Journal of the American College of Surgeons
Volume 211, Issue 3 , Pages 331-337.e1, September 2010

Online Spaced Education Generates Transfer and Improves Long-Term Retention of Diagnostic Skills: A Randomized Controlled Trial

  • B. Price Kerfoot, MD, EdM

      Affiliations

    • Surgical Service, Urology, Veterans Affairs Boston Healthcare System, Jamaica Plain, MA
    • Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
    • Corresponding Author InformationCorrespondence address: B Price Kerfoot, MD, EdM, Veterans Affairs Boston Healthcare System, 150 South Huntington Ave, 151DIA, Jamaica Plain, MA 02130
    • ,
  • Yineng Fu, MD

      Affiliations

    • Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
    • Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
    • ,
  • Harley Baker, EdD

      Affiliations

    • California State University Channel Islands, Camarillo, CA
    • ,
  • Donna Connelly, BS

      Affiliations

    • American Urological Association, Linthicum, MD
    • ,
  • Michael L. Ritchey, MD, FACS

      Affiliations

    • Department of Urology, Mayo Clinic, Phoenix, AZ
    • ,
  • Elizabeth M. Genega, MD

      Affiliations

    • Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
    • Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA

Received 4 February 2010; received in revised form 14 April 2010; accepted 26 April 2010. published online 13 July 2010.

Background

Retention of learning from surgical training is often limited, especially if the knowledge and skills are used infrequently. Using histopathology diagnostic skills as an experimental system, we compared knowledge transfer and retention between bolus Web-based teaching (WBT) modules and online spaced education, a novel email-based method of online education founded on the spacing effect.

Study Design

All US urology residents were eligible to participate. Enrollees were randomized to 1 of 2 cohorts. Cohort 1 residents received 3 cycles/repetitions of spaced education on prostate-testis histopathology (weeks 1 to 16) and 3 WBT modules on bladder-kidney (weeks 14 to 16). Cohort 2 residents received 3 cycles of spaced education on bladder-kidney (weeks 1 to 16) and 3 WBT modules on prostate-testis (weeks 14 to 16). Each daily spaced education email presented a clinical scenario with histopathology image and asked for a diagnosis. Participants received immediate feedback after submitting their answers. Each cycle/repetition was 4 weeks long and consisted of 20 questions with unique images. WBT used the identical content and delivery system, with questions aggregated into three 20-question modules. Long-term retention of all 4 topics was assessed during weeks 18 to 45.

Results

Seven-hundred and twenty-four urology residents enrolled. Spaced education and WBT were completed by 77% and 66% of residents, respectively. Spaced education and WBT generated mean long-term score increases of 15.2% (SD 15.3%) and 3.4% (SD 16.3%), respectively (p < 0.01). Spaced education increased long-term learning efficiency 4-fold.

Conclusions

Online spaced education generates transfer of histopathology diagnostic skills and substantially improves their long-term retention. Additional research is needed to determine how spaced education can optimize learning, transfer, and retention of surgical skills.

Abbreviations and Acronyms: IC, intervention cohort, OC, outcomes cohort, WBT, Web-based teaching

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 Disclosure Information: Dr Kerfoot owns equity in and is a board member of Spaced Education Inc. Drs Kerfoot and Genega have authored courses on Spaced Education's website (www.spaceded.com) but receive no compensation from the courses or company. Ms. Connelly is an employee of the American Urological Association, which is selling its Self-Assessment Study Program on the Spaced Education website. None of the authors receive compensation for these SASP sales. There are no other potential conflicts of interest relevant to this article.

 This study was supported in part by the American Urological Association, the American Urological Association Foundation, Astellas Pharma US, Inc., and the United States Agency for Healthcare Research and Quality.

 The views expressed in this article are those of the authors and do not necessarily reflect the position and policy of the United States Federal Government or the Department of Veterans Affairs. No official endorsement should be inferred.

PII: S1072-7515(10)00340-6

doi:10.1016/j.jamcollsurg.2010.04.023

Journal of the American College of Surgeons
Volume 211, Issue 3 , Pages 331-337.e1, September 2010

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