Boosting Recall: Enhancing Learning for Doctors

One of the biggest predictors of a medical student’s academic performance is their ability to assimilate and recall vast troves of factual knowledge when subsequently tested in examinations. Aided by techniques like raw rehearsal (reciting a fact over and over) and mnemonics, facts can be regurgitated short-term in a test situation, but long-term retention proves distinctively more challenging as time goes on – not a problem if you’re struggling to recall pythagoras’ theorem but a serious cause for concern if you’re struggling to recall “SOAP BRAIN MD,” whose every letter stands for one of the signs or symptoms of systemic lupus erythematosus.

Spaced out learning

“The spacing effect is one of the oldest and best documented phenomena in the history of learning and memory research.”
— Harry Bahrick & Lynda Hall (2005)

B. Price Kerfoot, an associate professor of surgery at Harvard Medical School, was frustrated at how much knowledge his students seemed to forget over the course of their medical education. He suspected this was because they engaged in what he calls “binge and purge” learning: they gorged themselves full of facts and then regurgitated them at test time. Research in cognitive science shows that this is a very poor way to retain information, as Kerfoot discovered when he went looking in the academic literature for answers. But he also stumbled upon a method that really is effective, called spaced repetition. Kerfoot devised a simple digital tool to make engaging in spaced repetition almost effortless. In more than two dozen studies published over the past five years, he has demonstrated that spaced repetition works, increasing knowledge retention by up to 50 percent.

More recently, Kerfoot studied the combination of spaced education with certain game mechanics (rules intended to make games engaging). He found game-like spaced education led to increased knowledge retention and test performance while being associated with improved course completion rates and motivation to participate in future spaced education programmes.
Kerfoot explains the theory behind spaced repetition in this video:

Improving Recall

A simple way to do spaced repetition is to use flashcards organised into a box. Set up a schedule for when you will revise the cards in each of the sections in your box. If you answer a card correctly, you put it into a section that you will revisit less frequently in the future, whereas if you get the answer wrong, you move the card into a section scheduled for frequent visits. The spaced repetition method can be applied to any subject by using several online programs, such as Anki, fullrecall and supermemo, in which you can schedule your own flashcards. The software will present a question and the user attempts to recall the answer from memory, once answered, the software will schedule the questions for a later date; most of the software out there will schedule them in intervals based on how you answered the question (correct or incorrect) and on your rating of it (hard or easy).

Use Digital Tools for Lifelong Learning in Medicine

In an era when medical evidence and knowledge are generated at unprecedented speed, health professionals may find it difficult to stay up-to-date, not just with the burgeoning amount of research, but also with the ever-changing technologies in healthcare. For the medical profession, where the onus is on continued and perpetual learning, it’s important to be aware of any tools that can aid the process and accelerate learning for the time-pressed MD.

Free Open Access Medical education (FOAM) is a term first coined at the 2012 International Conference of Emergency Medicine in Dublin. FOAMed has been described as ‘free open-access 2012 education1,2. It is a collection of evolving, collaborative and interactive updated resources that have become available to healthcare professionals and students through the Internet. It is a movement away from traditional modes of learning, embracing the diversity of platforms now available to us, encompassing Blogs, Twitter, Google hangouts, Podcasts, online videos, text documents, photographs and a whole lot more.

We can’t read the millions or thousands or even hundreds of articles published daily. What we need is a filtered daily briefing. A filtered view that gives us context and we can ignore or explore issues deeper as we need. The nature of the filters may vary but can include colleagues, content shared by experts, news from industry sites and algorithms based on our needs and interests. Apps like Medit curate the web, filtering the vast repository of online content to deliver trustworthy content. A good curator knows how to find, aggregate, and synthesise reliable information, putting it into context for their communities and sharing it in a format that is easy to access and understand – saving time and effort.

Information is so abundant and so easily available that we can quickly be overwhelmed to the point of paralysis. Curators provide a solution by qualifying, selecting, organising, distilling, and interpreting information for various audiences; they do not merely aggregate content.



  1. Nickson CP, Cadogan MD. Free Open Access Medical education (FOAM) for the emergency physician. Emerg Med Australas. 2014 Feb;26(1):76-83. doi: 10.1111/1742-6723.12191
  2. Shaw G. Don’t call it social media: FOAM and the future of medical education. Emergency Medicine News 2013; 35 (2): 1, 30.
  3. Lex J. International EM education efforts & e-learning. Free Emergency Medicine Talks. [Cited 5 Dec 2013.] Available from URL:
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