title: Adaptive spaced education improves learning efficiency: a randomized controlled trial.
abstract: OBJECTIVE
  Spaced education is a novel form of online education that harnesses the 2 psychology research findings of spacing and testing effects. Spaced education is delivered by daily emails containing clinically relevant multiple choice questions. To take advantage of the spacing effect the questions are repeated at fixed intervals for a fixed number of repetitions. An adaptive spaced education system was developed to customize spacing intervals and the number of repetitions based on learner knowledge level. To determine whether this system improves learning efficiency I performed a randomized trial to compare the learning efficiency of adaptive vs nonadaptive spaced education systems among surgery students at 2 medical schools.
  
  
  METHODS
  A total of 62 year 3 students were randomized to identical course content in adaptive or nonadaptive spaced education formats. The course consisted of 40 validated, spaced education items on the 4 urology topics benign prostatic hyperplasia, erectile dysfunction, prostate cancer and prostate specific antigen screening. The nonadaptive cohort received daily emails containing 2 questions with a linear review of the material 20 days after initial presentation. The adaptive cohort received daily emails via an adaptive algorithm that limited the repetition of mastered content. Each cohort completed a validated end of course test.
  
  
  RESULTS
  The adaptive cohort answered significantly fewer spaced education items than the nonadaptive cohort (p = 0.001) but achieved comparable end of course test scores (p = 0.37). The adaptive algorithm increased learning efficiency by 38%.
  
  
  CONCLUSIONS
  Adaptive spaced education boosts learning efficiency.
authors.affiliation: Surgical Service, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Massachusetts 02130, USA. price.kerfoot@gmail.com
authors.forename: B Price
authors.initials: BP
authors.lastname: Kerfoot
mesh_terms: D002982:Clinical Clerkship; D004501:Education, Medical / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male