A spaced-repetition approach to enhance medical student learning and engagement in medical pharmacology

Abstract

Background: Pharmacology is a cornerstone of medical education as it underlies safe prescribing practices. However, medical students have reported unease regarding their perceived proficiency in medical pharmacology. Despite the significant impetus to improve student outcomes, there is little analysis available of the techniques used by medical students to learn, retain and apply medical pharmacology knowledge.

Methods: A mixed-methods, student-focused approach was conducted to design and evaluate specific resources developed to address gaps in pharmacology education. This methodology comprised an anonymised scoping survey, followed by semi-structured focus group interviews. We then developed a flashcard resource as an intervention to support long-term revision for academic and clinical success. This resource was released to a cohort of 100 graduate entry preclinical medical students who were invited at the end of year to evaluate the intervention via a subsequent anonymous survey.

Results: The scoping survey received 103 complete responses. Surveys and focus group interviews revealed that only 50% of students engage in ongoing revision. Amongst our cohort, we identified that the evidence-based technique of spaced-repetition was particularly well regarded. Hence, we developed and evaluated a bespoke resource utilising Anki™, an open-source, spaced-repetition flashcard program. A total of 1208 flashcards spanning 156 distinct classes of drugs with supplementary summary tables, diagrams and explanatory video and summary guides were created. Designed as a strategic revision tool to reinforce learning, evaluation showed students greatly appreciated the "comprehensive" and "well formatted" Anki™ resource that supported existing teaching modalities, with a global rating of 3.8 out of 5.

Conclusions: Strategic and personalised resources for medical pharmacology education that assist with in-semester revision and long-term retention are highly valued amongst students for examination preparation and preparedness for practice. Collectively, these results reflect a novel approach to identifying and addressing weaknesses in existing learning resources in a manner that is inclusive of, and acceptable to, medical students.

Keywords: Flashcards; Medical education; Medical pharmacology; Spaced-repetition.

Fig. 1

Comparison of exposures to a knowledge with spaced-repetition and traditional techniques. This diagram illustrates the early focus of traditional learning techniques on amassing practice, which creates an initially strong memory that ultimately decays without further revision. By comparison, spaced-repetition is known to effectively distribute meaningful practice across time to reinforce learning and slow the decay of memory, promoting long-term retention [20]. Individual flashcards are personally scheduled based upon user ratings of difficulty, with the interval between revision instances reduced for more difficult flashcards, improving the retention of knowledge. Conversely, easier flashcards are given longer intervals to both increase time efficiency and ensure meaningful challenge in revision

Fig. 2

Flow-chart of resource development and evaluation. This diagram highlights the stepwise iterative process of resource creation. The initial scoping survey of medical students guided the design, development and implementation of bespoke medical pharmacology resources with evaluation and feedback processes for quality assurance and continual improvement

Fig. 3

Example design of Anki™ medical pharmacology flashcards. This view shows the back-end editing view of Anki™ flashcards, demonstrating the use of three distinct clozes, here represented in different colours, within a single note to produce three distinct flashcards that assess different items of knowledge. When reviewing, the students will be given the text section with one cloze blank, which tests the student’s ability to freely recall the missing information. Once answered, the program will flip the card to show a model answer and the more information section of the flashcard

Fig. 4

Likert scale rating of student-guided learning interventions. The Figure demonstrates the proportion of different student responses to a 5-point Likert scale evaluating the Anki™ resource developed and implemented from insights gained via the primary survey

Fig. 5

Incorporation of Anki™ Spaced-repetition flashcards into medical pharmacology teaching articulating with Bloom’s Taxonomy framework for learning. The Figure demonstrates how resources such as our flashcard intervention that assists with remembering and understanding of materials complements traditional methods of teaching and helps to develop further learning as students’ progress throughout the course