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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 37-41

Impact of a spaced learning initiative in an undergraduate student teaching program in pediatrics


1 Department of Pediatrics, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Ophthalmology, Melaka Manipal Medical College, Melaka, Malaysia
3 Department of Medicine, People's College of Medical Sciences and Research Centre, Bhopal, Madhaya Pradesh, India
4 Department of Anatomy, DMCH, Ludhiana, Punjab, India
5 Department of Community Medicine, Gandhi Medical College, Hyderabad, Telangana, India

Date of Submission04-Sep-2017
Date of Acceptance06-Feb-2018
Date of Web Publication25-May-2018

Correspondence Address:
Peter Prasanth Kumar Kommu
Department of Pediatrics, Pondicherry Institute of Medical Sciences, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_52_17

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  Abstract 


Objective: The purpose of this study is to assess the impact of spaced learning in an undergraduate teaching and learning program in pediatrics.
Methodology: Analytical study involving the final year medical students posted in the Department of Pediatrics. “Spaced” learning opportunities were provided in addition to the conventional didactic lectures over 8 weeks for the assigned topics. The scores obtained before and after the spaced learning were analyzed using “t”-test.
Results: A total of 37 students who underwent the spaced learning initiative and participated in both the tests (before and after spaced learning) were included in the analysis. There was significant positive correlation between the scores of the two groups r = 0.526 (P < 0.001). Paired sample “t”-test showed that there was a statistically significant difference between the test scores with a mean of 11.23, t = 7.434 (P < 0.001).
Conclusion: Spaced learning had a significant impact on the students in their learning and recall, leading to better performance in their examination.

Keywords: Pediatric, spaced learning, undergraduate


How to cite this article:
Kumar Kommu PP, Sahoo S, Kapoor A, Sharma A, Thomas V. Impact of a spaced learning initiative in an undergraduate student teaching program in pediatrics. J Curr Res Sci Med 2018;4:37-41

How to cite this URL:
Kumar Kommu PP, Sahoo S, Kapoor A, Sharma A, Thomas V. Impact of a spaced learning initiative in an undergraduate student teaching program in pediatrics. J Curr Res Sci Med [serial online] 2018 [cited 2018 Jul 18];4:37-41. Available from: http://www.jcrsmed.org/text.asp?2018/4/1/37/233198




  Introduction Top


Memory extinction (decline of a learned response over a period) has led many researchers to try out various methods of learning. One such method is “spaced learning” [Figure 1]. Learning that includes long intervals between training sessions is termed spaced learning.[1] Traditional learning is “massed.”
Figure 1: The spacing effect

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Since the seminal work of Ebbinghaus,[2] spaced learning is known to be more effective for learning. It is also known that learning over an extended period induces a more persistent memory. The spacing effect describes the robust finding that long-term learning is promoted when learning events are spaced out in time, rather than presented in immediate succession.[1] In classroom education of children, spaced learning was more effective both in science learning and vocabulary learning.[3]

The repeated stimulus presentation or learning opportunities are more likely to occur in multiple contexts if they are spaced in time, and memory therefore includes elements from each of these contexts. Hence, spaced learning forms a more robust memory. Another reason why spaced learning is more effective is because it elicits retrieval and reinforcement of existing memory. It also helps in consolidation of the existing memory. A positive correlation exists between the duration of spaced learning and the interval between the spaced learning and the test.[3] The learning involving medical graduates could potentially benefit from this strategy as the practice of medicine involves remembering volumes of information and long-term recall. Literature review showed only four studies,[4],[5],[6],[7],[8] which have been published in medical education so far on this topic. Of these, three studies showed a positive impact. Out of these, only two were conducted on medical students. Hence, we undertook this study to examine the impact of this spacing effect on undergraduate student training in pediatrics.

It is hypothesized that students who receive the “spaced learning” improve their performance in the examinations, thereby proving the point “spaced learning” has a positive impact on the undergraduate students in pediatrics. We undertook this study to assess the impact of spaced learning in an undergraduate teaching and learning program in Pediatrics.


  Methodology Top


After obtaining approval from the institutional ethics committee, a total of 63 final year undergraduate pediatric students were briefed about the study and informed consent was obtained.

The final year undergraduate theory teaching mainly involves the didactic methods. Once the lecture class is over, there is limited scope for the student to interact with the teacher. Students tend to learn just before the theory assessments and do not have much time in learning concepts. Hence, extra learning opportunities [Figure 2] were provided over 8 weeks on the topic which was taught to them in the class. In addition to theory classes and theory assessments as per the existing schedule of the department, a program was drawn for spaced learning opportunities in the form of problem-based case scenarios, picture quiz, open discussions, and question and answers for a duration which was spaced. The duration of intermittent exposure was picked during and after college hours. The total duration of this “spaced” learning came to over 8 weeks [Figure 3]. Students were then subjected to routine theory assessments consisting of structured essay, short answers, and multiple choice questions as per the department protocol. Utilizing these, an independent examiner assessed the theory tests (before and after spaced learning) and the results were tabulated.
Figure 2: Types of learning opportunities used for spaced learning

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Figure 3: Spacing

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Inclusion criteria

MBBS undergraduate students attending pediatric theory classes.

Exclusion criteria

Students unable to attend both the tests (before and after the spaced learning).

Out of the total of 63 students, only 37 students were able to take both the tests (as the rest 26 were posted in the obstetrics residential posting). Hence, the final analysis was conducted on these 37 students who could complete the study. The marks obtained in the assessments conducted before and after the “spaced learning” by the students and the performance was subjected to statistical analysis using SPSS statistical package version 20 (IBM, SPSS India).

In addition, the perception of the students and the faculty regarding the spaced learning were obtained using a validated questionnaire [Annexure 1] and [Annexure 2].

The scores obtained were analyzed using t-test.


  Results Top


A total of 37 students who underwent the spaced learning initiative and participated in both the tests (before and after spaced learning) were included in the analysis. The spaced learning was conducted in between the two tests. Out of the total score of 100, the mean score of the test conducted without spaced learning was 49.30 (standard deviation [SD] – 10.498). The minimum score obtained was 23 and maximum was 73 [Table 1]. Out of the total score of 100, the mean score of the test conducted after spaced learning was 60.57 (SD – 7.833). The minimum score obtained was 46, and the maximum score was 79 [Table 1]. There was significant positive correlation between the scores of the two groups. Correlation coefficient r = 0.526(P < 0.001) [Figure 4].
Table 1: Test scores before and after spaced learning

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Figure 4: Scatter plot of the test scores before and after spaced learning

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A paired sample “t”-test showed that there was a statistically significant difference between the two test scores with a mean of 11.23, t value of 7.434 (P < 0.001) [Table 2] and [Figure 5].
Table 2: Paired t-test

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Figure 5: Box and Whisker plot of the scores before and after spaced learning

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Feedback [Figure 6] and [Figure 7] from students and faculty was obtained using a validated questionnaire [Annexure 1].
Figure 6: Graph showing the student feedback

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Figure 7: Graph showing feedback from faculty

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  Discussion Top


This study assessed the effect of “spaced learning” on the undergraduate students in pediatrics. The study postulation was that students who received the “spaced learning” improved their performance in the examinations, thereby proving the point “spaced learning” has a positive impact on the undergraduate students in pediatrics. It was found that there was a statistically significant difference between the test scores. Furthermore, the feedback received from the students revealed that they had actively participated and had experienced self-directed learning. They found the spacing innovative, easy to handle the lessons, and concepts were understood better. Overall, it led to better performance of students. The limitation in this study is that the study tested the cognitive domain and this spacing effect cannot be generalized to the other domains. Furthermore, this study did not assess impact on the long-term memory outcomes. Replicating this spacing effect on the whole medical curriculum and studying, the long-term impact is the next step. Next research plan is to apply to one cohort and assess the long-term benefit.


  Conclusion Top


Spaced learning had a significant impact on the students in their learning and recall, leading to better performance in their examination.

Acknowledgement

We thank Dr. Nishad Plakkal (JIPMER, Pondicherry, India) and Dr. Lalitha Krishnan (PIMS Hospital, Pondicherry, India) for their valuable guidance and support. We also thank the FAIMER Institute at CMC Ludhiana for all the support and encouragement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Annexures Top


Annexure 1: Student feedback

Dear Students,

You are aware that we tried out this new initiative called “spaced learning in pediatrics.” As this was done as part of the project I am doing for the department of pediatrics. At this stage, I am taking this feedback to help us understand whether this program was useful to you and can be recommended to be continued in pediatric undergraduate teaching and learning. Please take some time to fill this feedback form. Please keep this feedback form anonymous.

Please read the following statements carefully and put the sign of “+” in the most appropriate box out of the given options.



Annexure 2: Faculty feedback questionnaire

Dear Faculty,

You are aware that we tried out this new initiative called “spaced learning in pediatrics.” As this was done as part of the project I am doing for the department of pediatrics. At this stage, I am taking this feedback to help us understand whether this program was useful to the students and can be recommended to be continued in pediatric undergraduate teaching and learning. Please take some time to fill this feedback form. Please keep this feedback form anonymous.

Please read the following statements carefully and put the sign of “+” in the most appropriate box out of the given options.





 
  References Top

1.
Sisti HM, Glass AL, Shors TJ. Neurogenesis and the spacing effect: Learning over time enhances memory and the survival of new neurons. Learn Mem 2007;14:368-75.  Back to cited text no. 1
    
2.
Ebbinghaus H. Memory: A Contribution to Experimental Psychology. New York: Dover Publications, Inc.; 1964.  Back to cited text no. 2
    
3.
Cepeda NJ, Pashler H, Vul E, Wixted JT, Rohrer D. Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychol Bull 2006;132:354-80.  Back to cited text no. 3
    
4.
Pernar LI, Corso K, Lipsitz SR, Breen E. Using spaced education to teach interns about teaching skills. Am J Surg 2013;206:120-7.  Back to cited text no. 4
    
5.
Maier EM, Hege I, Muntau AC, Huber J, Fischer MR. What are effects of a spaced activation of virtual patients in a pediatric course? BMC Med Educ 2013;13:45.  Back to cited text no. 5
    
6.
Nkenke E, Vairaktaris E, Bauersachs A, Eitner S, Budach A, Knipfer C, et al. Spaced education activates students in a theoretical radiological science course: A pilot study. BMC Med Educ 2012;12:32.  Back to cited text no. 6
    
7.
Kerfoot BP, DeWolf WC, Masser BA, Church PA, Federman DD. Spaced education improves the retention of clinical knowledge by medical students: A randomised controlled trial. Med Educ 2007;41:23-31.  Back to cited text no. 7
    
8.
Patocka C, Khan F, Dubrovsky AS, Brody D, Bank I, Bhanji F, et al. Pediatric resuscitation training-instruction all at once or spaced over time? Resuscitation 2015;88:6-11.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
Annexures
References
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