Skip to main content
Top
Published in: Perspectives on Medical Education 4/2017

Open Access 01-08-2017 | Original Article

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

Authors: Sandra Monteiro, Lindsay Melvin, Joshua Manolakos, Ameen Patel, Geoffrey Norman

Published in: Perspectives on Medical Education | Issue 4/2017

Login to get access

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. Further research is required to understand how these strategies affect the learning of simple and very complex skills.
Appendix
Available only for authorised users
Literature
1.
go back to reference Son LK, Simon DA. Distributed learning: Data, metacognition and educational implications. Educ Psychol Rev. 2012;24:379–99.CrossRef Son LK, Simon DA. Distributed learning: Data, metacognition and educational implications. Educ Psychol Rev. 2012;24:379–99.CrossRef
2.
go back to reference 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;24:369–78.CrossRef 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;24:369–78.CrossRef
3.
go back to reference Rohrer D. Interleaving helps students distinguish among similar concepts. Educ Psychol Rev. 2012;24:355–67.CrossRef Rohrer D. Interleaving helps students distinguish among similar concepts. Educ Psychol Rev. 2012;24:355–67.CrossRef
4.
go back to reference Roediger HL, Pyc MA. Inexpensive techniques to improve education: applying cognitive psychology to enhance educational practice. J Appl Res Mem Cogn. 2012;1:242–8.CrossRef Roediger HL, Pyc MA. Inexpensive techniques to improve education: applying cognitive psychology to enhance educational practice. J Appl Res Mem Cogn. 2012;1:242–8.CrossRef
5.
go back to reference 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;244:400–9. 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;244:400–9.
6.
go back to reference 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;177:1481–7.CrossRef 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;177:1481–7.CrossRef
7.
go back to reference 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;32:250–5.CrossRef 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;32:250–5.CrossRef
8.
go back to reference Rohrer D, Taylor K. The shuffling of mathematics practice problems boosts learning. Instr Sci. 2007;35:481–98.CrossRef Rohrer D, Taylor K. The shuffling of mathematics practice problems boosts learning. Instr Sci. 2007;35:481–98.CrossRef
9.
go back to reference 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;21:1323–30.CrossRef 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;21:1323–30.CrossRef
10.
go back to reference Rau MA, Aleven V, Rummel N. Interleaved practice in multi-dimensional learning tasks: Which dimension should we interleave? Learn Instr. 2013;23:98–114.CrossRef Rau MA, Aleven V, Rummel N. Interleaved practice in multi-dimensional learning tasks: Which dimension should we interleave? Learn Instr. 2013;23:98–114.CrossRef
11.
12.
go back to reference Linderholm T, Dobson J, Yarbrough MB. The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology texts. Adv Physiol Educ. 2016;40:329–34.CrossRef Linderholm T, Dobson J, Yarbrough MB. The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology texts. Adv Physiol Educ. 2016;40:329–34.CrossRef
13.
go back to reference Kang SH, Pashler H. Learning painting styles: spacing is advantageous when it promotes discriminative contrast. Appl Cogn Psychol. 2012;26:97–103.CrossRef Kang SH, Pashler H. Learning painting styles: spacing is advantageous when it promotes discriminative contrast. Appl Cogn Psychol. 2012;26:97–103.CrossRef
14.
go back to reference 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.CrossRef 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.CrossRef
15.
go back to reference 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.CrossRef 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.CrossRef
16.
go back to reference 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;20:356–63.CrossRef 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;20:356–63.CrossRef
17.
go back to reference Magill RA, Hall KG. A review of the contextual interference effect in motor skill acquisition. Hum Mov Sci. 1990;9:241–89.CrossRef Magill RA, Hall KG. A review of the contextual interference effect in motor skill acquisition. Hum Mov Sci. 1990;9:241–89.CrossRef
18.
go back to reference 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.CrossRef 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.CrossRef
19.
go back to reference 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.CrossRef 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.CrossRef
20.
go back to reference Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29:591–9.CrossRef Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29:591–9.CrossRef
21.
go back to reference Roediger HL III, Karpicke JD. Test-enhanced learning: Taking memory tests improves long-term retention. Psychol Sci. 2006;17:249–55.CrossRef Roediger HL III, Karpicke JD. Test-enhanced learning: Taking memory tests improves long-term retention. Psychol Sci. 2006;17:249–55.CrossRef
22.
go back to reference Easley H. The curve of forgetting and the distribution of practice. J Educ Psychol. 1937;28:474.CrossRef Easley H. The curve of forgetting and the distribution of practice. J Educ Psychol. 1937;28:474.CrossRef
23.
go back to reference Averell L, Heathcote A. The form of the forgetting curve and the fate of memories. J Math Psychol. 2011;55:25–35.CrossRef Averell L, Heathcote A. The form of the forgetting curve and the fate of memories. J Math Psychol. 2011;55:25–35.CrossRef
24.
go back to reference Hardt O, Nader K, Nadel L. Decay happens: the role of active forgetting in memory. Trends Cogn Sci (Regul Ed). 2013;17:111–20.CrossRef Hardt O, Nader K, Nadel L. Decay happens: the role of active forgetting in memory. Trends Cogn Sci (Regul Ed). 2013;17:111–20.CrossRef
25.
go back to reference Souza AS, Oberauer K. Time-based forgetting in visual working memory reflects temporal distinctiveness, not decay. Psychon Bull Rev. 2015;22:156–62.CrossRef Souza AS, Oberauer K. Time-based forgetting in visual working memory reflects temporal distinctiveness, not decay. Psychon Bull Rev. 2015;22:156–62.CrossRef
Metadata
Title
Evaluating the effect of instruction and practice schedule on the acquisition of ECG interpretation skills
Authors
Sandra Monteiro
Lindsay Melvin
Joshua Manolakos
Ameen Patel
Geoffrey Norman
Publication date
01-08-2017
Publisher
Bohn Stafleu van Loghum
Published in
Perspectives on Medical Education / Issue 4/2017
Print ISSN: 2212-2761
Electronic ISSN: 2212-277X
DOI
https://doi.org/10.1007/s40037-017-0365-x

Other articles of this Issue 4/2017

Perspectives on Medical Education 4/2017 Go to the issue

Statistical Points and Pitfalls

The bridge between design and analysis