1
|
Albert FA, Seidu AA, Mason HM, Anderson E, Alele FO, Heggarty P, Hollins A, Gupta TS, Hays RB, McArthur L, Malau-Aduli BS. A systematic review of medical practitioners' retention and application of basic sciences to clinical practice. BMC MEDICAL EDUCATION 2024; 24:997. [PMID: 39272053 PMCID: PMC11396528 DOI: 10.1186/s12909-024-05952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Medical education offers the foundational base for future healthcare professionals, with basic sciences playing a pivotal role in providing essential knowledge and skills for clinical practice. However, the long-term retention and application of this knowledge in clinical practice remain a significant challenge. This systematic review synthesised global evidence from diverse studies on the short / long-term retention and clinical application of basic sciences among medical doctors. METHODS A comprehensive search was conducted across six databases, including Web of Science, Scopus, Medline, CINAHL, Emcare, and Informit. The review included studies that encompassed a variety of study designs, participant groups, and educational interventions. The Quality Assessment with Diverse Studies (QuADS) tool was utilised to assess the quality of the reviewed studies. RESULTS A total of 10 studies were included in the review. The findings revealed that rehearsals significantly optimise the retention of basic science knowledge among medical practitioners. Retention varied by discipline, with medical practitioners retaining more knowledge in anatomy (mean scores ranging from 45.0 to 82.9%), while microbiology had the lowest retention score (39.1%). Factors influencing retention included age, gender, and curriculum type. Educational interventions such as targeted courses, integration of basic sciences with clinical skills, generative retrieval and continuous quality improvement in the curriculum were found to enhance both knowledge retention and clinical reasoning. The concept of 'encapsulated knowledge' demonstrates that integrated basic science knowledge helps in synthesising clinical presentations, reducing the need for detailed recall as clinical experience increases. The reviewed studies primarily involved interns and surgeons, leaving a significant gap in research for specialties like internal medicine and primary care/ general practice. CONCLUSION Detailed retention of basic science knowledge may diminish over time; however, the conceptual framework remains essential for ongoing learning and clinical reasoning. This review's findings highlight the need for specialised educational interventions to improve long-term retention. Continuous professional development and targeted educational techniques are vital for maintaining clinical competence and applying basic science knowledge effectively throughout a medical career. Further research is needed to address gaps in specialty-specific knowledge application and the impact of different instructional methods.
Collapse
Affiliation(s)
- Francis A Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Abdul-Aziz Seidu
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Hannah M Mason
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Emma Anderson
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Faith O Alele
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia
| | - Paula Heggarty
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Aaron Hollins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Richard B Hays
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Lawrie McArthur
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, SA, 5606, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, 2308, Australia.
| |
Collapse
|
2
|
Trieu PDY, Abu Awwad D, Barron ML, Lewis SJ. Optimizing Radiological Education: The Role of Learning Spacing via Test sets in Enhancing Diagnostic Proficiency in Breast Screening Readers. Acad Radiol 2024:S1076-6332(24)00425-2. [PMID: 39048496 DOI: 10.1016/j.acra.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
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.
Collapse
Affiliation(s)
- Phuong Dung Yun Trieu
- BREAST, Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia 2006.
| | - Dania Abu Awwad
- BREAST, Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia 2006
| | - Melissa L Barron
- BREAST, Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia 2006
| | - Sarah J Lewis
- BREAST, Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia 2006; School of Health Sciences, Western Sydney University, Campbelltown, Australia 2560
| |
Collapse
|
3
|
Majety P, Daaboul Y, Rencic J. Learning Theories Versus Practice: How Do Internal Medicine Residents Study for Licensing Examinations? Cureus 2023; 15:e50052. [PMID: 38186475 PMCID: PMC10767471 DOI: 10.7759/cureus.50052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE The ability to recall relevant medical knowledge within clinical contexts is a critical aspect of effective and efficient patient diagnosis and management. The ever-growing and changing body of medical literature requires learners to develop effective life-long learning techniques. Learners can more successfully build their fund of knowledge and ability to retrieve it by using evidence-based learning strategies. Our objective was to evaluate the study habits of internal medicine (IM) residents at an academic institution to understand if they apply key learning strategies for the American Board of Internal Medicine (ABIM) exam preparation. We also briefly review various learning strategies that can be applied to IM residency curricula. METHODS A web-based survey consisting of 16 multiple-response questions on study habits was filled out by the IM residents in 2019 at Tufts Medical Center. RESULTS Of the 75 residents invited to participate in the study, 69 responded (response rate = 92%). Of the responders, n=25 (36.2%) were post-graduate year (PGY)-1, n=20 (29.0%) were PGY-2, and n=24 (34.8%) were PGY-3 residents. More than half the residents (n=40, 58%) had Step 2 Clinical Knowledge (CK) scores > 250. Residents self-reported applying spaced learning (67%), interleaving (64%), retrieval (64%), and elaboration practices (46%) for exam preparation. There was a significant association between the Step 2 CK score and elaboration (p=0.017) technique but not with spaced learning, interleaving, or retrieval. The majority of residents felt not at all prepared (n=42, 60.9%) for the ABIM exam. CONCLUSIONS Despite two years of clinical training, 33% of the third-year residents felt inadequately prepared for the board certification exam. Incorporating evidence-based learning strategies into their daily curriculum may help them better prepare for the ABIM exam.
Collapse
Affiliation(s)
- Priyanka Majety
- Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Yazan Daaboul
- Cardiology, Baim Clinical Research Institute, Boston, USA
| | - Joseph Rencic
- Internal Medicine, Boston Medical Center, Boston, USA
| |
Collapse
|
4
|
Thompson CP, Hughes MA. The Effectiveness of Spaced Learning, Interleaving, and Retrieval Practice in Radiology Education: A Systematic Review. J Am Coll Radiol 2023; 20:1092-1101. [PMID: 37683816 DOI: 10.1016/j.jacr.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Radiology is a highly complex field that requires mastery over an ever-expanding body of knowledge. Spaced learning, interleaving, and retrieval practice are evidence-based learning strategies that enhance long-term retention of information. The aim of this systematic review is to assess the effectiveness of these interventions in the setting of radiology education. METHODS The authors searched MEDLINE, Embase, PsycInfo, ERIC, and forward and backward citations for studies published between database inception and February 19, 2023. Eligibility criteria for included studies were randomized and quasi-randomized controlled trials that investigated the impact of spaced, interleaved, or retrieval practice on knowledge retention of medical trainees after education related to medical imaging as assessed by postinterventional examination scores. RESULTS Of 1,316 records reviewed, 8 studies met eligibility criteria. Two studies investigated spaced learning, two studies interleaving, and six studies retrieval practice, including two trials that evaluated interventions incorporating both spaced learning and retrieval practice. Five of eight studies reported statistically significant differences between interventional and control groups on either immediate or delayed postinterventional examinations. CONCLUSIONS Despite extensive evidence in support of spaced, interleaved, and retrieval practice within the broader literature, few studies have examined the effectiveness of these strategies in radiology education. Additional trials are required to evaluate the usefulness of incorporating these techniques into educational programs related to medical imaging.
Collapse
Affiliation(s)
- Cole P Thompson
- Department of Radiology, University of California, San Diego, San Diego, California.
| | - Marion A Hughes
- Associate Director of the Diagnostic Radiology Residency Program, Associate Medical Director - Faculty Development, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
5
|
Pumilia CA, Lessans S, Harris D. An Evidence-Based Guide for Medical Students: How to Optimize the Use of Expanded-Retrieval Platforms. Cureus 2020; 12:e10372. [PMID: 33062495 PMCID: PMC7550004 DOI: 10.7759/cureus.10372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Recommendations have been made for improving medical education based on the available evidence regarding learning. Traditional learning methods in medical education (e.g. reading from textbooks) do not ensure long-term retention. However, expanded-retrieval studying methods have been shown to improve studying efficiency. Using evidence-based practices to optimize an expanded-retrieval platform has the potential to greatly benefit knowledge acquisition and retention for medical students. This literature review was conducted to identify the best practices of expanded-retrieval platforms. Themes within learning that promote knowledge gain and retention include presentation of related categorical information, schema formation, dual-coding, concrete examples, elaboration, changes in text appearance, and interleaving. Presentation of related categorical material together may mitigate retrieval-induced forgetting (RIF). Spaced retrieval helps to reinforce schema formation by solidifying the framework the individual students form when learning the material. Dual-coding improves learning by creating more neural pathways. Multiple concrete examples can be compared by students to see their respective differences, highlighting the true underlying principle. Variation in text appearance is most useful during the initial, short-term inter-study intervals. Interleaving is a theme where different topics are combined in the same study session and is unpopular with students but shown to be successful. Students’ subjective competency ratings of new material are largely inaccurate. More in-depth processing and learning methods that give off a sense of lower competency are actually associated with improved long-term retention. Expanded-retrieval platforms should utilize these evidence-based components of learning to increase knowledge gain and retention within all fields of medical education.
Collapse
Affiliation(s)
- Cyrus A Pumilia
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Spencer Lessans
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - David Harris
- Medical Education, University of Central Florida College of Medicine, Orlando, USA
| |
Collapse
|
6
|
Versteeg M, Hendriks RA, Thomas A, Ommering BWC, Steendijk P. Conceptualising spaced learning in health professions education: A scoping review. MEDICAL EDUCATION 2020; 54:205-216. [PMID: 31860936 PMCID: PMC7064953 DOI: 10.1111/medu.14025] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/05/2019] [Accepted: 10/21/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education. METHOD The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods. RESULTS Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching. CONCLUSIONS Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education.
Collapse
Affiliation(s)
- Marjolein Versteeg
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Renée A. Hendriks
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Aliki Thomas
- School of Physical and Occupational TherapyMontrealQuébecCanada
- Faculty of MedicineInstitute for Health Sciences EducationMcGill UniversityMontrealQuébecCanada
- Centre for Interdisciplinary Research in RehabilitationMontrealQuébecCanada
| | - Belinda W. C. Ommering
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Paul Steendijk
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| |
Collapse
|
7
|
Zisblatt L, Chen F, Dillman D, DiLorenzo AN, MacEachern MP, Miller Juve A, Peoples EE, Grantham AE. Critical Appraisal of Anesthesiology Educational Research for 2017. Cureus 2019; 11:e4838. [PMID: 31410321 PMCID: PMC6684110 DOI: 10.7759/cureus.4838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Critical appraisals provide a method for establishing the status of an area of study or evaluating the effectiveness of literature within it. The purpose of this study was to review and appraise studies published in 2017 on medical education in anesthesiology and to provide summaries of the highest-quality medical education research articles in the field. Methods Three Ovid MEDLINE databases, Embase.com, Education Resources Information Center (ERIC), and PsycINFO, were searched followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double-screened and quantitative articles subsequently scored by three randomly assigned raters. Qualitative studies were scored by two raters. Two different rubrics were used for scoring quantitative and qualitative studies, both allowed for scores ranging from 1-25. Results A total of 864 unique citations were identified through the search criteria. Of those, 62 articles met the inclusion criteria, with 59 quantitative and three qualitative. The top 10 papers with the highest scores were reported and summarized. Discussion As the first article to critically review the literature available for education in anesthesiology, we hope that this study will serve as the first manuscript in an annual series that will help individuals involved in anesthesiology education gain an understanding of the highest-quality research in the field. Once this process is repeated, trends can be tracked and serve as a resource to educators and researchers in anesthesiology for years to come.
Collapse
Affiliation(s)
- Lara Zisblatt
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Dawn Dillman
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, USA
| | - Amy N DiLorenzo
- Department of Anesthesiology, University of Kentucky, Lexington, USA
| | - Mark P MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, USA
| | - Amy Miller Juve
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, USA
| | - Emily E Peoples
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
| | | |
Collapse
|
8
|
Kleiman AM, Potter JF, Bechtel AJ, Forkin KT, Dunn LK, Collins SR, Lyons G, Nemergut EC, Huffmyer JL. Generative retrieval results in positive academic emotions and long-term retention of cardiovascular anatomy using transthoracic echocardiography. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:47-54. [PMID: 30615478 DOI: 10.1152/advan.00047.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With increasing medical knowledge, procedural, and diagnostic skills to learn, it is vital for educators to make the limited amount of teaching time available to students effective and efficient. Generative retrieval is an effective and efficient learning tool, improving long-term retention through the practice of retrieval from memory. Forty medical students were randomized to learn normal cardiovascular anatomy using transthoracic echocardiography video clips in a generative retrieval (GR) or standard practice (SP) group. GR participants were required to verbally identify each unlabeled cardiovascular structure after viewing the video. After answering, participants viewed the correctly labeled video. SP participants viewed the same video clips labeled with the correct cardiovascular structure for the same amount of total time without verbally generating an answer. All participants were tested for intermediate (1-wk), late (1-mo), and long-term (6- to 9-mo) retention of cardiovascular anatomy. Additionally, a three-question survey was incorporated to assess perceptions of the learning method. There was no difference in pretest scores. The GR group demonstrated a trend toward improvement in recall at 1 wk [GR = 74.3 (SD 12.3); SP = 65.4 (SD 16.7); P = 0.10] and 1 mo [GR = 69.9 (SD15.6); SP = 64.3 (SD 15.4); P = 0.33]. At the 6- to 9-mo time point, there was a statistically significant difference in scores [GR = 74.3 (SD 9.9); SP = 65.0 (SD 14.1); P = 0.042]. At nearly every time point, learners had a statistically significantly higher perception of effectiveness, enjoyment, and satisfaction with GR. In addition to improved recall, GR is associated with increased perceptions of effectiveness, enjoyment, and satisfaction, which may lead to increased engagement, time spent studying, and improved retention.
Collapse
Affiliation(s)
- Amanda M Kleiman
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Jennifer F Potter
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Allison J Bechtel
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Katherine T Forkin
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Lauren K Dunn
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Stephen R Collins
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| | - Genevieve Lyons
- Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia
| | - Edward C Nemergut
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
- Department of Neurosurgery, University of Virginia , Charlottesville, Virginia
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia , Charlottesville, Virginia
| |
Collapse
|
9
|
|
10
|
Sosa PM, Gonçalves R, Carpes FP, Mello-Carpes PB. Active memory reactivation previous to the introduction of a new related content improves students' learning. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:75-78. [PMID: 29341807 DOI: 10.1152/advan.00077.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Priscila Marques Sosa
- Physiology Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| | - Rithiele Gonçalves
- Physiology Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| | - Pâmela B Mello-Carpes
- Physiology Research Group, Federal University of Pampa, Uruguaiana, Rio Grande do Sul, Brazil
| |
Collapse
|