The spacing effect stands up to big data

The effect of duration between sessions on microperimetric biofeedback training in patients with maculopathies

Aim of this study was to explore the optimal training interval and times of microperimetric biofeedback training (MBFT) in maculopathies. Twenty-nine patients with maculopathies were divided into two groups: daily training (Group A) or alternate daily training (Group B). Both groups underwent 15 MBFT sessions. We compared the BCVA, reading speed, and fixation stability at baseline, after 5, 10, 15 sessions. After 15 sessions of MBFT, all visual parameters in both groups improved. There was a significant increase in BCVA after 5 sessions in both groups (P=0.016, and P<0.001 respectively), but Group A showed further improvement after 10 sessions (P<0.001). Regarding reading speed, Group A showed significant improvement from baseline after 15 sessions(P=0.020), Group B improved significantly after 5 sessions (P=0.047) and continued to improve after 10 sessions (P=0.030). Additionally, P1 and LgBCEA of Group A significantly improved after 10 sessions (P=0.001, and P=0.001 respectively), while Group B significantly improved after 5 sessions (P=0.002, and P<0.001 respectively). There was no significant difference in visual outcomes between the two groups (P>0.05) except LgBCEA (P=0.046) after 15 sessions. We concluded that the both MBFT frequencies are effective at improving vision and quality of life in patients with maculopathies. The alternate daily training group showed less time-dependent of improvement in all parameters and a greater benefit in fixation stability. Ten sessions are the optimal number of treatment sessions for alternate daily training.

Benefits of spaced learning are predicted by re-encoding of past experience in ventromedial prefrontal cortex

More than a century of research shows that spaced learning improves long-term memory. Yet, there remains debate concerning why. A major limitation to resolving theoretical debates is the lack of evidence for how neural representations change as a function of spacing. Here, leveraging a massive-scale 7T human fMRI dataset, we tracked neural representations and behavioral expressions of memory as participants viewed thousands of natural scene images that repeated at lags ranging from seconds to many months. We show that spaced learning increases the similarity of human ventromedial prefrontal cortex representations across stimulus encounters and, critically, these increases parallel and predict the behavioral benefits of spacing. Additionally, we show that these spacing benefits critically depend on remembering and, in turn, 're-encoding' past experience. Collectively, our findings provide fundamental insight into how spaced learning influences neural representations and why spacing is beneficial.

Enhancing delirium assessment and management through nursing education interventions: A scoping review

AIM/OBJECTIVE

The purpose of this scoping review was to explore the characteristics and outcomes of education interventions for nurses focused on delirium assessment and management.

BACKGROUND

Delirium is a prevalent acute and reversible neuropsychiatric syndrome in hospitalized patients. Delirium can cause cognitive, psychiatric and physical impairments and result in prolonged hospital stay, increased risk of readmission and elevated morbidity and mortality rates. Nurses play an essential role in managing delirium. There is a lack of understanding of the existing nursing educational interventions on delirium management.

DESIGN

The study was a scoping review.

METHODS

In this scoping review, we used Arksey and O'Malley's (2005) scoping review framework. We searched articles published between 2019 and 2023 in Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE using the following CINAHL/MeSH suggested subject terms: "delirium" in conjunction with "education" "intervention" and "nurse", "nurses" or "nursing." Studies on improving nursing knowledge and practices regarding delirium were included while those focusing on nursing students were excluded. Initial screening involved evaluating article titles and abstracts for relevance from 164 identified articles, followed by a full-text review of 42 articles. Finally, 17 articles were selected for comprehensive analysis. We extracted relevant information from each article and charted the findings in an evidence table.

RESULTS

The 17 selected articles showcased a variety of interventions used to educate nursing staff, such as workshops, simulations, group discussions, online modules and one-on-one coaching. Educational interventions primarily focused on delirium definition, risk factors, assessment and management. These educational interventions enhanced nurses' perception of delirium, boosting their confidence and knowledge in managing delirium. These interventions also led to increased compliance with delirium assessment and management protocols, which ultimately resulted in improved documentation accuracy and patient outcomes.

CONCLUSIONS

Findings from this scoping review suggest that nursing administration need to provide support and education for delirium prevention and management to enhance nursing staff confidence and competence in assessing and managing delirium. The use of interactive educational techniques has demonstrated profound benefits in schema development, expertize promotion and critical thinking. These findings have significant implications for future research, including the identification of essential nursing competencies for educational interventions and the assessment of long-term knowledge retention and its application in nursing practice.

Re-examining the testing effect as a learning strategy: the advantage of retrieval practice over concept mapping as a methodological artifact

Several previous studies appear to have demonstrated that studying with retrieval practice produces more learning than studying with concept mapping, a finding based on which an extended use of retrieval practice in educational practice was recommended. However, a closer examination of the methods used in these previous studies reveals a crucial confounding variable: Whereas participants in the concept mapping conditions performed a concept mapping task without any subsequent memorizing of the learning material, participants in the retrieval practice conditions performed not only retrieval practice but also an additional memorization task, which doubled the total memorization time. The present preregistered study examined whether the advantage observed in the retrieval practice condition over the concept mapping condition in previous studies was actually driven by additional memorization rather than by retrieval practice. While we replicated the previous finding that retrieval practice in combination with additional memorizing produces more learning than concept mapping without additional memorizing, this advantage of retrieval practice over concept mapping vanished when participants in the concept mapping condition, too, memorized the learning material after having created a concept map. These findings demonstrate that the assumed advantage of retrieval practice over concept mapping in fact represents a methodological artifact. Besides serving as a reminder of the importance of a solid methodology, the present study also illustrates the importance of using of an adequate terminology. Depicting a learning strategy condition as "retrieval practice" when the condition actually encompasses not only retrieval practice but also additional memorizing obfuscates the possibility that observed memory advantages may not be fueled by retrieval practice, i.e., the learning strategy as such. We conclude by giving an outlook on the ramifications of our findings for cognitive and educational psychology.

EXPRESS: Going Beyond the Spacing Effect: Does it Matter How Time on a Task is Distributed?

We assessed the effects of removing some constraints that characterize traditional experiments on the effects of spaced, rather than massed, study opportunities. In five experiments-using lists of to-be-remembered words-we examined the effects of how total study time was distributed across multiple repetitions of a given to-be-remembered word. Overall, within a given list, recall profited from study time being distributed (e.g., four 1-second presentations or two 2-second presentations versus one 4-second presentation). Among the implications of these findings is that if students choose to engage in massed studying (by virtue of constraints on their study time or a failure to appreciate the benefits of spaced study sessions), then studying the information twice but for half the time may produce memory benefits in a single study session.

How best can faculty development support teachers in clinical settings?

Faculty development is key to ensuring quality clinical teaching, but standardising teaching practices in multiple settings is a challenge. This article presents an example of a 3-year faculty development programme for teaching clinical reasoning skills, implemented by the Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada for its faculty members at multiple teaching sites. A follow-up study 1–5 months after the final workshop, using a self-assessment questionnaire, indicates that almost half of the participants transferred some of their newly acquired knowledge into their teaching practices. This article discusses factors to consider when developing a faculty development culture, at both a programme and faculty level, to support quality teaching and learning.

Front-loading of anatomy content has no effect on long-term anatomy knowledge retention among physical therapy students: a prospective cohort study

BACKGROUND

Information learned over a longer period of time has been shown to result in better long-term knowledge retention than information learned over a shorter period of time. In order to address multiple curricular goals, the timing and spacing of anatomy content within the Doctor of Physical Therapy (DPT) program at our institution recently changed from a very spaced to a very compressed format. The purpose of the present study was to assess differences in anatomy knowledge retention that might have been impacted by this change. The research hypothesis was that students receiving spaced instruction would have significantly better anatomy knowledge retention than students receiving massed instruction.

METHODS

Participants consisted of two cohorts of DPT students that both received 45 contact hours of anatomy lecture and 90 contact hours of anatomy lab. The LONG cohort experienced anatomy through a lecture and lab taught over a 30-week, 2 semester period as separate courses. In contrast, the SHORT cohort took their anatomy lecture and lab concurrently over one 10-week semester. A pre-test was administered on the first day of their anatomy lecture course, and a post-test was administered to each cohort 18 months after completion of their last anatomy exam.

RESULTS

After controlling for age-related differences in the two groups, no significant differences in mean pre-test, post-test, or percentage improvement were found between cohorts (p = 0.516; 0.203; and 0.152, respectively).

CONCLUSION

These findings refute the hypothesis and show that both spaced and massed instruction in these cohorts resulted in the same level of long-term anatomy knowledge retention.

Large-scale randomized experiments reveals that machine learning-based instruction helps people memorize more effectively

We perform a large-scale randomized controlled trial to evaluate the potential of machine learning-based instruction sequencing to improve memorization while allowing the learners the freedom to choose their review times. After controlling for the length and frequency of study, we find that learners for whom a machine learning algorithm determines which questions to include in their study sessions remember the content over ~69% longer. We also find that the sequencing algorithm has an effect on users' engagement.

The impact of weekly multicourse collective exams on pharmacy student academic behaviors and learning in an integrated biological sciences course

Doctor of Pharmacy (PharmD) degree program curricula are typically comprised of heavy course loads and assessment burden. Typically, students "live" from exam to exam only preparing and studying for the exam directly ahead of them while neglecting concurrent courses. Therefore, the aim of the study was to determine the impact of weekly multicourse collective exams academic behaviors and learning in an integrated biological sciences (BSI) course within a PharmD program. Weekly multicourse exams included questions, four per credit hour, from all first semester courses that traditionally included summative exams. Seven courses contributed questions, which amounted to 15 weekly exams of ∼60 questions. No other graded assessments were given in any of the courses, other than individual course cumulative final exams; the final exams in each course were not collective. After completion of final exams, a Qualtrics survey was emailed to all students and the two professors teaching the course. Course grades, not including the final exam, were compared between two cohorts with or without the collective exams to determine impact on learning. The cumulative final exam was compared between cohorts to determine impact on retention. The majority of students agreed or strongly agreed that the weekly collective exams encouraged them to study BSI more frequently, most days of the week, reduced the likelihood of skipping class, and increased likelihood to pay attention and engage in class. The majority believed that they better learned and retained the BSI material. The majority specified that they liked the collective exams for BSI and preferred it over a traditional exam schedule. Learning also appeared to be improved. However, the impact on retention is less clear and requires further research. In conclusion, the weekly multicourse collective exams improved academic behaviors and learning.

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.

A Functional Contextualist Approach to Mastery Learning in Vocational Education and Training

Along with technological progress, vocational education and training (VET) is consistently changing. Workforce disruption has serious consequences for workers and international economies, often requiring adults to transition into different occupations or to upskill to maintain employment. We review recent literature covering VET trends, theoretical considerations for the 21st century, and present an approach to workforce training to help workers not only learn necessary skills but also become adaptable to constant change. We suggest a functional contextualist approach to mastery learning achieves this aim. Specifically, we offer suggestions for pedagogy that not only develop skills but also encourage higher order thinking. Within a novice to expert continuum, we suggest deliberate practice, mental simulation, and reflective meaning making as methods to achieve efficiency and transfer-learning outcomes relevant to a changing workforce. This approach recognizes that learning is context bound and should promote broader human capabilities that support both employability and the continuing development of life literacies.

Optimizing the Use of an Online Self-assessment Exam to Promote Self-directed Learning Behaviors in Medical Students

Online self-assessment exams (SAEs) can be used to encourage self-directed learning (SDL) in medical education, but their effectiveness depends on how they are incorporated into the curriculum. In this pilot, we applied adult learning principles to the curricular design for implementing an online SAE in the neurology clerkship. We examined student perceptions of the efficacy in promoting SDL behaviors by analyzing survey responses from 76 medical students in the clerkship. Factors in the design and implementation of the SAE that promoted SDL behaviors included fostering autonomy, promoting paced study, broadening content exposure, encouraging self-reflection, and providing content with perceived value.