Nonuniform effects of reinstatement within the time window

Optimizing Radiological Education: The Role of Learning Spacing via Test sets in Enhancing Diagnostic Proficiency in Breast Screening Readers

RATIONALE AND OBJECTIVES

Integrating learning spacing in medicine has shown promise in enhancing knowledge retention and diagnostic proficiency. While studies demonstrate the effectiveness of spaced learning in various fields, limited research exists on its application in radiological training. This study aims to investigate the impact of intervals in spaced training on radiologists' and trainees' diagnostic performance via mammogram test sets.

METHODS

54 radiologists and 101 radiology trainees completed 207 and 458 first-time readings of 9 mammogram test sets between 2019 and 2023. Each test set comprised of 60 mammograms (20 cancer and 40 normal), sourced retrospectively from BreastScreen Australia. Each radiologist evaluated mammograms using the BIRADS lexicon. Readers' performance was compared with truth data and evaluated in terms of specificity, case sensitivity, lesion sensitivity, ROC AUC and JAFROC FOM. The progress of readers' performances in following test sets after the first one was analyzed using Wilcoxon Signed Rank test. The association of participants' performances and the intervals among test sets' completions was investigated using Pearson's test.

RESULTS

Significant positive correlations were found between intervals and radiologists' improvement in specificity and JAFROC FOM (P < 0.05). The separation of 4 to 10 days showed the most improvement among radiologists across all metrics, while intervals exceeding 90 days related to highest increase in case sensitivity (5.15%), lesion sensitivity (6.55%), ROC AUC (3.05%) and JAFROC FOM (6.3%). Trainees completing test sets in one day showed positive correlations with their ROC AUC (R=0.45; P = 0.008) and JAFROC FOM (R=0.43; P = 0.02), while those taking a longer time to complete showed negative impacts on case sensitivity (P = 0.009) and ROC AUC (P = 0.02). Remarkable progress in trainees was found in case sensitivity (6.15%), lesion sensitivity (11.6%), ROC AUC (3.5%) and JAFROC FOM (4.35%) with test set intervals of 31-90 days.

CONCLUSIONS

Radiologists demonstrated superior performance when the training test sets were spaced over longer intervals, whereas trainees exhibited proficiency with shorter time separations. By optimizing the spacing of reviewing and practicing radiological concepts, mammogram readers can bolster memory retention and diagnostic decision-making skills.

Retrieval-Based Learning in Children

Testing oneself with flash cards, using a clicker to respond to a teacher’s questions, and teaching another student are all effective ways to learn information. These learning strategies work, in part, because they require the retrieval of information from memory, a process known to enhance later memory. However, little research has directly examined retrieval-based learning in children. We review the emerging literature on the benefits of retrieval-based learning for preschool and elementary school students and draw on other literatures for further insights. We reveal clear evidence for the benefits of retrieval-based learning in children (starting in infancy). However, we know little about the developmental trajectory. Overall, the benefits are largest when the initial retrieval practice is effortful but successful.

Spacing Repetitions Over Long Timescales: A Review and a Reconsolidation Explanation

Recent accounts of the spacing effect have proposed molecular explanations that explain spacing over short, but not long timescales. In the first half of this paper, we review research on the spacing effect that has employed spaces of 24 h or more across skill-related tasks, language-related tasks and generalization for adults and children. Throughout this review, we distinguish between learning and retention by defining learning (or acquisition) as performance at the end of training and retention as performance after a delay period. Using this distinction, we find age- and task-related differences in the manifestation of the spacing effect over long timescales. In the second half of this paper, we discuss a reconsolidation account of the spacing effect. In particular, we review the evidence that suggests the spacing of repetitions influences the subsequent consolidation and reconsolidation processes; we explain how a reconsolidation account may explain the findings for learning; the inverted-U curve for retention; and compare the reconsolidation account with previous consolidation accounts of the spacing effect.

Carolyn Rovee-Collier's legacy to applied psychology, intervention, and public policy

In this article, we reflect upon Carolyn Rovee-Collier's pioneering research on learning and memory in infants, especially that using the mobile conjugate reinforcement task, for our understanding of (a) cognitive development in infants born prematurely and those with Down's syndrome and (b) her prediction that infants' performance in the mobile conjugate reinforcement and similar operant tasks would predict later intellectual functioning. We then examine the implications of her research on time windows (the integration of new information into a memory) and memory reactivation (the retrieval of a forgotten memory as a result of the re-exposure to a component of the original learning experience) for early intervention programs and clinicians treating victims of early trauma. We conclude with a discussion of the value of Rovee-Collier's work for the growing field of infant/toddler science and how this science has informed public policy and program development.

Developmental changes and the effect of self-generated feedback in metacognitive controlled spacing strategies in 7-year-olds, 10-year-olds, and adults

The current study investigated the development of metacognitive monitoring-based control of spacing choices in children and adults. Moreover, we assessed whether metacognitive learning decisions are influenced by the effects of previous metacognitive decisions. We tested groups of 7-year-olds, 10-year-olds, and adults in a task with two learning blocks in which they needed to monitor their learning through judgments of learning (JoL) and in which they then needed to decide whether to space their study, mass it, or terminate it. Extending previous findings, our study provides the first evidence that already by 7 years of age children can make metacognitive controlled scheduling decisions. The results also revealed that adults had more clearly differentiated strategies related to their JoL. Furthermore, our study provides evidence that participants of all age groups improved their relative monitoring accuracy in the second learning block and adjusted their JoL. However, only adults changed their strategy choices.

Pattern and predictability in memory formation: from molecular mechanisms to clinical relevance

Most long-term memories are formed as a consequence of multiple experiences. The temporal spacing of these experiences is of considerable importance: experiences distributed over time (spaced training) are more easily encoded and remembered than either closely spaced experiences, or a single prolonged experience (massed training). In this article, we first review findings from studies in animal model systems that examine the cellular and molecular properties of the neurons and circuits in the brain that underlie training pattern sensitivity during long-term memory (LTM) formation. We next focus on recent findings which have begun to elucidate the mechanisms that support inter-trial interactions during the induction of LTM. Finally, we consider the implications of these findings for developing therapeutic strategies to address questions of direct clinical relevance.

Distributing learning over time: the spacing effect in children's acquisition and generalization of science concepts

The spacing effect describes the robust finding that long-term learning is promoted when learning events are spaced out in time rather than presented in immediate succession. Studies of the spacing effect have focused on memory processes rather than for other types of learning, such as the acquisition and generalization of new concepts. In this study, early elementary school children (5- to 7-year-olds; N = 36) were presented with science lessons on 1 of 3 schedules: massed, clumped, and spaced. The results revealed that spacing lessons out in time resulted in higher generalization performance for both simple and complex concepts. Spaced learning schedules promote several types of learning, strengthening the implications of the spacing effect for educational practices and curriculum.

Potentiation in young infants: the origin of the prior knowledge effect?

In two experiments with 6-month-old infants, we found that prior learning of an operant task (remembered for 2 weeks) mediated new learning of a modeling event (remembered for only 1 day) and increased its recall. Infants first learned to associate lever pressing with moving a toy train housed in a large box. One or 2 weeks later, three target actions were modeled on a hand puppet while the train box (a retrieval cue) was in view. Merely retrieving the train memory strengthened it, and simultaneously pairing its retrieved memory with the modeled actions potentiated their learning and recall. When paired 1 week later, deferred imitation increased from 1 day to 4 weeks; when paired 2 weeks later, it increased from 1 day to 6 weeks. The striking parallels between potentiated learning in infants and the prior knowledge effect in adults suggests that the prior knowledge effect originates in early infancy.

Time windows in retention over the first year-and-a-half of life: spacing effects

The time window construct describes when and how an earlier experience will be enduring. According to the construct, there is a limited period after an event occurs, or time window, in which a second event can retrieve and be integrated with the memory of the first event. The construct also holds that when the integration occurs later in the time window, its effects are more enduring. This study examined the time window construct for session spacing with 6- to 18-month-old human infants. Infants of all ages exhibited the retention benefit of two (integrated) sessions only when the second session occurred within the time window, but only 6-month-olds remembered longer when it occurred late in the time window. Combined with 3-month-olds' data, these findings document the generality and predictive validity of the time window construct throughout the infancy period with one modification: Integration late in the time window only benefits infants younger than 9 months.

Memory reactivation in the second year of life

Memory reactivation has not been systematically studied with infants older than 1 year. Currently, three experiments examined the effects of a reactivation treatment (priming) on retention throughout the second postnatal year. Fifteen- and 18-month-olds learned an operant train task, forgot it, received a 2-min or 10-s prime, and later were tested for retention. Although the longer prime was effective for 15-month-olds, 18-month-olds required the shorter prime (Experiment 1). The memory was reactivated after delays two (18 months) and three (15 months) times longer than infants originally remembered it (Experiment 2). The reactivated memory was forgotten as fast as the original memory after the 2-min prime and twice as fast after the 10-s prime (Experiment 3). The fact that reactivation changes quantitatively but not qualitatively throughout infancy suggests that the same mechanism mediates it at all ages. These findings have major implications for the impact of early experience on cognitive development.