Spacing and Retrieval Practice in Health Professions
By Althea Need Kaminske
Cover Image by Bruno from Pixabay
Spacing and retrieval practice are two of the simplest and most effective way to improve learning. As such, we advocate for using them in educational setting. I was therefore very excited to see a recent review that examined how these learning strategies are used within health professions education (1).
In this review the Trumble and colleagues sought to better understand how spacing and retrieval practice are used in health professions education and whether these strategies led to improvements in academic grades (1). They categorized health professions somewhat broadly to include all tertiary education (i.e., undergraduate and post graduate education) in health professions fields (e.g., medicine, nursing, phsyiotherapy, clinical psychology, etc.). The authors looked for studies that measured grades or other academic results, had an experimental element (used randomized control trials, controlled or comparative trials), and, of course, focused on the use of retrieval and/or spaced practice. They ultimately were able to include 56 studies in their review.
The summary of the articles they found paints a picture of who is implementing and studying these learning strategies. Not surprisingly, introductory psychology courses were the most common setting to find studies (there were 16 studies like this) on the use of retrieval practice and spacing. After that, the most common setting to find these studies was in either anatomy (6 studies), physiology (8 studies), or anatomy and physiology (4 studies) courses. I think this is interesting because it speaks to the need to better understand how these learning strategies are applied within specific disciplines. While we have a good idea of how these strategies been implemented in psychology and anatomy & physiology course work - the success and the limitation; we know somewhat less about the potential success or limitations of implementing these strategies in, say, a cardiology course in medical school.
The authors also note that the most common type of retrieval practice was recognition or cued recall, with free recall being less frequent. In other words, retrieval was often assessed via multiple-choice assessments. They noted that when forms of retrieval practice were compared that free recall was more effective than recognition or cued recall. For more on differences in types of retrieval practice, check out one of our early podcasts (Episode 3 - Bite-Size Research on Retrieval Practice Formats). In terms of spaced practice they note that only 5 studies compared the different possible type of distributed practice (expanding, equal, and contracting; for more on schedules of spaced practice see this review by Carolina). Of those, 3 of the 5 found an expanding schedule to be better.
One of the major critiques that the authors had of the literature is that very few studies reported time on task or reported on stakes of assessments. The premise of their critique, I believe, is that time is a valuable resource for students. All things being equal, if the outcome of two learning strategies was the same, but one took less time, then that strategy would be superior. Certainly if a learning strategy produced less learning and took more time it would be considered much less effective than one that produced more learning and took less time. While this is true, I think this critique is much more applicable to post-graduate education.
For example, a typical Introductory Psychology course takes place over about 15 weeks. Further, introductory psychology courses are commonly used as electives and requirements for students who are not psychology majors. Therefore, students in these classes are typically first-year students with no interest in pursuing clinical psychology. As such, the educational goals and outcomes of these courses are often to give people a broad introduction and interest in the field. Compare that to the 6 week course on Neuroscience and Behavior that students get at my medical school. The educational goals and outcomes of this course are vastly different from the Introductory Psychology course. Here, the goal is to not only cover the basics, but to prepare students for clinical rotations in psychiatry where they will be expected to diagnose and develop treatment plans based on the DSM-5. Time on task is a much more pressing concern for these students at this level of education, as are the stakes. Clearly there are differences in what effectiveness or efficiency might mean across these two settings even though there is an overlap in content and learning strategy.
Overall, the authors conclude that both distributed practice and retrieval practice are effective at improving academic grades in health professions education (yay!). For me, this review highlighted the need to conduct more research on the implementation of these strategies in post-graduate settings in health professions education to better understand what successful implementation looks like in these settings.
References
Trumble, E., Lodge, J., Mandrusiak, A., Forbes, R. (2024). Systematic review of distributed practice and retrieval practice in health professions education. Advances in Health Sciences Education, 29, 689-714. https://doi.org/10.1007/s10459-023-10274-3
