Randomized, Controlled Trial of Spaced Education to Urology Residents in the United States and Canada

PURPOSE: We investigated whether an online educational program based on spacing effect principles could significantly improve the acquisition and retention of medical knowledge. MATERIALS AND METHODS: In this randomized, controlled trial involving urology residents in the United States and Canada participants randomized to cohort 1 (bolus education) were e-mailed a validated set of 96 study questions on 4 urology topic areas in June 2005. Residents in cohort 2 (spaced education) were sent daily educational e-mails during 27 weeks (June to December 2005), each of which contained 1 or 2 study questions presented in a repeating, spaced pattern. In November 2005 participants completed the Urology In-Service Examination. Participants were also randomized to 1 of 5 outcome cohorts, which completed a 32-item online test at staggered time points (1 to 14 weeks) after completion of the spaced education program. RESULTS: Of 537 participants 400 (74%) completed the online staggered tests and 515 (96%) completed the In-Service Examination. Residents in the spaced education cohort demonstrated significantly greater online test scores than those in the bolus cohort (ANOVA p <0.001). One-way ANOVA with trend analysis revealed that online test scores for the spaced education cohort remained stable with no significant differences with time, while test scores in the bolus cohort demonstrated a significant linear decrease (p = 0.007). The specific learning gains attributable to Spaced Education were robust when controlling for use of the study materials but they did not generalize to higher scores on the In-Service Examination. CONCLUSIONS: Online spaced education improves the acquisition and retention of clinical knowledge.