurs halfway through the presentation of each pair, may encourage learners to devote more attention to the pair during the second half of the encoding episode, which may contribute to enhanced recall performance. To investigate this idea, an online sample of participants (Experiment 1) and undergraduate students (Experiment 2) studied a set of moderately related word pairs (e.g., dairy-cow) in preparation for a cued recall test. Some participants made JOLs for each pair halfway through the presentation, whereas other participants did not. Also, some participants were presented with a fixation point halfway through the presentation, whereas other participants were not. The goal of this fixation point was to simulate the possible "reorienting" effect of a JOL prompt halfway through each encoding episode. In both an unsupervised online context and a supervised laboratory context, cued recall performance was higher for participants who made JOLs compared to those who did not make JOLs. However, presenting a fixation point halfway through the presentation of each pair did not lead to reactive effects on memory. Thus, JOLs are more effective than a manipulation that reoriented participants to the word pairs in another way (i.e., via a fixation point), which provides some initial evidence that positive reactivity for related pairs is not solely driven by attentional reorienting during encoding.

Study smart - impact of a learning strategy training on students' study behavior and academic performance

Recent research shows the importance to teach students the self-regulated use of effective learning strategies at university. However, the effects of such training programs on students' metacognitive knowledge, use of learning strategies, and academic performance in the longer term are unknown. In the present study, all first-year pharmacology students from one university attended a learning strategy training program, i.e., the 'Study Smart program', in their first weeks. The 20% (n = 25) lowest scoring students on the first midterm received further support regarding their learning strategies. Results showed that all students gained accurate metacognitive knowledge about (in)effective learning strategies in the short- and long-term and reported to use less highlighting, less rereading, but more interleaving, elaboration, and distributed practice after the training program. Academic performance was compared to the prior cohort, which had not received the Study Smart program. While in the previous cohort, students in the top, middle, and bottom rank of midterm 1 stayed in these ranks and still differed significantly in the final exam, students in the Study Smart cohort that received the training program improved throughout the year and differences between ranks were significantly reduced. A learning strategy training program including a remediation track for lower performing students can thus support students to study more effectively and enhance equal chances for all students at university.

Impact of Simulation on Critical Care Fellows’ Electroencephalography Learning

Introduction

Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator.

Methods

This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator.

Results

All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F_9,108 = 11.7, p < 0.001), percent of first words correct (F_9,108 = 13.6, p < 0.001), and overall percent hint-based score (F_9,108 = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman’s rho = 0.67, p = 0.023).

Conclusions

A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

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.

Cumulative oral examinations in undergraduate human physiology: process, student perceptions, and outcomes

Assessment methods vary widely across undergraduate physiology courses. Here, a cumulative oral examination was administered in two sections of a 300-level undergraduate physiology course. Student performance was quantified via instructor grading using a rubric, and self-perceptions (n = 55) were collected via survey. Overall, students affirmed that the oral examination assisted in their learning, specifically by leading them to begin preparation for their final written exam earlier than they otherwise would. The instructor considered the oral exam useful for student learning by providing a scaffold to the written final exam and a way to connect with students before a high-stakes final exam. Specific details of the examination format and suggestions and considerations for those considering this assessment approach are provided.

An online, interactive, screen-based simulator for learning basic EEG interpretation

OBJECTIVE

Develop and pilot test a simulator that presents ten commonly encountered representative clinical contexts for trainees to learn basic electroencephalogram (EEG) interpretation skills.

METHODS

We created an interactive web-based training simulator that allows self-paced, asynchronous learning and assessment of basic EEG interpretation skills. The simulator uses the information retrieval process via a free-response text box to enhance learning. Ten scenarios were created that present dynamic (scrolling) EEG tracings resembling the clinical setting, followed by questions with free-text answers. The answer was checked against an accepted word/phrase list. The simulator has been used by 76 trainees in total. We report pilot study results from the University of Florida's neurology residents (N = 24). Total percent correct for each scenario and average percent correct for all scenarios were calculated and correlated with most recent In-training Examination (ITE) and United States Medical License Examination (USMLE) scores.

RESULTS

Neurology residents' mean percent correct scenario scores ranged from 27.1-86.0% with an average scenario score of 61.2% ± 7.7. We showed a moderately strong correlation r = 0.49 between the ITE and the average scenario score.

CONCLUSION

We developed an online interactive EEG interpretation simulator to review basic EEG content and assess interpretation skills using an active retrieval approach. The pilot study showed a moderately strong correlation r = 0.49 between the ITE and the average scenario score. Since the ITE is a measure of clinical practice, this is evidence that the simulator can provide self-directed instruction and shows promise as a tool for assessment of EEG knowledge.