Expanded vs. Equal Interval Spaced Retrieval Practice: Exploring Different Schedules of Spacing and Retention Interval in Younger and Older Adults

Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study

BACKGROUND

Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD.

OBJECTIVE

This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user's rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting.

METHODS

In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied.

RESULTS

After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app's automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it.

CONCLUSIONS

These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations.

A method for rewarding collaborative efforts in preclinical assessments

Student success in basic medical science courses is typically determined by their individual performance on examinations of various types. Previous research both within and outside medical education has shown that the use of educational assessment activities can increase learning as demonstrated by performance on subsequent examinations, a phenomenon known as the testing effect. Activities primarily designed and used for assessment and evaluation purposes can also be used as teaching opportunities. We developed a method for measuring and evaluating student accomplishment in a preclinical basic science course that incorporates both individual and collaborative efforts, encourages and rewards active participation, does not compromise the reliability of the assessment outcome and is perceived by the students as helpful and valuable. The approach involved a two-part assessment activity composed of an individual examination and a small group examination with each component differentially weighted in determining an overall examination score. We found that the method was successful in encouraging collaborative efforts during the group component and provided valid measures of student grasp of the subject matter. We describe the development and implementation of the method, provide data derived from its use in a preclinical basic science course and discuss factors to be addressed when utilizing this approach to ensure fairness and reliability of the outcome. We include brief summary comments from students regarding their impressions of the value of this method.

Preservation of long-term memory in older adults using a spaced learning paradigm

How much information we retain depends on type/schedule of training. It has been widely acknowledged that spaced learning is advantageous compared to massed learning for cognitively healthy young adults and should be considered an educational standard. Literature would suggest that the spacing effect is preserved with age, though it is unclear whether this effect translates to more ecologically valid concepts such as face-name associations, which are particularly susceptible to deterioration with age. Two experiments were conducted to investigate the effects of spacing across recent/remote retention intervals, and the effect of age on spacing in cognitively healthy older adults using the Face-Name Pairs task. Experiment 1 results suggest that the beneficial memory effects of spacing are particularly observed with long-term memory. Experiment 2 results suggest that older adults are impaired at learning compared to younger adults, that the spacing effect influences both older and younger adults at longer intervals, and that spaced-trained participants display similar forgetting patterns at longer intervals, irrespective of age. These results may have some implications regarding improving the conditions under which optimum retention occurs (namely, whether spacing is beneficial when learning ecologically valid concepts at longer intervals outside of laboratory settings), and may provide insight into the effect of age on our ability to learn and remember face-name associations.

Relevance of working memory for reinforcement learning in older adults varies with timescale of learning

In young adults, individual differences in working memory (WM) contribute to reinforcement learning (RL). Age-related RL changes, however, are mostly attributed to decreased reward prediction-error (RPE) signaling. Here, we investigated the contribution of WM to RL in young (18-35) and older (≥65) adults. Because WM supports maintenance across a limited timescale, we only expected a relation between RL and WM with short delays between stimulus repetitions. Our results demonstrated better learning with short than long delays. A week later, however, long-delay associations were remembered better. Computational modeling corroborated that during learning, WM was more engaged by young adults in the short-delay condition than in any other age-condition combination. Crucially, both model-derived and neuropsychological assessments of WM predicted short-delay learning in older adults, who further benefitted from using self-conceived learning strategies. Thus, depending on the timescale of learning, age-related RL changes may not only reflect decreased RPE signaling but also WM decline.

Specifying the neural basis of the spacing effect with multivariate ERP

The spacing effect refers to the finding that, given a fixed amount of study time, a longer interval between study repetitions improves long-term retention (e.g., Cepeda et al., 2006; Ebbinghaus, 1885/1967; Melton, 1970). Although the spacing effect is a robust and reliable finding in the memory literature, its cognitive and neural mechanisms remain unclear. We used event-related potentials (ERPs) to investigate the neural correlates of the spacing effect in the context of the study-phase retrieval hypothesis, which posits that repeated exposure of an item serves as a reminder of one's previous experience with the item, thereby promoting long-term retention. ERPs were recorded from 30 healthy young adults as they studied pairs of words under three levels of lag, corresponding to 0, 4, or 12 intervening pairs between the first and second occurrences of a target pair. We used two study-phase tasks that differed in the degree of retrieval that was required. During the test phase, participants were tested on paired-associate recall. The results demonstrated a significant effect of spacing on memory performance. However, the effect of encoding task and the interaction between encoding task and spacing were not significant. The results of the partial least squares analyses, which are not constrained by time window or electrode selection, revealed a spacing effect on the ERP data for both study-phase tasks; this effect occurred late in the epoch and was most salient over the centro-parietal scalp region. The results add to the literature on the neural correlates of the spacing effect by providing a more comprehensive account compared to past ERP findings that were focused on testing specific ERP components. They also call for further investigation on the various theoretical accounts of the spacing effect.

Spaced Retrieval and Episodic Memory Training in Alzheimer's Disease

Introduction

This study replicated and extended the findings from the author's previous pilot study to further explore how a spaced retrieval (SR) memory training program might be effectively applied to help persons with Alzheimer’s disease (AD)  improve both short- and long-term recall of recent episodic events.

Methods

A quasi-experimental within-subject group study was conducted with 15 participants with a diagnosis of AD.

Results

Compared to a control condition, all participants were able to spontaneously recall significantly more specific details about trained events, and their recall was significantly enhanced when they were provided with cues. Although the findings indicated that people with AD were able to encode information during training, recall gains diminished by the end of the maintenance period.

Discussion

This study provides evidence that individuals with mild to moderate AD can learn and recall new episodic information through SR training. These findings support the use of SR as an intervention tool to help individuals maintain their functioning in episodic recent memory. However, more research into maintaining the long-term recall of recent episodic events is warranted.

A role for familiarity in supporting the testing effect over time

Endel Tulving (1985) drew a distinction between Remembering and Knowing, spurring a great deal of research on the memorial experiences of recollection and familiarity and their contribution to various phenomena in memory. More recently, studies have used this distinction to situate our understanding of the processes that contribute to the testing effect-or, the benefit of retrieval practice to later memory (see also Tulving, 1967). Using retention intervals of approximately 15 min or less between initial and final testing, several studies have found that initial testing magnifies estimates of recollection but not familiarity, regardless of whether a testing effect is revealed in overall recognition performance (Chan and McDermott, 2007). However, the efficacy of prior testing in enhancing memory has been shown to change over time, as have estimates of recollection and familiarity. Thus, the mechanisms that underlie the quintessential testing effect-one that occurs in overall recognition or recall over longer delays-are still uncertain. To investigate this issue, in two experiments, subjects studied word lists, took 3-letter stem cued-recall tests on half of the studied words, and completed a final recognition test in which estimates of recollection and familiarity were obtained via confidence (Experiment 1) or Remember-Know-New (Experiment 2) judgments. Critically, final recognition tests occurred either immediately, 1 day (Experiment 1 only), or 4 days after initial learning. At all retention intervals and in both methods of estimating recollection and familiarity on the final test (i.e. receiver-operating characteristic and remember-know analyses), initial testing magnified estimates of both recollection and familiarity. These findings suggest that the testing effect can result from changes in both processes and pose issues for theories of the testing effect that consider an exclusive role for recollection.

Diminishing-cues retrieval practice: A memory-enhancing technique that works when regular testing doesn't

Retrieval practice has been shown to be a highly effective tool for enhancing memory, a fact that has led to major changes to educational practice and technology. However, when initial learning is poor, initial retrieval practice is unlikely to be successful and long-term benefits of retrieval practice are compromised or nonexistent. Here, we investigate the benefit of a scaffolded retrieval technique called diminishing-cues retrieval practice (Finley, Benjamin, Hays, Bjork, & Kornell, Journal of Memory and Language, 64, 289-298, 2011). Under learning conditions that favored a strong testing effect, diminishing cues and standard retrieval practice both enhanced memory performance relative to restudy. Critically, under learning conditions where standard retrieval practice was not helpful, diminishing cues enhanced memory performance substantially. These experiments demonstrate that diminishing-cues retrieval practice can widen the range of conditions under which testing can benefit memory, and so can serve as a model for the broader application of testing-based techniques for enhancing learning.

Ameliorating Episodic Memory Deficits in a Young Adult With Developmental (Congenital) Amnesia

OBJECTIVES

Although the spacing effect has been investigated extensively in a variety of populations, few studies have focused on individuals with hippocampal amnesia and none, to our knowledge, have investigated differences in performance as a function of spacing schedule in these cases. In the current study, we investigated the benefit of expanding and equal-interval, compared to massed, spacing schedules in a developmental amnesic person, H.C., who shows congenitally based abnormal development of the hippocampal memory system.

METHODS

Given the possibility of plasticity and reorganization in the developing brain, we investigated whether H.C. would benefit more from an expanding versus equal-interval schedule using a continuous recognition paradigm, even though this task has been shown to recruit structures within the medial temporal lobe, including the hippocampus.

RESULTS

H.C. and matched controls both showed a clear spacing effect, although neither group benefited more from an equal-interval or expanding spacing schedule.

CONCLUSIONS

The results of the current study show that the spacing effect is an effective and clinically meaningful memory intervention technique that may be applied to clinical conditions known to affect hippocampal function and episodic memory early in life. (JINS, 2018, 24, 1003-1012).

Examining the contributions of desirable difficulty and reminding to the spacing effect

Although substantial evidence indicates that spacing repeated study events with intervening material generally enhances memory performance relative to massing study events, the mechanism underlying this benefit is less clear. Two experiments examined the role of reminding difficulty during the acquisition of material in modulating final memory performance for spaced repetitions utilizing recognition (Experiment 1) and recall tests (Experiment 2). Specifically, participants studied a list of words presented one or two times separated by one or five items. On each trial participants reported whether the item had been previously presented (i.e., repetition detection judgment), and the response latency served as a proxy for reminding difficulty such that longer response latencies reflected more difficult reminding. A third experiment extended this paradigm with the inclusion of a massed condition and novel lag conditions (three and ten items). Results revealed significant lag effects in final test performance across experiments despite comparable repetition detection difficulty between lag conditions during acquisition. Moreover, results from within-participant point-biserial analyses and mediation analyses converged on overall performance measures in suggesting that repetition detection difficulty failed to modulate final test performance in the current paradigm. Discussion considers the implications of the current results for mechanisms proposed to underlie the benefits of spaced study and spaced retrieval practice.

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.

Recall and response time norms for English-Swahili word pairs and facts about Kenya

In the vast literature exploring learning, many studies have used paired-associate stimuli, despite the fact that real-world learning involves many different types of information. One of the most popular materials used in studies of learning has been a set of Swahili-English word pairs for which Nelson and Dunlosky (Memory 2; 325-335, 1994) published recall norms two decades ago. These norms involved use of the Swahili words as cues to facilitate recall of the English translation. It is unclear whether cueing in the opposite direction (from English to Swahili) would lead to symmetric recall performance. Bilingual research has suggested that translation in these two different directions involves asymmetric links that may differentially impact recall performance, depending on which language is used as the cue (Kroll & Stewart, Journal of Memory and Language 33; 149-174,1994). Moreover, the norms for these and many other learning stimuli have typically been gathered from college students. In the present study, we report recall accuracy and response time norms for Swahili words when they are cued by their English translations. We also report norms for a companion set of fact stimuli that may be used along with the Swahili-English word pairs to assess learning on a broader scale across different stimulus materials. Data were collected using Amazon's Mechanical Turk to establish a sample that was diverse in both age and ethnicity. These different, but related, stimulus sets will be applicable to studies of learning, metacognition, and memory in diverse samples.

The Value of Standardized Testing

Recent years have seen an increased push toward the standardization of education in the United States. At the federal level, both major national political parties have generally supported the institution of national guidelines known as Common Core—a curriculum developed by states and by philanthropic organizations. A key component of past and present educational reform measures has been standardization of tests. However, increased reliance upon tests has elicited criticism, limiting their popular acceptance and widespread adoption. Tests are not only useful for assessment purposes, however. The goal of this article is to review evidence from the recent literature in psychology that indicates that tests produce direct educational benefits for students. A reconsideration of how and how many tests are implemented based on these principles may help soften the focus on testing solely as a means of assessment and help promote wider recognition of the role of tests as potent instructional interventions.

Contracting, equal, and expanding learning schedules: the optimal distribution of learning sessions depends on retention interval

In laboratory and applied learning experiments, researchers have extensively investigated the optimal distribution of two learning sessions (i.e., initial learning and one relearning session) for the learning of verbatim materials. However, research has not yet provided a satisfying and conclusive answer to the optimal scheduling of three learning sessions (i.e., initial learning and two relearning sessions) across educationally relevant time intervals. Should the to-be-learned material be repeated at decreasing intervals (contracting schedule), constant intervals (equal schedule), or increasing intervals (expanding schedule) between learning sessions? Different theories and memory models (e.g., study-phase retrieval theory, contextual variability theory, ACT-R, and the Multiscale Context Model) make distinct predictions about the optimal learning schedule. We discuss the extant theories and derive clear predictions from each of them. To test these predictions empirically, we conducted an experiment in which participants studied and restudied paired associates with a contracting, equal, or expanding learning schedule. Memory performance was assessed immediately, 1 day, 7 days, or 35 days later with free- and cued-recall tests. Our results revealed that the optimal learning schedule is conditional on the length of the retention interval: A contracting learning schedule was beneficial for retention intervals up to 7 days, but both equal and expanding learning schedules were better for a long retention interval of 35 days. Our findings can be accommodated best by the contextual variability theory and indicate that revisions are needed to existing memory models. Our results are practically relevant, and their implications for real-world learning are discussed.

Retrieval practice and spacing effects in young and older adults: An examination of the benefits of desirable difficulty

In the present study, we examined how the function relating continued retrieval practice (e.g., one, three, or five tests) and long-term memory retention is modulated by desirable difficulty (R. A. Bjork, 1994). Of particular interest was how retrieval difficulty differed across young and older adults and across manipulations of lag (Exp. 1) and spacing (Exp. 2). To extend on previous studies, the acquisition phase response latency was used as a proxy for retrieval difficulty, and our analysis of final-test performance was conditionalized on acquisition phase retrieval success, to more directly examine the influence of desirable difficulty on retention. The results from Experiment 1 revealed that continued testing in the short-lag condition led to consistent increases in retention, whereas continued testing in the long-lag condition led to increasingly smaller benefits in retention for both age groups. The results from Experiment 2 revealed that repeated spaced testing enhanced retention relative to taking one spaced test, for both age groups; however, repeated massed testing only enhanced retention over taking one test for young adults. Across both experiments, the response latency results were overall consistent with an influence of desirable difficulty on retention. The discussion focuses on the role of desirable difficulty during encoding in producing the benefits of lag, spacing, and testing.

What you learn is more than what you see: what can sequencing effects tell us about inductive category learning?

Inductive category learning takes place across time. As such, it is not surprising that the sequence in which information is studied has an impact in what is learned and how efficient learning is. In this paper we review research on different learning sequences and how this impacts learning. We analyze different aspects of interleaved (frequent alternation between categories during study) and blocked study (infrequent alternation between categories during study) that might explain how and when one sequence of study results in improved learning. While these different sequences of study differ in the amount of temporal spacing and temporal juxtaposition between items of different categories, these aspects do not seem to account for the majority of the results available in the literature. However, differences in the type of category being studied and the duration of the retention interval between study and test may play an important role. We conclude that there is no single aspect that is able to account for all the evidence available. Understanding learning as a process of sequential comparisons in time and how different sequences fundamentally alter the statistics of this experience offers a promising framework for understanding sequencing effects in category learning. We use this framework to present novel predictions and hypotheses for future research on sequencing effects in inductive category learning.

What is more effective: a daily or a weekly formative test?

BACKGROUND

Exams in anatomy courses are traditionally summative. Formative testing induces retrieval practice, provides feedback and enhances learning results. We investigated the optimal frequency for retrieval practice during an anatomy course.

METHOD

During a first-year course, students were offered four online daily quizzes a week that assessed thoracic anatomy. Once a week they received a quiz about abdominal anatomy. Students immediately received feedback afterwards. In the fourth course week, a survey about participation and satisfaction was taken. 424 students participated in the final summative exam. Trunk wall questions were used as a control. Relationship between participation and test results was investigated with a one-way ANOVA.

RESULTS

More frequent participation in formative tests was correlated to higher scores in the summative exam with no difference between daily and weekly quizzes. This effect was found for thorax-abdomen and 'control' trunk wall questions. Participation in weekly quizzes was higher (p < 0.001). All survey responses showed a significant difference in favour of the weekly quiz (p < 0.001).

DISCUSSION AND CONCLUSION

Participation in formative quizzes was correlated to summative exam scores. This correlation was not specific for the material tested, probably because of diligence. Student participation and preference were much higher in weekly quizzes.

Interactions between Identity and Emotional Expression in Face Processing across the Lifespan: Evidence from Redundancy Gains

We tested how aging affects the integration of visual information from faces. Three groups of participants aged 20–30, 40–50, and 60–70 performed a divided attention task in which they had to detect the presence of a target facial identity or a target facial expression. Three target stimuli were used: (1) with the target identity but not the target expression, (2) with the target expression but not the target identity, and (3) with both the target identity and target expression (the redundant target condition). On nontarget trials the faces contained neither the target identity nor expression. All groups were faster in responding to a face containing both the target identity and emotion compared to faces containing either single target. Furthermore the redundancy gains for combined targets exceeded performance limits predicted by the independent processing of facial identity and emotion. These results are held across the age range. The results suggest that there is interactive processing of facial identity and emotion which is independent of the effects of cognitive aging. Older participants demonstrated reliably larger size of the redundancy gains compared to the young group that reflect a greater experience with faces. Alternative explanations are discussed.

Retrieval practice is an efficient method of enhancing the retention of anatomy and physiology information

Although a great deal of empirical evidence has indicated that retrieval practice is an effective means of promoting learning and memory, very few studies have investigated the strategy in the context of an actual class. The primary purpose of this study was to determine if a series of very brief retrieval quizzes could significantly improve the retention of previously tested information throughout an anatomy and physiology course. A second purpose was to determine if there were any significant differences between expanding and uniform patterns of retrieval that followed a standardized initial retrieval delay. Anatomy and physiology students were assigned to either a control group or groups that were repeatedly prompted to retrieve a subset of previously tested course information via a series of quizzes that were administered on either an expanding or a uniform schedule. Each retrieval group completed a total of 10 retrieval quizzes, and the series of quizzes required (only) a total of 2 h to complete. Final retention of the exam subset material was assessed during the last week of the semester. There were no significant differences between the expanding and uniform retrieval groups, but both retained an average of 41% more of the subset material than did the control group (ANOVA, F = 129.8, P = 0.00, ηp(2) = 0.36). In conclusion, retrieval practice is a highly efficient and effective strategy for enhancing the retention of anatomy and physiology material.

Effects of spacing of item repetitions in continuous recognition memory: does item retrieval difficulty promote item retention in older adults?

BACKGROUND/STUDY CONTEXT: Older adults exhibit an age-related deficit in item memory as a function of the length of the retention interval, but older adults and young adults usually show roughly equivalent benefits due to the spacing of item repetitions in continuous memory tasks. The current experiment investigates the seemingly paradoxical effects of retention interval and spacing in young and older adults using a continuous recognition memory procedure.

METHODS

Fifty young adults and 52 older adults gave memory confidence ratings to words that were presented once (P1), twice (P2), or three times (P3), and the effects of the lag length and retention interval were assessed at P2 and at P3, respectively.

RESULTS

Response times at P2 were disproportionately longer for older adults than for younger adults as a function of the number of items occurring between P1 and P2, suggestive of age-related loss in item memory. Ratings of confidence in memory responses revealed that older adults remembered fewer items at P2 with a high degree of certainty. Confidence ratings given at P3 suggested that young and older adults derived equivalent benefits from the spacing between P1 and P2.

CONCLUSION

Findings of this study support theoretical accounts that suggest that recursive reminding and/or item retrieval difficulty promote item retention in older adults.

Improving Students’ Learning With Effective Learning Techniques

Many students are being left behind by an educational system that some people believe is in crisis. Improving educational outcomes will require efforts on many fronts, but a central premise of this monograph is that one part of a solution involves helping students to better regulate their learning through the use of effective learning techniques. Fortunately, cognitive and educational psychologists have been developing and evaluating easy-to-use learning techniques that could help students achieve their learning goals. In this monograph, we discuss 10 learning techniques in detail and offer recommendations about their relative utility. We selected techniques that were expected to be relatively easy to use and hence could be adopted by many students. Also, some techniques (e.g., highlighting and rereading) were selected because students report relying heavily on them, which makes it especially important to examine how well they work. The techniques include elaborative interrogation, self-explanation, summarization, highlighting (or underlining), the keyword mnemonic, imagery use for text learning, rereading, practice testing, distributed practice, and interleaved practice.

To offer recommendations about the relative utility of these techniques, we evaluated whether their benefits generalize across four categories of variables: learning conditions, student characteristics, materials, and criterion tasks. Learning conditions include aspects of the learning environment in which the technique is implemented, such as whether a student studies alone or with a group. Student characteristics include variables such as age, ability, and level of prior knowledge. Materials vary from simple concepts to mathematical problems to complicated science texts. Criterion tasks include different outcome measures that are relevant to student achievement, such as those tapping memory, problem solving, and comprehension.

We attempted to provide thorough reviews for each technique, so this monograph is rather lengthy. However, we also wrote the monograph in a modular fashion, so it is easy to use. In particular, each review is divided into the following sections: General description of the technique and why it should work How general are the effects of this technique?  2a. Learning conditions  2b. Student characteristics  2c. Materials  2d. Criterion tasks Effects in representative educational contexts Issues for implementation Overall assessment

The review for each technique can be read independently of the others, and particular variables of interest can be easily compared across techniques.

To foreshadow our final recommendations, the techniques vary widely with respect to their generalizability and promise for improving student learning. Practice testing and distributed practice received high utility assessments because they benefit learners of different ages and abilities and have been shown to boost students’ performance across many criterion tasks and even in educational contexts. Elaborative interrogation, self-explanation, and interleaved practice received moderate utility assessments. The benefits of these techniques do generalize across some variables, yet despite their promise, they fell short of a high utility assessment because the evidence for their efficacy is limited. For instance, elaborative interrogation and self-explanation have not been adequately evaluated in educational contexts, and the benefits of interleaving have just begun to be systematically explored, so the ultimate effectiveness of these techniques is currently unknown. Nevertheless, the techniques that received moderate-utility ratings show enough promise for us to recommend their use in appropriate situations, which we describe in detail within the review of each technique.

Five techniques received a low utility assessment: summarization, highlighting, the keyword mnemonic, imagery use for text learning, and rereading. These techniques were rated as low utility for numerous reasons. Summarization and imagery use for text learning have been shown to help some students on some criterion tasks, yet the conditions under which these techniques produce benefits are limited, and much research is still needed to fully explore their overall effectiveness. The keyword mnemonic is difficult to implement in some contexts, and it appears to benefit students for a limited number of materials and for short retention intervals. Most students report rereading and highlighting, yet these techniques do not consistently boost students’ performance, so other techniques should be used in their place (e.g., practice testing instead of rereading).

Our hope is that this monograph will foster improvements in student learning, not only by showcasing which learning techniques are likely to have the most generalizable effects but also by encouraging researchers to continue investigating the most promising techniques. Accordingly, in our closing remarks, we discuss some issues for how these techniques could be implemented by teachers and students, and we highlight directions for future research.

Diminished but not forgotten: effects of aging on magnitude of spacing effect benefits

OBJECTIVES

Age-related changes in memory performance are common in paired associate episodic memory tasks, although the deficit can be ameliorated with distributed practice. Benefits of learning episode spacing in older adults have been shown in single-session studies with spaced presentations of items followed by a test. This study examined the magnitude of the spacing effect benefit in older adults relative to younger adults when given a multiday spacing effect paradigm.

METHOD

We examined the impact of spacing gap (~15min vs. 24hr) in younger (N = 51, Mage = 19 years, SD = 0.6) and older (N = 54, Mage = 65 years, SD = 8.8) adults with a 10-day retention interval.

RESULTS

Spacing of learning episodes benefited both younger and older adults. There was an age-related difference in the magnitude of this benefit that has not been observed in earlier studies.

DISCUSSION

These results suggest that spacing benefited the long-term memory of older adults, however the effect was diminished and qualitatively different from that of younger adults.

Effect of uniform versus expanding retrieval practice on the recall of physiology information

The purpose of this study was to compare the retention of selected physiology concepts throughout 30 days of two different uniform schedules of retrieval and two different expanding schedules of retrieval. Participants (n = 250) first read and reread 30 immunology and reproductive physiology concepts and were then repeatedly assessed, without feedback, according to one of the following four randomly assigned schedules: 1) immediately after learning and again 9 and 19 days later [uniform (days 1, 10, and 20)]; 2) 7, 14, and 21 days after learning [uniform (days 8, 15, and 22)]; 3) immediately after learning and again 5 and 15 days later [expanding (days 1, 6, and 16)]; and 4) 1, 6, and 16 days after learning [expanding (days 2, 7, and 17)]. All participants completed a final assessment 29 days after learning the physiology concepts. Mean final assessment scores ± SE for the uniform (days 1, 10, and 20), uniform (days 8, 15, and 22), expanding (days 1, 6, and 16), and expanding (days 2, 7, and 17) groups were 36.15 ± 1.97, 32.31 ± 1.87, 45.80 ± 2.56, and 39.71 ± 2.48, respectively. There were no differences in final assessment scores between the two expanding retrieval groups, but expanding (days 1, 6, and 16) group scores were significantly higher than those in both uniform retrieval groups (ANOVA, F = 6.52, P = 0.00). Also, the combined mean of the two expanding retrieval conditions (42.57 ± 1.80) was significantly higher (F = 14.09, P = 0.00) than the combined mean of the two uniform retrieval conditions (34.10 ± 1.36). The results indicate that participants benefited more from expanding retrieval practice, particularly when the first assessment was administered immediately after learning.

Influence of Multiple-Day Temporal Distribution of Repetitions on Memory: A Comparison of Uniform, Expanding, and Contracting Schedules

Very few studies have examined the influence of schedules of repetitions across multiple days (e.g., Tsai, 1927). Three temporal schedules of four presentations of pseudoword/word pairs over a 7-day learning period were compared: a uniform (presentations on Days 1, 3, 5, and 7), an expanding (1, 2, 3, 7), and a contracting (1, 5, 6, 7) schedule. Schedule was a within-subjects variable. Experiment 1 was performed on the Internet and showed that cued recall on Day 9 led to higher scores for the stimuli of the expanding schedule. Experiment 2 was performed in the laboratory and showed that the expanding and the uniform schedules led to the highest scores on Day 9. A recognition task performed during the learning phase revealed that stimuli recognized at the time of their repetition were more likely to be retrieved later than the others. Our results are discussed within the framework of the study-phase retrieval and encoding variability theories.

Self control of when and how much to test face-name pairs in a novel spaced retrieval paradigm: an examination of age-related differences

Although the mnemonic benefit of spaced retrieval is well established, the way in which participants naturally space their own retrieval is relatively unexplored. To examine this question, a novel experimental paradigm was developed in which young and healthy older adults were given control over the frequency and timing of retrieval practice in the context of an ongoing reading task. Results showed that both age groups naturally expanded the intervals of their retrieval practice. When instructed, younger adults but not older adults were better able to employ equal spaced retrieval during retrieval practice. However, even under equal spaced retrieval instructions, young adults included an early retrieval attempt prior to equally spacing their retrieval. Although memory performance was equivalent, secondary task performance was reduced in the experimenter-instructed condition compared with the participant-selected condition. The results overall indicate that both younger and older participants naturally monitor their memory and efficiently use testing to titrate the number and timing of retrieval attempts used during the acquisition phase.

Errorless learning in cognitive rehabilitation: a critical review

Cognitive rehabilitation research is increasingly exploring errorless learning interventions, which prioritise the avoidance of errors during treatment. The errorless learning approach was originally developed for patients with severe anterograde amnesia, who were deemed to be at particular risk for error learning. Errorless learning has since been investigated in other memory-impaired populations (e.g., Alzheimer's disease) and acquired aphasia. In typical errorless training, target information is presented to the participant for study or immediate reproduction, a method that prevents participants from attempting to retrieve target information from long-term memory (i.e., retrieval practice). However, assuring error elimination by preventing difficult (and error-permitting) retrieval practice is a potential major drawback of the errorless approach. This review begins with discussion of research in the psychology of learning and memory that demonstrates the importance of difficult (and potentially errorful) retrieval practice for robust learning and prolonged performance gains. We then review treatment research comparing errorless and errorful methods in amnesia and aphasia, where only the latter provides (difficult) retrieval practice opportunities. In each clinical domain we find the advantage of the errorless approach is limited and may be offset by the therapeutic potential of retrieval practice. Gaps in current knowledge are identified that preclude strong conclusions regarding a preference for errorless treatments over methods that prioritise difficult retrieval practice. We offer recommendations for future research aimed at a strong test of errorless learning treatments, which involves direct comparison with methods where retrieval practice effects are maximised for long-term gains.

Effect of selected "desirable difficulty" learning strategies on the retention of physiology information

The purpose of this study was to examine the effects of interleaving and expanding retrieval on the retention of physiology concepts. Participants (n = 189) read and then reread 30 immunology and reproductive physiology passages. Half of the participants read and then reread the passages in a blocked manner (e.g., a(1)a(2)a(3)b(1)b(2)b(3)), and the other half did so in an interleaved manner (e.g., a(1)b(1)b(2)a(2)a(3)b(3)). Participants were then repeatedly assessed, without feedback, after either a uniform or an expanding series of intervals. Half of the students from both the blocked and interleaved groups completed the assessments 1, 2, and 3 days after rereading the passages (uniform), whereas the other half completed the assessments immediately and 1 and 3 days after rereading the passages (expanding). All participants completed a final assessment 10 days after rereading the passages. There were no significant differences between the blocked and interleaved groups on any of the assessments, nor were there any significant interactions between the groups on any of the assessments. Those in the expanding retrieval group scored significantly higher than those in the uniform group on all four assessments (ANOVA; assessment 1: F = 35.12, P = 0.00; assessment 2: F = 13.88, P = 0.00; assessment 3: F = 10.87, P = 0.00; and assessment 4: F = 6.79, P = 0.01). Mean final assessment scores were 47.58 ± 19.81 and 40.50 ± 17.17 for the expanding and uniform groups, respectively. The results indicate that participants benefited more from expanding retrieval practice.

The role of forgetting rate in producing a benefit of expanded over equal spaced retrieval in young and older adults

The current study examined the effects of two manipulations on equal and expanded spaced retrieval schedules in young and older adults. First, we examined the role that the type of expansion (systematic vs. nonsystematic) has in producing a benefit of expanded retrieval. Second, we examined the influence of an immediate retrieval attempt to minimize forgetting after the original encoding event. It was predicted that including multiple retrieval attempts with minimal intervening spacing (best accomplished in a nonsystematic retrieval schedule) would be necessary to produce a benefit of expanded retrieval over equal spaced retrieval for older adults but not young adults due to age differences in working memory capacity. Results from two experiments revealed that the presence of an expanded over equal spaced retrieval benefit is modulated by the extent to which the spacing conditions minimize forgetting in the early retrieval attempts in the spaced conditions. As predicted, these conditions differ substantially across young and older adults. In particular, in older adults two intervening items between early retrieval attempts produce dramatic rates of forgetting compared to one intervening item, whereas younger adults can maintain performance up to five intervening events in comparable conditions. Discussion focuses on age differences in short term forgetting, working memory capacity, and the relation between forgetting rates and spaced retrieval schedules.

Testing to enhance retention in human anatomy

Recent work in cognitive psychology has shown that repeatedly testing one's knowledge is a powerful learning aid and provides substantial benefits for retention of the material. To apply this in a human anatomy course for medical students, 39 fill-in-the-blank quizzes of about 50 questions each, one for each region of the body, and four about the nervous system, were developed. The quizzes were optional, and no credit was awarded. They were posted online using Blackboard, which provided feedback, and they were very popular. To determine whether the quizzes had any effect on retention, they were given in a controlled setting to 21 future medical and dental students. The weekly quizzes included questions on regional anatomy and an expanded set of questions on the nervous system. Each question about the nervous system was given three times, in a slightly different form each time. The second quiz was given approximately half an hour after the first one, and the third was given one week after the second to assess retention. The quizzes were unpopular, but students showed robust improvement on the questions about the nervous system. The scores increased by almost 9% on the second quiz, with no intervention except viewing the correct answers. The scores were 29% higher on the third quiz than on the first, and there was also a positive correlation between the grades on the quizzes and the final examination. Thus, repeated testing is an effective strategy for learning and retaining information about human anatomy.

What makes distributed practice effective?

The advantages provided to memory by the distribution of multiple practice or study opportunities are among the most powerful effects in memory research. In this paper, we critically review the class of theories that presume contextual or encoding variability as the sole basis for the advantages of distributed practice, and recommend an alternative approach based on the idea that some study events remind learners of other study events. Encoding variability theory encounters serious challenges in two important phenomena that we review here: superadditivity and nonmonotonicity. The bottleneck in such theories lies in the assumption that mnemonic benefits arise from the increasing independence, rather than interdependence, of study opportunities. The reminding model accounts for many basic results in the literature on distributed practice, readily handles data that are problematic for encoding variability theories, including superadditivity and nonmonotonicity, and provides a unified theoretical framework for understanding the effects of repetition and the effects of associative relationships on memory.

Durable improvements in prostate cancer screening from online spaced education a randomized controlled trial

CONTEXT

Prostate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines.

BACKGROUND

It was hypothesized that an e-mail-based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer.

DESIGN

The study was conducted as an RCT.

SETTING/PARTICIPANTS

The study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009.

INTERVENTION

Participants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers.

MAIN OUTCOME MEASURES

The primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or <40 years. Appropriateness of screening was dichotomized based on patient age at time of screening. Patients with PSA testing for non-screening reasons were excluded using a validated protocol. Logistic regression with adjustment for patient clustering by clinician was performed. Analyses were conducted in 2009.

RESULTS

During the intervention period (Weeks 1-36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p=0.041). Over the 72-week period following the intervention (Weeks 37-108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p=0.011), representing a 40% relative reduction in inappropriate screening.

CONCLUSIONS

Spaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.

Optimizing retrieval as a learning event: when and why expanding retrieval practice enhances long-term retention

Retrieving information from memory makes that information more recallable in the future than it otherwise would have been. Optimizing retrieval practice has been assumed, on the basis of evidence and arguments tracing back to Landauer and Bjork (1978), to require an expanding-interval schedule of successive retrievals, but recent findings suggest that expanding retrieval practice may be inferior to uniform-interval retrieval practice when memory is tested after a long retention interval. We report three experiments in which participants read educational passages and were then repeatedly tested, without feedback, after an expanding or uniform sequence of intervals. On a test 1 week later, recall was enhanced by the expanding schedule, but only when the task between successive retrievals was highly interfering with memory for the passage. These results suggest that the extent to which learners benefit from expanding retrieval practice depends on the degree to which the to-be-learned information is vulnerable to forgetting.

Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial

OBJECTIVE

To determine whether Interactive Spaced Education (ISE) is an effective and acceptable form of graduate and continuing medical education (GME/CME), using clinical practice guideline (CPG) education as an experimental system.

SUMMARY BACKGROUND DATA

ISE is a novel form of online education, which combines the pedagogical merits of the spacing and testing effects. Its efficacy for GME and CME is not known.

METHODS

One-hundred sixty urologists and 320 urology residents were randomized to 1 of 2 cohorts. We developed and validated 48 ISE items (questions and answers) on 5 urology CPGs (hematuria and priapism [HP]; staghorn calculi, infertility, and antibiotic use [SIA]). Physicians were sent 3 emails a week, each containing 2 questions. Content was repeated 3 times over 20 weeks. Cohort A physicians received the 3-cycle ISE course on HP, with 24 control items on SIA in cycle 3. Cohort B physicians received the 3-cycle ISE course on SIA, with 24 control items on HP in cycle 3.

RESULTS

The ISE program was completed by 71% urologists and 83% residents. Cohort A scores on HP increased from mean 44.9% in cycle 1% to 75.7% in cycle 3, a 57% relative increase compared with controls (P < 0.001; Cohen effect size, 2.2). Similarly, cohort B scores on SIA increased from 45.2% in cycle 1% to 69.5% in cycle 3, a 56% relative increase compared with controls (P < 0.001; effect size, 2.2). Eighty-four percent of all participants requested to enroll in further ISE programs.

CONCLUSIONS

ISE is an effective and well-accepted form of GME and CME and is a promising new methodology to improve CPG knowledge.

Aging, spaced retrieval, and inflexible memory performance

Spaced retrieval is a memory-training technique whereby information is tested at progressively longer delays. Two experiments were conducted in order to examine the effects of spaced retrieval on controlled recollection and automatic influences of memory. In Experiment 1, word pairs were read once, three times, or once and retrieved twice by young and older adults. Retrieval practice improved performance on a later test for both age groups. Experiment 2 was arranged so that recollection opposed automatic influences of retrieval practice. Retrieval practice increased intrusions on a later test only for older adults. Results suggest that because of a deficit in recollection, older adults were less able to oppose the automatic influence of spaced retrieval and thus exhibited less flexible memory performance.