Menu Icon Search
Close Search
Flashcard photo courtesy of Shutterstock

Spaced Repetition in Medical Education

Created August 3, 2015 by Peter Wei and Alex Chamessian
Share

We all want to train to become the best clinicians we can be, but education in the health professions is often like drinking from a firehose. Worse yet, most of us haven’t learned how to learn – how to effectively synthesize and retain the knowledge for the long term, both to do well on board exams and to have that knowledge available to inform our clinical practice.When we came into medical school, one of the most common pieces of advice we’d get from upperclassmen was “don’t worry about remembering this; you’ll forget it all by rotations and you’ll have to relearn it anyway.” What a depressing thought – but it’s true! By the time they arrive in medical school, most students have forgotten the majority of what they learned in college courses. Students routinely need to re-learn massive amounts of forgotten information before taking their board exams, and residents eventually forget much of what they learned in medical school outside their specialty. All this translates into vast amounts of time wasted.

But what if there was a better way to learn – one that would enable you to retain information for longer, with less investment of time, than how everyone else is doing it? In fact there is one, and it’s called spaced repetition.

Over a hundred years ago, a German psychologist, Hermann Ebbinghaus, used careful experiments to determine how learning and forgetting works. From these experiments he described a ‘forgetting curve’ in which “large amounts of forgetting occur quickly, followed by a more slow and steady decline in retention.” When you learn something, you start forgetting almost immediately. Within 20 minutes of learning some new information, you can only recall about 60% of the information they just learned. By 9 hours, retention is less than 40%, and 20% by 10 days. {Stahl:2010vz}

These results led to another key observation: the temporal relationship of studying matters. “Learning events that are repeated over time result in more efficient learning and greater retention compared to exposure to a single bolus of material.”{Stahl:2010vz}, a psychological finding termed the “spacing effect.” A recent article remarked that “The spacing effect is arguably the most replicable and robust finding from experimental psychology. Hundreds of articles, including a number of reviews and meta-analyses have found a spacing effect in a wide variety of memory tasks.” {Vlach:2012un}. Spaced repetition, a technique in which students review material according to a schedule determined by the spacing effect, has been found to be effective in numerous educational contexts, including in medical student and resident education.

The catch, however, is that the spacing effect requires patience and diligence. And many students have gotten quite far in our academic careers by doing the exactly the opposite, through cramming and “hit and run” studying. Why is that? Well, the simple truth is that massed learning, more commonly known as cramming, does work in the short term. You can load up your memory with information and some of it will stay there for a time. But as anyone who has ever crammed for a test can confirm, the gains are merely temporary. For anything longer-lasting, spaced repetition is the way to go.

Okay, you’re sold. How do you harness the power of spaced repetition for yourself? Fortunately, getting started is quite straightforward. Many med students, on their own initiative, now use free, open-source flashcard apps, such as Anki and Mnemnosyne in their studies. These programs that use an algorithm to exploit the spacing effect and optimally schedule their reviews of class material; ideally, it would prompt students to review a fact as soon as they were in immediate danger of forgetting it. Students have been able to use these tools for all aspects of medical learning, from biochemistry to clinical guidelines. There is also fertile ground for student collaboration to create shared resources (such as standard flashcard “decks”) to pool their learning efforts.

The power of modern medicine is in large part the result of an explosion of our understanding of the human body. As a result, students will have to continue to grapple with how to learn the ever-increasing amounts of information it takes to be an excellent clinician. But spaced repetition gives us an opportunity to learn more effectively, improve board performance, and become better-informed doctors. As more students understand the tradeoffs between spaced studying and cramming, they can make more informed decisions about how they want to navigate learning in medical school.

Peter Wei is a radiology resident at UT Houston; Alex Chamessian is a MD/PhD student at Duke. They are authors of Learning Medicine: An Evidence-Based Guide.

// Share //

// Recent Articles //

  • General Haze-pital

  • Posted April 28, 2017 by The Short Coat Podcast
  • Improvisational acting is a greater part of medical school than one might expect. Between pretending to be doctors for one’s simulated patients, or acting like you know what you’re doing when you’re not entirely sure, a big part of med ed is faking it until you make it. So Dave, in his never ending quest to...VIEW >
  • Financial Literacy for the Newly Minted Physician: Part One

  • Posted April 27, 2017 by David Presser, MD, MPH
  • “Compound interest is the eighth wonder of the world. He who understands it, earns it…he who doesn’t, pays it. -Albert Einstein Your Life Of Abundance The first thing to note about your life the day after you finish residency is that, despite the fashionable whining of your peers, yours has been an existence of relative...VIEW >
  • Rabbit, Rabbit

  • Posted April 26, 2017 by Hannah Decker
  • Reposted with permission from here. The Americans gave each family two rabbits, which we were to care for over the summer and eventually cook. Well, as you might imagine, Tante Ingrid and I got quite attached to the little critters. When the time came for rabbit stew, we were despondent. We begged Mutti to please...VIEW >
  • What is Diabetes Mellitus?

  • Posted April 25, 2017 by Open Osmosis
  • Diabetes is notorious in American culture, both as the cause of innumerable health issues and (sometimes in jest) as the result of consuming sugary treats like the Starbucks Unicorn Frappuccino. But what is diabetes mellitus? Diabetes mellitus occurs when there’s too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split...VIEW >
  • The Year of Privilege: A New Perspective on Third Year

  • Posted April 24, 2017 by Brent Schnipke
  • During my pediatrics clerkship, one of our core faculty gave a lecture during orientation. This orientation lecture was particularly good, as the professor giving it was one of our most-loved faculty members who is deeply in tune with medical students at all stages. This was back in the summer when we were just getting started...VIEW >
  • Real, and Fake, Research Day

  • Posted April 21, 2017 by The Short Coat Podcast
  • We’ve got a crowd of M1s in the house rapidly approaching the end of their first year.  This past week, Kylie Jade Miller, Levi Endelman, Adam Erwood, and new co-host Irene Morcuende took their physical exam skills practical exam; and they discussed some research they did at the intersections of medical and society–the public health...VIEW >

// Forums //