1. Use of online spaced education to reinforce learning Kitt Shaffer, MD PhD Vice-Chair of Radiology for Education Boston Medical Center

2. what is the spacing effect? information that is delivered multiple times, with some length of time in between repetitions, is retained better than information delivered once

3. do we make use of the spacing effect in medical education? yes and no for some courses, detailed information is given in one large bolus (1 st year Anatomy) however, material may be revisited in later courses (systems-based courses may review anatomy pertinent to each organ system in 2 nd yr, clinical courses review anatomy in 3-4 th yr) this is probably too LONG for real spacing effect to be seen Custers EJ. Long-term retention of basic science knowledge: a review study. Adv Health Sci Educ Theory Pract 2008;Feb 15.

4. what is the research to support the spacing effect? Kerfoot BP, DeWolf WC et al. Spaced education improves the retention of clinical knowledge by medical students: a randomized controlled trial. Med Educ 2007;41(1):23-31.

5. what is the testing effect? material that is tested is retained this is separate from the student and faculty tendency to teach to the test, or the question will this be on the test? facts which a learner has had to RECALL for a test will be retained better than other facts

6. what is the research to support the testing effect? college students were either quizzed weekly on material or given additional reading assignments quizzing led to significantly higher scores on final exam fill-in format quizzes led to higher scores than MCQ format quizzes McDanier MA, Anderson JL et al, Testing the testing effect in the classroom. Eur J Cog Psych 19:494-513;2007.

7. do we make use of the testing effect in medical education? yes and no obviously, we test students on material we may select what to test on based on non- rational choices (what type of material lends itself to testing, what type of material is easy to formulate as an MCQ?)

8. is there another way to make use of both the spacing and testing effects? SpacedEd – a website that provides infrastructure to design online courses that offer various testing formats as well as customizable spacing intervals – use the website to enter questions and explanations – invite learners to join course – select spacing interval, other parameters

9. what do course participants see? emails in their inbox Your SpacedEd questions for today… upon opening email, link takes them to the website question is displayed, may include images, video, text, diagrams participant answers, gets feedback same question is sent again after appropriate spacing interval

10. demonstration--user

11. what does the course designer see? http://www.spaceded.com tools available to set up a course on any topic – type in questions, explanations – upload image files, diagrams, movies – set parameters for participants how often to repeat (spacing interval)

12. demonstration--teacher

13. Conclusions Repetition is key to retention for learners – even a single repetition at an appropriate interval (2-6 weeks) can dramatically improve retention Testing itself improves retention – effect is most pronounced for fill-in questions SpacedEd is a site that allows design of courses that take advantage of both the spacing effect and the testing effect – CT Anatomy review is in the top 15 courses on site