Ben and Frank were just at Dartmouth Medical School taking about the science behind Gunner's approach. Check out the presentation and let us know if you like free Pizza (i.e. if you'd like us to visit your school to talk about USMLE prep, match, etc.)! :)
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Memory Science & Medical Education
1. Memory Science in
Medical Education
Frank Lau, MD
Co-Founder & Chief Medical Officer
GunnerTraining.com
2. The Challenge for Medical Students
“I feel like every time I
review something or learn something new, I
forget something else.”
– C.C., 2nd year medical student,
University of Michigan Medical School
3. The Challenge Persists for Residents
Resuscitation, July 2009
70 Johns Hopkins pediatrics residents
66% failed to start timely CPR (basic life support)
95% of the residents had received this level of training
83% made errors during defibrillation (shocking the patient)
80% of the residents had been trained in defibrillation
More years of training did not improve physician performance
Medical knowledge is routinely forgotten,
even by the best and the brightest.
4. The Challenge Persists for Attending
Physicians
Journal of Trauma, June 1996
60 practicing trauma physicians took the standard Advanced
Trauma Life Support course, followed by an examination
National course for managing traumas (car accidents, gunshots, stab
wounds, etc)
Immediate testing: 86% average score
6 months later, 50% failed
13 years after this study, no novel approaches to learning and
retaining medical knowledge
Basic, critical knowledge is routinely forgotten,
even by experienced specialists.
5. Who Should Care?
Medical Students
Physicians-in-training (residents)
Educators
Foreign medical graduates
Practicing physicians
Patients
Healthcare policy makers
Patient safety advocates
6. The 2 Phases of Knowledge Acquisition
Mastering the
material
Maintaining that
knowledge
7. Mastering the Material
We think we’re good at this
We did well on the MCAT, we pass our exams
But these are graded on a curve!
Patient outcomes don’t work on a curve
In reality, we do poorly at judging how well we’ve
mastered specific topics
10. Maintaining Your Knowledge
We rarely focus on knowledge maintenance
Johns Hopkins study, the ATLS study
Affects patient outcomes
For Step 1, the review process involves re-learning a lot of
material that you once knew but have since forgotten
11. Intro to Gunner Training
The first Knowledge Management platform
Created to help students master and maintain their Step 1
knowledge base
Personalized: users choose which subjects to study can
correlate with school's curriculum
Dynamic: custom review schedule changes according to
student's forward learning
Mobile:
iPhone/mobile browser compatible
No software installation required
12. Intro to Gunner Training
Launched April 2009:
Hundreds of users
Thousands of data points
We use this data and user feedback to continually validate
and improve Gunner Training
13. The GT Way
1. Learn the material from flashcards
• High-yield, interactive
2. Immediate testing on that material
• Open-ended study questions
3. Spaced Learning algorithms create a personalized review
schedule for that material
• Incorporates Step 1 style multiple choice questions
• Short intervals help you master that material
• Longer intervals maintain your knowledge
4. Exam simulation
• Eases anxiety
• Increases test-taking stamina
14. The GT Way
1. Learn the material from flashcards
• High-yield, interactive
2. Immediate testing on that material
• Open-ended study questions Apply 19
3. Spaced Learning algorithms create a principles of
personalized review schedule for that
material efficient,
• Incorporates Step 1 style multiple
choice questions effective
• Short intervals help you master that
material learning
• Longer intervals maintain your
knowledge
4. Exam simulation
• Eases anxiety
• Increases test-taking stamina
15. GT: Flashcard Learning Principles
1. Contiguity Effects. Ideas that are associated should be
presented contiguously in space and time
One flashcard per topic, rather than one-fact-per-flashcard
2. Dual Code and Multimedia Effects. Visual + multimedia
form richer representations vs. a single medium
Hundreds of relevant images: gram stains, CT scans, X-rays,
clinical photos
3. Coherence Effect. Materials should explicitly link related
ideas
16. GT: Flashcard Learning Principles
4. Segmentation Principle. A complex lesson should be broken
down into manageable subparts
Two levels of bulletpoints
5. Manageable Cognitive Load. The information presented to
the learner should not overload working memory
Second bulletpoints are initially hidden
6. Cognitive Flexibility. This improves w/ multiple viewpoints
linking facts and deep conceptual principles
Material presented in several locations
Ex: TB is covered under Microbiology, Pulmonology, Immunology
7. Anchored Learning. Materials are anchored in real world
problems that you care about
Clinical correlation
21. GT: Study Question Principles
8. Imperfect Metacognition. We rarely have an accurate
knowledge of our cognition need assistance with
calibrating comprehension, learning, and memory
Immediate testing solves this
9. Generation Effect. Learning is enhanced when learners
produce answers (vs. recognizing answers)
This is why GT employs open-ended study questions
10. Testing Effect. Testing enhances learning, especially when
the tests are aligned with important content
22. GT: Study Question Principles
11. Feedback Effects. Students benefit from immediate
feedback on their performance
12. Negative Suggestion Effects. Learning wrong information
can be reduced when feedback is immediate
13. Deep questions. More benefit from answering questions
that elicit explanations (e.g., why, why not, how, what-if)
25. GT: Review Schedule Principles
14. Goldilocks Principle. Assignments should be at the right
difficulty level
15. Self-regulated Learning. Most students need to self-
regulate their learning
16. Exam Expectations. Students benefit more from
repeated testing
17. Spaced Learning.
27. GT: MCQ Principles
18. Desirable difficulties. Challenges make learning and
retrieval effortful improve retention
Multi-part questions, on par with Step 1 question difficulty
20. Cognitive Disequilibrium. Deep reasoning and learning is
stimulated by problems that create cognitive
disequilibrium, such as obstacles to goals, contradictions,
conflict, and anomalies
“2-jump” & “3-jump” questions
31. Spaced Learning
In 1913, Ebbinghaus discovered that the best time to
review something was just before it was forgotten
Minimizes the amount of time spent learning
Minimizes the number of times the same material must be
relearned
32. Spaced Learning: Example
Let’s say it takes 2 minutes to memorize the 15 bones of
the wrist
Reviewing this material if it’s not forgotten takes 30
seconds
Re-learning this material if it’s forgotten takes another 2
minutes
Without review, this information is forgotten in 4 days
There is a test at the end of Day 6
33. Spaced Learning: Example
Option 1: Review it every day
Day 0: 2 minutes learning
Day 1: 30 second review
Day 2: 30 second review
Day 3: 30 second review
Day 4: 30 second review
Day 5: 30 second review
Day 6: 30 second review Take the test
Total time: 5 minutes
Pros: In this approach, the knowledge is never forgotten
Cons: Large burden of review few people will adhere to this
review schedule
34. Spaced Learning: Example
Option 2: Cram for the exam
Day 0: 2 minutes learning
Day 1: no time spent
Day 2: no time spent
Day 3: no time spent
Day 4: no time spent (knowledge forgotten)
Day 5: no time spent
Day 6: 2 minutes re-learning Take the test
Total time: 4 minutes
Pros: It’s “easy” – learn it once and re-learn it just before the
test
Cons: The knowledge is forgotten
Cramming produces high stress
Doesn’t work in clinical settings (no predetermined “test” date)
Less effective as the volume of information goes up
35. Spaced Learning: Example
Option 3: Spaced Learning
Day 0: 2 minutes learning
Day 1: no time spent
Day 2: no time spent
Day 3: no time spent
Day 4: 30 second review
Day 5: no time spent
Day 6: Take the test
Total time: 2 minutes, 30 seconds
Compared to daily review (5 mins): 50% less time spent
Compared to cramming (4 mins): 38.5% less time spent
Pros: In this approach, information is never forgotten and
time spent studying is minimized
36. Spaced Learning Works in Medicine
3 randomized, controlled trials at Harvard Medical School
demonstrate that Spaced Learning improves retention of
medical knowledge
RCTs are the gold standard experimental methodology
Published in:
American Journal of Surgery, January 2009
Journal of General Internal Medicine, January 2008
Medical Education, January 2007
37. Basic Research on Spaced Learning
The molecular mechanism behind Spaced Learning is an
active area of research
Cell, October 2009. Cold Spring Harbor & Mount Sinai School
of Medicine
The Phosphatase SHP2 Regulates the Spacing Effect for Long-Term Memory Induction
Journal of Neuroscience, August 2009. McGill University
PKC Differentially Translocates during Spaced and Massed Training in Alypsia
Neuron, December 2006. Baylor College of Medicine
Drosophila Mushroom Body Neurons Form a Branch-Specific, Long-Term Cellular
Memory Trace after Spaced Olfactory Conditioning
There is rock-solid science behind Spaced Learning.
39. Gunner Training’s Effectiveness
*
19.3%
(p<0.000001)**
* All data where user completed 4 reviews within the maximum time (115 days)
** Heteroscedastic, one-tailed t-test. Same results with paired, 2-tailed t-test.
40. Gunner Training’s Effectiveness
Avg time to 4th
review: 26.4 days
Max time to 4th
review: 115 days
Two major successes:
1) Knowledge isn’t lost during >100 days since initial review
2) 19.3% gain in retained knowledge
41. Summary
GT is the first Knowledge Management specifically
platform for medical students
The application of 19 Learning Principles yields a highly
efficient and effective program
Users who follow our algorithms gain an average of 19.3%
in ability to recall knowledge after 4 reviews
Users don’t forget what they have already learned
43. User Comments
“I absolutely loved this site. I “I'll definitely let the 2nd years
didn't get far into the program in my school know about
because of time constraints, but your program. I've already
I really wish I knew about it recommended the program to
before starting 2nd year. It the Dean of Student Affairs at
would've been amazing to use my school.”
it while studying for the – J.W., 2nd year
course. I used to study with
medical student
RecallPlus and Anki during the
course but found it so time
consuming to make the cards,
so you can say Gunner Training
is just perfect.”
– H.A., 2nd year
medical student
44. Anonymous Comments
It's surprising how much I've learned “On my exam, there were questions
in such a short time span with what that I actually thought, ‘I know that
feels like not a lot of effort. I've maybe flashcard exactly.’ This is, however,
spent 30 minutes to an hour every after I had continuously gotten the nit
other day (sometimes every 2nd or picky factoid wrong on several
3rd day) on it and it's gone quickly. occasions at Gunner Training. ”
I've been tracking my progress with Caboose, on
the analytics it provides. After 2
weeks of studying and a few Student Doctor Network
repetitions my recall has gone up
significantly (the amount of 5's has
increased by almost 20% - this
meaning that when I do my scheduled
review questions, the number of
answers that I get right without having
to think about the question is
increasing). ”
AggieSean, on
Student Doctor Network