The effect of testing and feedback on the forgetting curves for radiograph interpretation skills

Boutis, Kathy; Pecaric, Martin; Carrière, Benoit; Stimec, Jennifer; Willan, Andrew R.; Chan, Julie; Pusic, Martin

doi:10.1080/0142159x.2019.1570098

Cited by 22 publications

(26 citation statements)

References 53 publications

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“…The system automatically time stamped the time a case was started to the time a case response was submitted. Participants were given a time limit of 4 weeks to minimize decay of learning that may confound results . At 2 weeks, participants who had not completed at least one application were sent an e‐mail reminder.…”

Section: Methodsmentioning

confidence: 99%

“…We also examined the change in accuracy per application between the first and last 25 cases . Further, we measured the effect size of learning gains, changes in sensitivity and specificity per application, and differences in learning gains between fellows versus attendings and made comparisons between applications.…”

Section: Methodsmentioning

confidence: 99%

“…From our previous work, the educationally important difference between initial and final scores was approximately 10% and the proportion of discordant pairs is about 12% . We also assumed that α = 0.05 and β = 0.80.…”

Section: Methodsmentioning

confidence: 99%

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The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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Objectives: To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners.Methods: This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computerbased image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4week period.Results: We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most.Conclusions: Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.From the

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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“…17 Our study con rms the 'learning and forgetting curve' described in the literature, where competence increases with training, but declines without ongoing teaching 48 and testing. 49 In this study, all students experienced attrition of ECG competence in the absence of ongoing ECG training. The attrition rate was the same over time amongst those who engaged in blended learning and those who attended lectures during their clerkship.…”

Section: Discussionmentioning

confidence: 85%

“…However, an additional challenge for educators will be to further improve retention of ECG competence through continuous exposure in a longitudinal curriculum. 49…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Blended Learning versus Lectures alone on ECG Analysis and Interpretation by Medical Students

Viljoen

Millar

Manning

et al. 2020

Preprint

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Background Most medical students lack confidence and are unable to accurately interpret ECGs. Better methods of ECG instruction are therefore being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, than with conventional teaching (lectures alone). Methods Two cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n=67) attended four hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n=64) used a web application that facilitated deliberate practice of ECG analysis and interpretation, with structured feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediately post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence six months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test. Results The pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02±13.19% versus 31.23±11.52% respectively, p=0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27±16.22% vs 50.27±17.1%, p<0.001; Cohen’s d =1.58), and delayed post-intervention tests (57.70±18.54% vs 37.63±16.35%, p<0.001; Cohen’s d =1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation. Conclusion Blended learning was superior in teaching ECG analysis and interpretation skills to medical students and achieved better levels of ECG competence and confidence than conventional lectures. Although medical students undergo a significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications enabling deliberate practice with structured feedback may therefore be a useful adjunct to lectures for teaching Electrocardiography.

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Practical Guide to Curricular Development Research

Pei,

Schwartz,

Boermeester

2024

JAMA Surg

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The effect of testing and feedback on the forgetting curves for radiograph interpretation skills

Cited by 22 publications

References 53 publications

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Effectiveness of Blended Learning versus Lectures alone on ECG Analysis and Interpretation by Medical Students

Practical Guide to Curricular Development Research

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