ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.

residents (typically six) cannot attend LLLC because they are on vacation, on call or on evening shift assignments. Those absent from LLLC miss this ongoing group learning activity and consequently suffer gaps in the learning threads. Finally, because case-prompted questions, concepts and learning points are often numerous and highly complex, substantial time is required for careful, deliberate examination and synthesis of relevant evidence and ideas. Also, as participants typically number over a dozen, the time limitation of the conference (30-minutes) often prevents the complete resolution of issues and full participation by every individual in attendance. What was done Two web-based technologies were implemented to enhance learner engagement with ongoing LLLC sessions. Evaluation of results and impact Resident usage of the blog was assessed for a 3-month period by examining page view statistics and posted comments. Residents, including those unable to attend LLLC, participated in asynchronous e-discussion. Pages were viewed and comments posted throughout the day, as well as during overnight and weekend on-call hours. Resident comments were consistently thoughtful and substantive. The addition of a web-based LLLC repository provided a permanent and growing record of conference 'proceedings', with links to a multitude of sources, and allowed access to a larger community of learners on a 24-hour basis. However, the repository represents a static source, which is directed in one-way only from participants to readers. The addition of a blog overcame this limitation by extending opportunities for continued participation and contributions from all residents, and thus expanding asynchronous group e-learning beyond the bounds of live morning conferences. Blending web-based tools with traditional group learning leverages the advantages of both, and may better match current evolving and diverse learning styles and strategies. Context and setting Interactive spaced education (ISE) is an online education system which harnesses the spacing effect, the psychological finding that educational material which is repeatedly presented over spaced intervals is learned and retained more efficiently. In an ISE course, educational items (multiple-choice questions and explanations) are delivered via interactive e-mails every 1-3 days and are then repeated at fixed intervals. By clicking within these e-mails, learners submit answers to the questions and receive immediate feedback. Randomised trials have demonstrated that ISE is educationally effective and is well accepted by learners ranging from medical students to attending doctors. Why the idea was necessary E-mail fatigue (too many ISE e-mails received too frequently) has been cited as a reason why some learners have not completed ISE courses. It is not known whether the pedagogical benefits of the spacing effect will be attenuated if ISE items (questions-explanations) are clustered within fewer e-mails. What was done We conducted a randomised controlled trial to investigate whethe...