Enhancing application and long-term retention of clinical knowledge using an extracurricular non-credit course

BACKGROUND AND PURPOSE

Curricular overload in doctor of pharmacy (PharmD) programs is necessitating innovative approaches to support student learning. The purpose of this study was to describe the design, delivery, and assessment of a non-credit extracurricular course that reinforced foundational concepts through the application of learning in case-based activities.

EDUCATIONAL ACTIVITY AND SETTING

A 14-week extracurricular course, designed using principles of spaced repetition and interleaving in the context of case-based exercises, was offered to third-year PharmD students. Content focused on Top 300 and over-the-counter medications, brown bag sessions/drug utilization review, and medication therapy management. Short-term course effectiveness was assessed through post-course focus groups. Longitudinal effectiveness was assessed nine months post-course using an online survey. Qualitative data were analyzed using a content analysis process with overarching themes identified. Clinical interventions identified in the post-course survey were analyzed descriptively.

FINDINGS

Twenty-four students completed the course and all assessments. Focus group themes were: (1) making connections to prior learning; (2) moving beyond memorizing facts; and (3) benefit from a low-stakes course. Students identified 162 course-linked clinical interventions during advanced pharmacy practice experiences (APPEs) in 16 different settings.

SUMMARY

Student learning can be enhanced through integration of evidence-based teaching strategies both within and across the curriculum. This can be accomplished not only through introduction of an extracurricular course but through modification of existing courses. Providing additional opportunities for reinforcing core clinical knowledge and applying clinical decision-making in a low-stakes environment was well-received by students and helped them make clinical interventions during APPEs.

Cognitive perspectives on maintaining physicians' medical expertise: IV. Best practices and open questions in using testing to enhance learning and retention

Although tests and assessments-such as those used to maintain a physician's Board certification-are often viewed merely as tools for decision-making about one's performance level, strong evidence now indicates that the experience of being tested is a powerful learning experience in its own right: The act of retrieving targeted information from memory strengthens the ability to use it again in the future, known as the testing effect. We review meta-analytic evidence for the learning benefits of testing, including in the domain of medicine, and discuss theoretical accounts of its mechanism(s). We also review key moderators-including the timing, frequency, order, and format of testing and the content of feedback-and what they indicate about how to most effectively use testing for learning. We also identify open questions for the optimal use of testing, such as the timing of feedback and the sequencing of complex knowledge domains. Lastly, we consider how to facilitate adoption of this powerful study strategy by physicians and other learners.

Interleaving Effects in Blindfolded Perceptual Learning Across Various Sensory Modalities

Research on sequence effects on learning visual categories has shown that interleaving (i.e., studying the categories in a mixed manner) facilitates category induction as compared to blocking (i.e., studying the categories one by one), but learners are unaware of the interleaving effect and prefer blocking. However, little attention has been paid to sequence effects in perceptual learning across further sensory modalities. The present (preregistered) research addresses this shortcoming by using auditory (birdcalls), olfactory (tealeaves), gustatory (ingredient mixtures), and tactile (stones) stimuli across four analog experiments. The number of participants per experiment was determined based on a medium effect size of interleaving. Participants studied six categories (with six exemplars, respectively) either interleaved or blocked. No single experiment showed a significant effect of interleaving. We ran a comprehensive meta-analysis based on the data from all experiments, which revealed a significant small effect of interleaving, demonstrating its applicability to perceptual learning across all sensory modalities. Learners in the interleaved condition underestimated their classification performance. Overall, learners did not rate interleaving as less effective than blocking, which is at odds with previous studies that consistently demonstrated a metacognitive preference of blocking. Our findings suggest that learners rely less on conventional beliefs about the effectivity of study sequence when dealing with unfamiliar (blindfolded) perceptual learning tasks.

A Computational Model of Context-Dependent Encodings During Category Learning

Although current exemplar models of category learning are flexible and can capture how different features are emphasized for different categories, they still lack the flexibility to adapt to local changes in category learning, such as the effect of different sequences of study. In this paper, we introduce a new model of category learning, the Sequential Attention Theory Model (SAT‐M), in which the encoding of each presented item is influenced not only by its category assignment (global context) as in other exemplar models, but also by how its properties relate to the properties of temporally neighboring items (local context). By fitting SAT‐M to data from experiments comparing category learning with different sequences of trials (interleaved vs. blocked), we demonstrate that SAT‐M captures the effect of local context and predicts when interleaved or blocked training will result in better testing performance across three different studies. Comparatively, ALCOVE, SUSTAIN, and a version of SAT‐M without locally adaptive encoding provided poor fits to the results. Moreover, we evaluated the direct prediction of the model that different sequences of training change what learners encode and determined that the best‐fit encoding parameter values match learners’ looking times during training.

Misconceptions in IONM Part I: Interleaved Intraoperative Somatosensory Evoked Potential Stimulation

A misconception in the field of intraoperative neurophysiological monitoring (IONM) is that continuous, multi-nerve (four-limb), interleaved somatosensory evoked potential (SSEP) stimulation, while advantageous, is not universally utilized due to variety of misunderstandings regarding this approach to SSEP stimulation. This article addresses the rationale for this misconception. We find that continuous, multi-nerve, interleaved SSEP stimulation is superior to all other stimulation paradigms in most operative scenarios, allowing the fastest acquisition of SSEPs at low stimulation repetition rates, which generate the highest amplitude cortical responses.

Transfer of category learning to impoverished contexts

Learning often happens in ideal conditions, but then must be applied in less-than-ideal conditions - such as when a learner studies clearly illustrated examples of rocks in a book but then must identify them in a muddy field. Here we examine whether the benefits of interleaving (vs. blocking) study schedules, as well as the use of feature descriptions, supports the transfer of category learning in new, impoverished contexts. Specifically, keeping the study conditions constant, we evaluated learners' ability to classify new exemplars in the same neutral context versus in impoverished contexts in which certain stimulus features are occluded. Over two experiments, we demonstrate that performance in new, impoverished contexts during test is greater for participants who received an interleaved (vs. blocked) study schedule, both for novel and for studied exemplars. Additionally, we show that this benefit extends to both a short (3-min) or long (48-h) test delay. The presence of feature descriptions during learning had no impact on transfer. Together, these results extend the growing literature investigating how changes in context during category learning or test impacts performance and provide support for the use of interleaving to promote the far transfer of category knowledge to impoverished contexts.

Mitigating the Effect of COVID Lockdown Period on Channel and Bandwidth Utilization in Mobile Communication Network in North Western Rajasthan (India)

The COVID-19 lockdown has led all the citizens (mobile subscribers) of India to stay at home and rather work from home. The people have started consuming more channel utilization (in mobile communication) through a continuous long duration conversations and more internet data through more streaming content as well as logging on to work from home. It was also reflected in how data demand from residential areas rose as compared to commercial areas. Consequently the bandwidth and channel saturation has evolved out to be a severe problem thereby affecting the work performance of all online offices and multi-national companies. This research paper proposes the simulation based experimental study of DITMC technique for mitigating this effect with a special concern in North Western Rajasthan part of India. The simulation results show that significant enhancement of 60.52% in channel utilization and bandwidth optimization is possible with negligible overhead of 0.23%. This technique also enables the telecom operators to ponder research in this field that will promisingly lead to manage augmented number of mobile subscribers (independent of any lockdown period) in limited bandwidth thereby using the spectrum efficiently.

Visual category learning: Navigating the intersection of rules and similarity

Visual categorization is fundamental to expertise in a wide variety of disparate domains, such as radiology, art history, and quality control. The pervasive need to master visual categories has served as the impetus for a vast body of research dedicated to exploring how to enhance the learning process. The literature is clear on one point: no category learning technique is always superior to another. In the present review, we discuss how two factors moderate the efficacy of learning techniques. The first, category similarity, refers to the degree of featural overlap of exemplars. The second moderator, category type, concerns whether the features that define category membership can be mastered through learning processes that are implicit/non-verbal (information-integration categories) or explicit/verbal (rule-based categories). The literature on each moderator has been conducted almost entirely in isolation, such that their potential interaction remains underexplored. We address this gap in the literature by reviewing empirical and theoretical evidence that these two moderators jointly influence the efficacy of learning techniques.

The effect of object similarity and alignment of examples on children's learning and transfer from picture books

Story picture books with examples can be used to teach young children science concepts. Learners can abstract relational information by comparing the analogical examples in the books, leading to a more abstract transferrable understanding of the concept. The purpose of this study was to determine whether manipulating the content or arrangement of the examples included in a picture book would support children's generalization and transfer of a relational concept, namely color camouflage. In total, 81 3-year-olds and 80 4-year-olds were read one of four books at two visits spaced approximately 1 week apart. Examples were manipulated in a 2 (Object Similarity: high or low) × 2 (Arrangement: interleaved or blocked) design. At each visit, children were asked forced-choice questions with photographs (generalization) and real animals (transfer) and needed to explain their choices. At the first visit, only 3-year-olds who had been read a book with high object similarity displayed generalization and transfer. After they were read the same book again at the second visit, 3-year-olds in all conditions performed above chance on generalization questions but made more correct selections if they had been read the books with blocked examples. The 4-year-olds showed no book-related differences on forced-choice questions at either visit but gave better explanations at the second visit if they had been read interleaved books. Our study provides evidence that picture books with analogical examples can be used to teach children about science but that different types and arrangements of examples may better support children at different ages and with different amounts of prior experience.

Verbal and spatial acquisition as a function of distributed practice and code-specific interference

Theories of memory must account for memory performance during both the acquisition (i.e., ongoing learning) and retention (i.e., following disuse) stages of training. One factor affecting both stages is whether repeated encounters with a set of material occur with no delay between blocks (massed) or alternating with another intervening task (spaced). Whereas the retention advantage for spaced over massed practice is well accounted for by some current theories of memory, theories of decay or general interference predict massed, rather than spaced, advantages during acquisition. In a series of 3 experiments, we show that the effects of spacing on acquisition depend on the relationship between primary and delay tasks. Specifically, massed acquisition advantages occur only in the presence of code-specific interference (the engagement in two alternating tasks both emphasizing the same processing code, such as verbal or spatial processing codes; e.g., learning letter-number pairs and reading text), whereas spaced acquisition advantages are observed only when code-specific interference is absent. These results present a challenge for major theories of memory. Furthermore, we argue that code-specific interference is important for researchers of the spacing and interleaving effects to take into consideration, as the relationship between the alternating tasks used has a substantial impact on acquisition performance.

Optimal sequencing during category learning: Testing a dual-learning systems perspective

Recent studies demonstrate that interleaving the exemplars of different categories, rather than blocking exemplars by category, can enhance inductive learning-the ability to categorize new exemplars-presumably because interleaving affords discriminative contrasts between exemplars from different categories. Consistent with this view, other studies have demonstrated that decreasing between-category similarity and increasing within-category variability can eliminate or even reverse the interleaving benefit. We tested another hypothesis, one based on the dual-learning systems framework-namely, that the optimal schedule for learning categories should depend on an interaction of the cognitive system that mediates learning and the structure of the particular category being learned. Blocking should enhance rule-based category learning, which is mediated by explicit, hypothesis-testing processes, whereas interleaving should enhance information-integration category learning, which is mediated by an implicit, procedural-based learning system. Consistent with this view, we found a crossover interaction between schedule (blocked vs. interleaved) and category structure (rule-based vs. information-integration).