title: Interactive spaced-education to teach the physical examination: a randomized controlled trial.
abstract: BACKGROUND
  Several studies have documented that physical examination knowledge and skills are limited among medical trainees.
  
  
  OBJECTIVE
  The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed 'interactive spaced-education' (ISE) as a method to teach the physical examination.
  
  
  METHODS
  The design of the study is randomized controlled trial.
  
  
  METHODS
  All 170 second-year students in the physical examination course at Harvard Medical School were eligible to enroll.
  
  
  METHODS
  Spaced-education items (questions and explanations) were developed on core physical examination topics and were content-validated by two experts. Based on pilot-test data, 36 items were selected for inclusion. Students were randomized to start the 18-week program in November 2006 or 12 weeks later. Students were sent 6 spaced-education e-mails each week for 6 weeks (cycle 1) which were then repeated in two subsequent 6-week cycles (cycles 2 and 3). Students submitted answers to the questions online and received immediate feedback. An online end-of-program survey was administered.
  
  
  RESULTS
  One-hundred twenty students enrolled in the trial. Cycles 1, 2, and 3 were completed by 88%, 76%, and 71% of students, respectively. Under an intent-to-treat analysis, cycle 3 scores for cohort A students [mean 74.0 (SD 13.5)] were significantly higher than cycle 1 scores for cohort B students [controls; mean 59.0 (SD 10.5); P < .001], corresponding to a Cohen's effect size of 1.43. Eighty-five percent of participants (102 of 120) recommended the ISE program for students the following year.
  
  
  CONCLUSIONS
  ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.
authors.affiliation: Veterans Affairs Boston Healthcare System, Boston, MA, USA. price.kerfoot@gmail.com
authors.forename: B Price
authors.initials: BP
authors.lastname: Kerfoot
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Armstrong
authors.forename: Patricia N
authors.initials: PN
authors.lastname: O'Sullivan
mesh_terms: D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D006801:Humans; D010808:Physical Examination