title: Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial.
abstract: OBJECTIVE
  Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer-term memory? We investigated whether 'spaced education', consisting of weekly e-mailed case scenarios and clinical questions, could improve the retention of students' learning.
  
  
  METHODS
  During the 2004-5 surgery clerkships, 3rd-year students completed a mandatory 1-week clinical rotation in urology and validated web-based teaching programme on 4 core urology topics. Spaced educational e-mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple-choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e-mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28-item test (Cronbach's alpha = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year.
  
  
  RESULTS
  A total of 95 of 133 students (71%) completed the end-of-year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end-of-year test scores (P < 0.001, paired t-test). The impact of the spaced educational e-mails was largest for those students who completed their urology education 6-8 and 9-11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively).
  
  
  CONCLUSIONS
  Spaced education consisting of clinical scenarios and questions distributed weekly via e-mail can significantly improve students' retention of medical knowledge.
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. drskerfoot@msn.com
authors.forename: B Price
authors.initials: BP
authors.lastname: Kerfoot
authors.forename: William C
authors.initials: WC
authors.lastname: DeWolf
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Masser
authors.forename: Paul A
authors.initials: PA
authors.lastname: Church
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Federman
mesh_terms: D001900:Boston; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D034742:Electronic Mail; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007858:Learning; D008297:Male; D008568:Memory; D013663:Teaching / Q000379:methods; D014572:Urology / Q000193:education*