This study investigated the efficacy of Interactive Spaced Education (ISE) for teaching physical examination skills to medical students. 170 second-year students were randomly assigned to receive ISE via daily emails over 3 cycles or act as a control. ISE combined spaced repetition with self-testing. Students receiving ISE showed an average retention improvement of 7.9% after the first cycle and 74.4% after the third cycle compared to controls. Students found ISE to be an effective and acceptable learning method and recommended continuing the program. However, the study was limited by being conducted at a single institution and only assessing physical exam knowledge rather than skills.

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2. Interactive Spaced-Education
(ISE) to teach the Physical examination: a randomized
controlled trial
B. Price Kerfoot, MD EdM1,2,3, Elizabeth G. Armstrong, PhD2,3, and Patricia N. O’Sullivan, MD3,4
1Veterans Affairs Boston Healthcare System, Boston, MA, USA
2Harvard Medical International, Boston, MA, USA
3Harvard Medical School; Boston, MA, USA
4Hebrew Rehabilitation Center, Boston, MA, USA
Malak Eddwib 3rd semester _ medical student
2016 impact factor : 3.701
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3. 1. Why this study?
2. What is ISE?
3. Study design and organization.
4. Results.
5. Advantages of the study .
6. Limitations of the study .
7. Conclusion .
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OUTLINES OF THE PRESENTATION

4. To investigate the efficacy and acceptability of ISE as novel
online educational methodology.
OBJECTIVE OF THE STUDY
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5. WHAT IS ISE ?
• Combines the pedagogical merits of both the ‘spacing effect’ and
the ‘testing effect.’
• Instead of delivering static educational material, new ISE system
repeatedly tests and educates students on curricular material over
spaced intervals via e-mail.
• ‘Spacing effect’ and the ‘testing effect’ found to play important
role in retention of learning.
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6. SPACED LEARNING EFFECT AND
FORGETTING CURVE
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7. STUDY DESIGN AND ORGANIZATION-1
• A randomized controlled trial study (November 2006 to June 2007).
• All 170 2nd year students at Harvard were enrolled in the course
(patient–doctor 2 :introduction to clinical medicine). Participation
was voluntary with no exclusion criteria .
• The students were assigned to 1 of 9 clinical sites where they
attended weekly/biweekly 4- to 8-hour sessions.
• Improvement of students’ knowledge of the physical examination
through didactic sessions and practice.
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8. STUDY DESIGN AND ORGANIZATION-2
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November- 2006 January- 2007
6 wks
6 wks
6 wks
18 wks

9. • During each cycle, students would be sent a daily interactive
spaced-education e-mail each contained a single question.
• The identical educational material was repeated in each
subsequent cycle .
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Students receive
spaced-education
e-mails containing a
clinical scenario and
question
Student submits an
answer
Webpage displaying
the correct answer
to the question and
an explanation
ISE MATERIALS
Recorded using the MyCourses™
web-based education platform
Discontinuing
participation if <80% of
answers of ISE items were
submitted

10. 77
questions
70
questions
36
questions
Seven questions
eliminated due to
limited validity
pilot-tested online by
third-year student volunteers
constructed by
PNS and BPK
ISE MATERIALS
ISE items consist of:
- An evaluative component (question ).
- An educational component (answer & explanation).
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11. RESULTS
SDMean of
retention
10.757.9%Cycle 1
13.974.4%Cycle3
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- 120 of the 170 students in the PD2 course were enrolled in the trial.
ISE is very well accepted by student.
-85% of students recommended this program to PD2 students the
following year.
- 83% wanted to participate themselves in a similar ISE program the
following year.

12. FEED BACK
PercentageQuestion
86%Students rated the ISE program to be
educationally effective
82%
The optimal number of spaced-education
emails to receive each week
90%The optimal number of cycles for the ISE
program
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13. LIMITATIONS OF THE STUDY
- It was performed at a single institution & focused on a single domain.
- Utilizes traditional web-pages for the submission of answers and for the
presentation of learning point.
- Using the results from a single cycle for high-stakes evaluation of individual
students. Even so, the aggregate reliability of the entire program appropriate
for individual assessment .
-Focused on physical examination knowledge rather than skills .
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14. DISCUSSION & CONCLUSION
- It can generate substantial improvements in knowledge.
- It’s an effective form of remediation.
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15. MY OPINION -1
About the article:
• Some students were excluded at the beginning without
mentioning why.
• Many abbreviations without their meaning.
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16. MY OPINION -2
About the ISE:
• It can be an efficient educational method, that deserves a try.
• It has some obstacles specific to our country such as:
 Bad internet services
 Some students might complain about the costs.
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