Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology

Abstract

Applied memory research in the field of cognitive and educational psychology has generated a large body of data to support the use of spacing and testing to promote long-term or durable memory. Despite the consensus of this scientific community, most learners, including radiology residents, do not utilize these tools for learning new information. We present a discussion of these parallel and synergistic learning techniques and their incorporation into a software platform, called Spaced Radiology, which we created for teaching radiology residents. Specifically, this software uses these evidence-based strategies to teach pediatric radiology through a flashcard deck system.

Keywords: Internet; Medical education; Memory; Pediatric radiology; Picture archiving and communication system; Self-testing; Spaced repetition.

Fig. 1

Adaptation of the “forgetting curve” initially described by Ebbinghaus in 1885 [16]. The red curve is a typical representation of a forgetting curve, showing that memory retention falls exponentially after initial encoding of new information. Active, effortful strategies of learning are required to interrupt the decline. The purple, blue, green and yellow curves show the hypothetical impact of repeated study/test sessions at later dates, with each forgetting curve less steep than the one prior

Fig. 2

This screenshot demonstrates the user interface of one flashcard in a deck. This card demonstrates the limited number of diagnoses included in each deck (in this case four, including normal). Additionally, the integration with Pacsbin is demonstrated, in this case showing three images from one radiograph series

Fig. 3

The Leitner system is a spaced repetition algorithm, which sorts flashcards into five piles according to how well the learner knows each diagnosis. Each correct answer advances the flashcard to the next, less frequent pile. Incorrect answers are sent back to the first pile. This system skews exposure toward unknown diagnoses

Fig. 4

This screenshot demonstrates the use of filtering on the deck search page. Available flashcard decks can be filtered by those with administrative approval, individual user flags, specialty, tags (such as musculoskeletal [MSK] in this example) or author

Fig. 5

This diagram of the workflow from identifying an image for saving in Pacsbin to the ultimate product of a flashcard deck. All of the steps within the dashed box represent the innovations of the Spaced Radiology platform