Courses vs Distributed Learning

I think attending courses are great ways to sharpen our knowledge and skills. It cramps the whole thing that I should know in 1 day or 1 week, like the BRCU for Nephrologist-to-be. But how much actually we retain from attending courses, way down the line?

Interesting studies were performed to further evaluate this 'mass learning' like attending courses vs 'spaced repetition' like regular CME/attending ward round. Whether we agree or not, studies have consistently shown that spaced learning (learning over period of time) is much better at retention of knowledge and skills.

Moulton Ca et al divided 38 surgical post graduate doctors into 2 groups for learning - 19 in massed group and 19 in distributed learning group. The massed group learnt 4 session in a day of microvascular anatomoses, and the distributed learner groups learnt weekly session for 4 weeks. They were tested 1 month after their last training sessions. The result showed both groups improve their performance, but the one in distributed group learning outperformed the other group almost in every domain that was tested. (Moulton CA et al, Ann Surg 2006).

Another way of studying is to mix different aspect of knowledge instead of of studying one block of knowledge after another, although the superiority of this technique was not consistently shown. For example, when learning chest xray, instead of learning all pleural effusion xray 1st then learning all pneumothorax xrays, it is suggested that learning pleural effusion and pneumothorax and others in a mixed way allow students to compare and perhaps retain it for much longer. Similar thing with ECG learning (Hatala RM, 2003).

Mixed practice allows contrasting different subject, while blocked learning allows looking for similarities. Both are beneficial.

The spaced and interleaving learning have become the mainstream so much so that in the US, the board of anaesthesiology and radiology have change their assessment. Previously, everybody has to resit their exam every 10 years - which essentially means you have to learn for the beginning. Now, they will be doing this in smaller chunk but more regularly.

Another practical example is, instead of blocked nephrology training of 6 months transplant and 6 months PD etc, it can be argued that a mixed approach may help the trainee better. I was tempted to buy a book called "Make It Stick" by Peter Brown (Imprint of Harvard University Press) who wrote it form cognitive psychology perspective.

(https://www.amazon.com/Make-Stick-Science-Succ…/…/0674729013)