All students studying all disciplines have to learn information and commit it to memory. Sometimes, this involves cramming for an upcoming exam, but most of the time this does (or at least should) entail studying information in order to commit it to long-term memory for later use in the working world. There are as many ways to study as there are people in the world, each with their own methods or combination of study methodologies. For medical students specifically, who have an especially high volume of information to remember, the accuracy of their memories and understanding of concepts can quite literally make all the difference in a life or death situation.
So how do medical students around the world consistently learn, apply, and retain their knowledge? Many of their study routines include some version of Spaced Repetition – which when it comes down to it, is simply an active review of learned information at increasingly spaced intervals. It may sound simple and obvious – to review learned information over time – but Spaced Repetition is actually a bit more complicated than that.
To fully understand the effectiveness of Spaced Repetition, it is helpful to have at least a basic understanding of how the brain takes in, processes, and stores memories. As it relates to events, real-time sensory experience takes place in the prefrontal cortex (right behind the forehead). In order for a memory to “stick,” it must be consolidated. This is done in several ways.
First, through repetition.
Second, through analysis, which enhances understanding and can also encode significance.
Third, through muscle memory (an example of this would be a person learning to ride a bicycle or driving a car – at first a challenging endeavor, the motions of which eventually become more or less automatic, whether shifting gears or hitting the breaks).
Fourth, memory also obtains a degree of permanence via a strong emotional connection. In this case, we focus on the repetition element of making memories stick.
First described in 1885 by German psychologist Hermann Ebbinghaus, one of the factors that make Spaced Repetition so unique and effective, as compared to other heuristic models such as the Leitner system, is its adaptability to users’ performance over time. As more time comes between the initial engagement with information and when a person attempts to retrieve it, the harder it is for that person to recall information.
With Spaced Repetition, the mind is trained to continue to recall this information over time, beginning with shorter intervals and leading up to longer intervals. Spaced Repetition also prioritizes the content which is remembered less quickly and/or less accurately, so that rather than reviewing all content needed for an exam or to learn, a student ultimately spends more time with that which s/he has more trouble with. This removes a false sense of progress by presenting the information which is already known and stored in one’s memory at less frequent intervals.
But how can one determine the proper space and proper prioritization of concepts that need to be remembered?
One way is making flashcards and spending more time reviewing the cards that are answered or matched incorrectly. However, why not go digital? Nowadays, there are algorithms online that take the guesswork out of prioritizing which content needs to be reviewed and when.
Flashcard apps such as Quizlet or Anki have their own Spaced Repetition algorithms built-in, and students can add/create their own content or use what others have already provided on those platforms.
Lecturio builds Spaced Repetition quiz questions into each of their videos, to test immediate retention and which are then fed back to users at increasing intervals based on their answer confidence and correctness and ultimately to prepare for USMLE Step 1 and further exams.
Duolingo’s model also includes an element of competition (albeit against one’s own brain) by including “gold skills” and having those skills “crack” when they need to be reviewed.
Given the vast amount of information that students need to learn, commit to memory, and be able to utilize in their future medical practice, utilizing Spaced Repetition in their studies is essential for medical students worldwide.
For students, who didn’t took the advantage of the benefits that come with the implementing Spaced Repetition (with or without the help of an existing online platform or algorithm), there is no better time to start than now. Not only can Spaced Repetition help medical students perform better on exams, but it can also help them become better doctors.
