An Adaptive Spaced Practice Approach to Blood Pressure Measurement Among First-Year Medical Students: A Pilot Study

Abstract Spaced repetition has been shown to promote knowledge retention and has demonstrated efficacy in studies of medical students and residents. There is also substantial evidence to show that spaced practice is superior to massed practice in formation and retention of procedural skills. This pilot study further explored if implementation of adaptive practice intervals in accordance with student performance provides a benefit to skill development, retention, or time efficiency. A set of new medical students were randomized into three parallel groups following a training session on blood pressure assessment. Practice intervals in these groups were fixed, adapted based on accuracy of blood pressure readings, and unmonitored respectively. The accuracy of their blood pressure measurements was assessed immediately following the training session and at the end of the intervention period and number of practice repetitions was recorded. Changes in accuracy and total repetitions were compared among the three groups. Qualitative data regarding changes in confidence and ease of implementation of different protocols were evaluated in tandem. Students universally gained confidence and accuracy with blood pressure measurement skills across the interval of study. Most students attained competency (< 7mmHg total error between systolic and diastolic) within 3–7 weeks of practice. This initial study was unable to detect differences in these gains, likely due to few participants, variation in protocol adherence, and variation in measurement accuracy. Nonetheless, the study protocol provides groundwork for further research in the developing area of implementing adaptive spaced learning to clinical skills.