A spaced-repetition approach to enhance medical student learning and engagement in medical pharmacology

Quantifying Efficacy of Video Interventions about Adverse Events in Medical Student Education

OBJECTIVES

The coronavirus disease 2019 pandemic catalyzed a rapid shift toward remote learning in medicine. This study hypothesized that using videos on adverse events and patient safety event reporting systems could enhance education and motivation among healthcare professionals, leading to improved performance on quizzes compared with those exposed to standard, in-person lectures.

METHODS

Participants were randomly assigned to a group both watching the video and attending an in-person lecture or a group that received only the in-person lecture in this study performed in 2022. Surveys gathered demographic information, tested knowledge, and identified barriers to reporting adverse events.

RESULTS

A total of 83 unique participants responded to the survey out of the 130 students enrolled (64%; 83/130). Among the students completing all of the surveys, the group who watched the Osmosis video had a higher average quiz score (6.46/7) than the lecture group (6.31/7) following the first intervention. Only 25% of respondents agreed or strongly agreed that they knew what to include in a patient safety report and only 10% agreed or strongly agreed that they knew how to access the reporting system.

CONCLUSIONS

This study suggests virtual preclass video learning can be a beneficial tool to complement traditional lecture-based learning in medical education. Further research is needed to determine the efficacy of long-term video interventions in adverse events.

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.

Anki flashcards: Spaced repetition learning in the undergraduate medical pharmacology curriculum

BACKGROUND

Teaching clinical pharmacology is often a challenge for medical schools. The benefits and popularity of active recall and spaced repetition through Anki flashcards are well-established and can offer a solution for teaching complex topics, but educators are often unfamiliar with this resource.

APPROACH

We implemented 501 faculty-generated pharmacology flashcards in five modules across the medical preclinical curriculum, available to 104 first-year students. At the end of each module, students were surveyed on the usefulness of this novel resource. The data from the cohort who had access to flashcards was compared with the previous cohort, without access, to analyse whether student use of Anki flashcards changed students' perceptions of the pharmacology curriculum and whether there were changes in pharmacology exam performance.

EVALUATION

Seventy-five percent of the respondents rated the Anki pharmacology flashcards as 'very useful' or 'somewhat useful'. Eight hundred and seventy-five responses were analysed with a natural language processing algorithm, showing that fewer students mentioned pharmacology as a difficult topic in the cardiovascular and renal modules, compared with the cohort who did not use Anki flashcards. There was not a statistically significant difference in test scores between the cohorts.

IMPLICATIONS

Anki flashcards were well-received by medical students, which might have impacted their perception of the curriculum, as evidenced by the decrease in mentions of pharmacology being a difficult topic, maintaining consistency in academic performance. Educators should consider providing flashcards to offer spaced repetition opportunities in the curriculum; an additional benefit could be increasing information equality in medical schools.

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.

Effectiveness of spaced repetition for clinical problem solving amongst undergraduate medical students studying paediatrics in Pakistan

BACKGROUND

Studies using spaced repetition for teaching and learning in undergraduate clinical rotations such as paediatrics are limited, even more so in the South Asian region. Therefore, this study aimed to identify the effectiveness of utilizing spaced repetition compared to traditional learning methods among undergraduate medical students during their paediatric rotation at a medical university in Pakistan.

METHODS

Bahria University Medical and Dental College (BUMDC) conducted quasii-experimental research in Karachi. Four topics were identified from the Year 5 Pediatrics curriculum to be used in the study, using which the study content was developed along with 50 multiple choice questions (MCQs) for assessment. All BUMDC Year 5 medical students rotating in Pediatrics were included and randomly allocated to the control or intervention group. In the control group, they provided the students with traditional study methods consisting of books and lectures to learn topics. In the intervention group, we created an Anki flashcard deck of the same topics to enable learning via spaced repetition. The researchers conducted a pretest and post test assessment of the 50 MCQs in both groups at the beginning and after the four-week study interval. The data were analysed using SPSS 19.

RESULTS

A total of 115 BUMDC medical students agreed to participate in the study; 70 (59.1%) were in the intervention group, and 45 (41.7%) were in the control group. The pretest mean score of the control group was 27.96 ± 3.70, and the posttest mean score was 27.22 ± 5.02, with no statistically significant difference at the 95% confidence level. The mean score of the pretest for the intervention group was 27.93 ± 4.53, and that of the posttest was 30.8 ± 4.56, with a statistically significant difference at the 95% confidence level. The intervention showed a significant effect size of 0.8.

CONCLUSION

The use of spaced repetitions resulted in significantly greater scores for medical students studying paediatrics than for those using more traditional methods of learning, compromising medical books and lectures. Considering that medical students need to retain a vast amount of information, using spaced repetition through flashcards can be a more effective learning tool that is more cost-efficient and time-efficient than traditional learning methods.

Digital flashcards and medical physiology performance: a dose-dependent effect

Use of digital flashcards promotes active recall, spaced repetition, and self-assessment academic principles. This work explores the association and dose-dependent effect of this study method and locomotor (LP) and cardiovascular physiology (CP) grades. A single-faculty cohort study of medical LP and CP students was conducted, and 155 and 676 flashcards, respectively, were created through Moodle. An exploratory analysis examined three exam results (2019), and a confirmatory study used a fourth exam (2021) in another CP cohort. Of 685 students enrolled, 558 participated in the exploratory analysis: 319 (69%) for LP and 311 (84%) for CP, of which 203 LP and 267 CP students were flashcard users. Median grades were higher among flashcard users, and the number of cards reviewed was positively correlated with grades (r = 0.275 to 0.388 for LP and r = 0.239 to 0.432 for CP, P < 0.001). Multiple linear regression models confirmed a positive dose-dependent association between results and the number of flashcards studied: for every 100 LP cards reviewed, exam grades increased 0.44-0.75 on a 0-20 scale range (P < 0.001), and for every 1,000 CP flashcards, results raised 0.81-1.08 values (P < 0.05). These findings were confirmed in the 2021 CP cohort of 269 participants, of whom 67% were flashcard users. Digital flashcard revision has a consistent positive dose-dependent association on LP and CP grades.NEW & NOTEWORTHY Implementing flashcard-based strategies is a feasible way to promote active recall, spaced repetition, and self-assessment, and students are highly adherent to these initiatives. There is a positive dose-dependent association between the number of flashcards reviewed and physiology grades. These results are consistent across different physiology subjects, under different cohorts, over short and medium terms.

QuizTime: Innovative Learning Platform to Support Just-In-Time Asynchronous Quizzes to Improve Health Outcomes

QuizTime is an innovative, asynchronous, spaced learning platform that provides just-in-time learning to increase knowledge and retention. QuizTime was created in 2015, and since then, its effectiveness has been tested and studied across multiple healthcare learning interventions. This paper describes the importance of spaced learning in knowledge acquisition and retention, and the motivation behind the creation of the innovative QuizTime platform. We demonstrate the usefulness of this platform, as shown by multiple case studies using QuizTime, to increase and engage medical students, residents, physicians and health care providers with new quizzes and interventions.

Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students

OBJECTIVE

This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students.

METHODS

This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model.

RESULTS

The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner.

CONCLUSION

Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.

Effectiveness of endotracheal intubation and mask ventilation procedural skills training on second-year student using modified Peyton's Four-Step approach during COVID-19 pandemic

BACKGROUND

Airway emergency is the reason behind competency in mask ventilation and intubation skills for doctors. Procedural skills are taught through face-to-face training. However, the COVID-19 pandemic has had an impact on the education system, including medical education. The face-to-face training method cannot be carried out and requires a modification to an online method. Therefore, Peyton's Four-Step Approach is modified to adapt this change.

OBJECTIVE

Assessing the effectiveness of learning methods between modified Peyton's Four-Step approach and classic Peyton's Four Step approach in learning basic skills of mask ventilation and intubation during the COVID-19 pandemic.

METHOD

This was an experimental study with two groups of subjects in the Basic ClinicalSkills module of endotracheal intubation and mask ventilation at the Faculty ofMedicine, Universitas Indonesia during February-June 2022. The first group received training with classic Peyton's Four-Step approach and another group with modified Peyton's Four-Step approach. Both groups were tested and assessed using rubric score and global rating score, and asked to fill a feedback questionnaire.

RESULTS

This study was conducted with 133 students in the classic group and 96 students in the modified group. The median rubric score was 21.2 for both groups and the global rating score showed 82%and 78% students passed, for classic and modified group respectively. Therubric score and global rating score, also the pass rate between two learningmethods showed no significant results (P > 0.05). The satisfaction and self-confidence questionnaires got answers 'agree and strongly agree' for all questions.

CONCLUSION

The learning method using modified and classic Peyton Four-StepApproach were equally effective for learning basic skill of endotracheal intubation and mask ventilation for students of the Faculty of Medicine,University of Indonesia. Both methods provided equal students' satisfaction and self-confidence.

Anki Flashcards for Radiology Education

From online textbooks to educational social media posts, digital learning tools are transforming medical education. Spaced repetition programs are a popular tool, with 70% of first-year medical students reporting using the free, open-source flashcard application Anki.1 The Anki program pairs active recall and spaced repetition learning principles with a simple but versatile user interface.2 Spaced repetition flashcard programs such as Anki are uniquely suited to radiology education because they strengthen image-based recall, a necessary skill for radiology trainees to develop. In this review, we will describe the science behind active recall and spaced repetition programs, introduce the Anki platform, and describe future directions for its potential as an educational resource for radiology.

Virtual reality simulation as a training tool for perfusionists in extracorporeal circulation: Establishing face and content validity

Objective

We conducted a prospective study to assess the face and content validity of a new virtual reality (VR) extracorporeal circulation simulator (ECC) developed for perfusionists to facilitate training and practice. We evaluated the opinions of students and staff members about the feasibility of the simulation. The 2 groups consisted of experts (qualified perfusionists) and novices (trainee perfusionists).

Methods

Perfusionists (n = 12 experts and n = 11 trainees) received instructions on how to use the VR simulator and then proceeded to perform the start of cardiopulmonary bypass in the VR environment. Participants then completed a Usefulness, Satisfaction, and Ease of Use Questionnaire. The questions were rated on a 5-point Likert scale, ranging from 1 (fully disagree) to 5 (fully agree), to assess the face validity and content validity of this simulator.

Results

Participants reported a predominantly positive experience with the VR-ECC simulator, with 96% (n = 22) agreeing that the simulator was a useful way of training ECC scenarios. All participants found it easy to interact with the software (100%, n = 23), and 82% of students (n = 9) believed it helped them remember the steps involved with initiating ECC. Finally, (87% [n = 20]) of participants believed the image quality and depth perception were good.

Conclusions

Our next-generation simulator was valid for face and content constructs, and almost all participants found it to be a useful way of training for ECC scenarios. This simulator represents a first step toward truly blended digital learning and a new interactive, flexible, and innovative modality for perfusion training.

Implementation of Spaced Repetition by First-Year Medical Students: a Retrospective Comparison Based on Summative Exam Performance

Many medical students use spaced repetition as a study strategy to improve knowledge retention, and there has been growing interest from medical students in using flashcard software, such as Anki, to implement spaced repetition. Previous studies have provided insights into the relationship between medical students' use of spaced repetition and exam performance, but most of these studies have relied on self-reports. Novel insights about how medical students use spaced repetition can be gleaned from research that takes advantage of the ability of digital interfaces to log detailed data about how students use software. This study is unique in its use of data extracted from students' digital Anki data files, and those data are used to compare study patterns over the first year of medical school. Implementation of spaced repetition was compared between two groups of students who were retrospectively grouped based on average performance on three exams throughout the first year of medical school. Results indicate that students in the higher scoring group studied more total flashcards and implemented spaced repetition via Anki earlier in the year compared to the lower scoring group. These findings raise the possibility that implementing spaced repetition as a study strategy early in medical school may be related to improved knowledge retention and exam performance. Additional research should be performed at more sites to further examine the relationship between spaced repetition implementation and exam performance.

Anki Tagger: A Generative AI Tool for Aligning Third-Party Resources to Preclinical Curriculum

Using large language models, we developed a method to efficiently query existing flashcard libraries and select those most relevant to an individual's medical school curricula.

A Cohort Study Assessing the Impact of Anki as a Spaced Repetition Tool on Academic Performance in Medical School

Introduction

Anki is an application that capitalizes upon the techniques of spaced repetition and is increasingly utilized by medical students for examination preparation. This study examines the impact of Anki usage in a medical school curriculum on academic performance. Secondary objectives analyzed individual Anki utilization and a qualitative assessment of Anki use.

Methods

A cohort-control study was conducted at Boonshoft School of Medicine. One hundred thirty first-year medical students were enrolled in an Anki utilization training program from July 2021 to September 2021. Training included educational Anki courses and subsequent survey data collection over Anki usage. Data variables included all course final examinations, the Comprehensive Basic Science Exam (CBSE), individual Anki user statistics, nationally standardized exams scores, and Qualtrics surveys on student perceived ease of use.

Results

Seventy-eight students reported using Anki for at least one of the exams, and 52 students did not use Anki for any exam. Anki users scored significantly higher across all four exams: Course I (6.4%; p < 0.001); Course II (6.2%; p = 0.002); Course III (7.0%; p = 0.002); and CBSE (12.9%; p = 0.003). Students who reported higher dependency on Anki for studying performed significantly better on the Course I, II, and CBSE exams.

Conclusion

Anki usage may be associated with an increase in standardized examination scores. This supports Anki as an evidence-based spaced repetition and active retrieval learning modality for medical school standardized examinations. There was little correlation between its specific statistical markers and examination performance. This is pertinent to physicians and medical students alike as the learning and preservation of biomedical knowledge is required for examinations and effective clinical care.

Flashcards: The Preferred Online Game-Based Study Tool Self-Selected by Students to Review Medical Histology Image Content

Medical students use several supplementary digital resources to support learning. Majority of these supplementary resources enhance learning by recall and repetition. A few examples of these resources are concept maps, flashcards (FCs), and self-testing tools. Traditionally, paper-based FCs are used in higher education. The concept of paper-based FCs is extended to the digital world in the form of electronic/web-based FCs. The use of electronic/digital flashcards has been reported to review course material in the medical school curriculum. Some of the medical school coursework requires students to acquire visual skills, for example, histology and pathology. Students, who do not have prior knowledge of the basic content on histology and pathology struggle to identify microscopic tissues and organs. Therefore, students look for other supplementary resources to support visual learning. Digital resources like Anki, Quizlet, and Osmosis provide study tools that support visual skills. A review of the literature revealed only a few publications pertaining to the use of digital testing tools for histology education in medical school curriculum. In the medical histology course at the Albert Einstein College of Medicine (Einstein), Bronx, NY, first-year medical students used a game-based platform (Quizlet) to review image-based histology course content in the form of four Quizlet study sets. Students chose from six Quizlet study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) to review the image-based course material and test their knowledge on accurate identification of histological images. The data on student usage of study tools was tracked and analyzed for 4 years (Graduating Classes of 2018 to 2021) to calculate: the total usage of the game-based study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) over the period of 4 years, total percent usage over 4 years of each game-based study tools (Flashcards, Learn, Speller, Test, Match, and Race/Gravity) in each of the four Quizlet study sets and to identify the preferred game-based study tool. The data showed a consistent year-on-year increase in usage of game-based study tools by 50% (M = 445 in 2018 compared to M = 849 in 2021). For the four Quizlet study sets the percent usage of each study tool Flashcards, Learn, Test, Match, Gravity, and Speller was tracked and combined across the four academic years. It was found that Flashcards were used significantly more frequently than any other tool and this was followed by Learn, Test, Match, Gravity, and Speller (p < 0.0001 using chi-square). The study concludes that flashcards are the preferred study tool used by students to acquire visual skills for identifying histological images and could be incorporated when designing online study tools.

Exploring Anki Usage Among First-Year Medical Students During an Anatomy & Physiology Course: A Pilot Study

Objectives

As medical schools worldwide condense the preclinical phase of medical education, it is increasingly important to identify resources that help medical students retain and employ the medical information. One popular tool among medical students is an application called Anki, a free and open-source flashcard program utilizing spaced repetition for quick and durable memorization. The purpose of this study is to determine how variable Anki usage among first-year medical students throughout a standardized anatomy and physiology course correlates with performance.

Methods

We designed a novel Anki add-on called "Anki Stat Scraper" to collect data on first-year medical students at Kirk Kerkorian School of Medicine during their 8-week anatomy and physiology course. Anki users (N = 45) were separated into four groups: Heavy (N = 5), intermediate (N = 5), light (N = 16), and limited-Anki (N = 19) users, based on the time each student spent on the flashcard app, how many flashcards they studied per day, and how many days they used the app prior to their anatomy and physiology exam. A 14-question Likert scale questionnaire was administered to each participant to gauge their understanding of Anki and how they used the app to study.

Results

Heavy and intermediate Anki users had higher average exam scores than their counterparts who did not use Anki as a study method. Average exam scores were 90.34%, 91.74%, 85.86%, and 87.75% for heavy, intermediate, light, and limited-Anki users respectively (p > 0.05). Our survey demonstrated that Anki users spent an average of 73.86% of their study time using Anki, compared to an average of 36.53% for limited-Anki users (p < 0.001).

Conclusion

Anki users did not score significantly higher compared to limited-Anki users. However, survey responses from students believe that Anki may still be a useful educational tool for future medical students.

On enhancing students' cognitive abilities in online learning using brain activity and eye movements

The COVID-19 pandemic has interrupted education institutions in over 150 nations, affecting billions of students. Many governments have forced a transition in higher education from in-person to remote learning. After this abrupt, worldwide transition away from the classroom, some question whether online education will continue to grow in acceptance in post-pandemic times. However, new technology, such as the brain-computer interface and eye-tracking, have the potential to improve the remote learning environment, which currently faces several obstacles and deficiencies. Cognitive brain computer interfaces can help us develop a better understanding of brain functions, allowing for the development of more effective learning methodologies and the enhancement of brain-based skills. We carried out a systematic literature review of research on the use of brain computer interfaces and eye-tracking to measure students' cognitive skills during online learning. We found that, because many experimental tasks depend on recorded rather than real-time video, students don't have direct and real-time interaction with their teacher. Further, we found no evidence in any of the reviewed papers for brain-to-brain synchronization during remote learning. This points to a potentially fruitful future application of brain computer interfaces in education, investigating whether the brains of student-teacher pairs who interact with the same course content have increasingly similar brain patterns.