Evaluating the effect of instruction and practice schedule on the acquisition of ECG interpretation skills

Sandra Monteiro; Lindsay Melvin; Joshua Manolakos; Ameen Patel; Geoffrey Norman

doi:10.1007/S40037-017-0365-X

Abstract

Introduction Evidence of the benefit of distributed instruction and interleaved practice comes from studies using simple materials (e. g. word pairs). Furthermore, there is currently no evidence of the combined impact of these strategies in undergraduate medical education. The present study evaluated the impact of varying both instruction and practice schedules for the acquisition of ECG interpretation skills.

Methods We conducted a 2 × 2 factorial study with two levels of instruction (massed and distributed) and two levels of practice (interleaved and blocked). A three-module introductory course in ECG interpretation was delivered to 80 first year medical undergraduate students. Students were assigned to one of four Instruction-Practice conditions: Massed-Interleaved, Massed-Blocked, Distributed-Interleaved and Distributed-Blocked. Learning was evaluated by a multiple choice quiz at the end of each module and a final multiple choice quiz at the end of the course.

Results End of module mean scores showed that distributed instruction was consistently superior to massed instruction (52% vs 42%, p < 0.01). However, there was no effect of practice and no interaction between teaching and practice methods. The delayed final test scores revealed an advantage for blocked over mixed practice (34% vs 24%, p < 0.05) and distributed over massed instruction (34% vs 24%, p < 0.05).

Discussion These results suggest that these popular strategies may have varying effects with complex learning materials.

References

Son LK Simon DA Distributed learning: Data, metacognition and educational implications Educ Psychol Rev 2012 24 379 399 10.1007/s10648-012-9206-y
Open DOI Search in Google Scholar Back to article
Carpenter SK Cepeda NJ Rohrer D Kang SH Pashler H Using spacing to enhance diverse forms of learning: Review of recent research and implications for instruction Educ Psychol Rev 2012 24 369 378 10.1007/s10648-012-9205-z
Open DOI Search in Google Scholar Back to article
Rohrer D Interleaving helps students distinguish among similar concepts Educ Psychol Rev 2012 24 355 367 10.1007/s10648-012-9201-3
Open DOI Search in Google Scholar Back to article
Roediger HL Pyc MA Inexpensive techniques to improve education: applying cognitive psychology to enhance educational practice J Appl Res Mem Cogn 2012 1 242 248 10.1016/j.jarmac.2012.09.002
Open DOI Search in Google Scholar Back to article
Moulton CA Dubrowski A Macrae H Graham B Grober E Reznick R Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial Ann Surg 2006 244 400 409
Search in Google Scholar Back to article
Kerfoot BP Baker HE Koch MO Connelly D Joseph DB Ritchey ML Randomized, controlled trial of spaced education to urology residents in the United States and Canada J Urol 2007 177 1481 1487 10.1016/j.juro.2006.11.074
Open DOI Search in Google Scholar Back to article
Raman M Mclaughlin K Volato C Rostom A Allard JP Coderre S Teaching in small portions dispersed over time enhances long-term knowledge retention Med Teach 2010 32 250 255 10.3109/01421590903197019
Open DOI Search in Google Scholar Back to article
Rohrer D Taylor K The shuffling of mathematics practice problems boosts learning Instr Sci 2007 35 481 498 10.1007/s11251-007-9015-8
Open DOI Search in Google Scholar Back to article
Rohrer D Dedrick RF Burgess K The benefit of interleaved mathematics practice is not limited to superficially similar kinds of problems Psychon Bull Rev 2014 21 1323 1330 10.3758/s13423-014-0588-3
Open DOI Search in Google Scholar Back to article
Rau MA Aleven V Rummel N Interleaved practice in multi-dimensional learning tasks: Which dimension should we interleave? Learn Instr 2013 23 98 114 10.1016/j.learninstruc.2012.07.003
Open DOI Search in Google Scholar Back to article
Carter CE Grahn JA Optimizing music learning: exploring how blocked and interleaved practice schedules affect advanced performance Front Psychol 2016
Search in Google Scholar Back to article
Linderholm T Dobson J Yarbrough MB The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology texts Adv Physiol Educ 2016 40 329 334 10.1152/advan.00157.2015
Open DOI Search in Google Scholar Back to article
Kang SH Pashler H Learning painting styles: spacing is advantageous when it promotes discriminative contrast Appl Cogn Psychol 2012 26 97 103 10.1002/acp.1801
Open DOI Search in Google Scholar Back to article
Helsdingen A van Gog T van Merriënboer J The effects of practice schedule and critical thinking prompts on learning and transfer of a complex judgment task J Educ Psychol 2001 103 383 10.1037/a0022370
Open DOI Search in Google Scholar Back to article
Avrahami J Kareev Y Bogot Y Caspi R Dunaevsky S Lerner S Teaching by examples: Implications for the process of category acquisition Q J Exp Psychol A 1997 50 586 606 10.1080/713755719
Open DOI Search in Google Scholar Back to article
Tauber SK Dunlosky J Rawson KA Wahlheim CN Jacoby LL Self-regulated learning of a natural category: Do people interleave or block exemplars during study? Psychol Bull Rev 2013 20 356 363 10.3758/s13423-012-0319-6
Open DOI Search in Google Scholar Back to article
Magill RA Hall KG A review of the contextual interference effect in motor skill acquisition Hum Mov Sci 1990 9 241 289 10.1016/0167-9457(90)90005-X
Open DOI Search in Google Scholar Back to article
Hatala RM Brooks IR Norman GR Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills Adv Health Sci Educ Theory Pract 2003 8 1726 10.1023/A:1022687404380
Open DOI Search in Google Scholar Back to article
Birnbaum MS Kornell N Bjork EL Bjork RA Why interleaving enhances inductive learning: The roles of discrimination and retrieval Mem Cognit 2013 41 392 402 10.3758/s13421-012-0272-7
Open DOI Search in Google Scholar Back to article
Ten Cate O Durning S Peer teaching in medical education: twelve reasons to move from theory to practice Med Teach 2007 29 591 599 10.1080/01421590701606799
Open DOI Search in Google Scholar Back to article
Roediger HL III Karpicke JD Test-enhanced learning: Taking memory tests improves long-term retention Psychol Sci 2006 17 249 255 10.1111/j.1467-9280.2006.01693.x
Open DOI Search in Google Scholar Back to article
Easley H The curve of forgetting and the distribution of practice J Educ Psychol 1937 28 474 10.1037/h0057409
Open DOI Search in Google Scholar Back to article
Averell L Heathcote A The form of the forgetting curve and the fate of memories J Math Psychol 2011 55 25 35 10.1016/j.jmp.2010.08.009
Open DOI Search in Google Scholar Back to article
Hardt O Nader K Nadel L Decay happens: the role of active forgetting in memory Trends Cogn. Sci. (Regul. Ed.) 2013 17 111 120 10.1016/j.tics.2013.01.001
Open DOI Search in Google Scholar Back to article
Souza AS Oberauer K Time-based forgetting in visual working memory reflects temporal distinctiveness, not decay Psychon Bull Rev 2015 22 156 162 10.3758/s13423-014-0652-z
Open DOI Search in Google Scholar Back to article

Evaluating the effect of instruction and practice schedule on the acquisition of ECG interpretation skills

Abstract

Paradigm

My account