Small Changes, Big Results: Incorporating Retrieval for Retention into Your Teaching

By:  Morgan Crawford, PharmD/MS Candidate 2024 and David E. Matthews, PharmD, BCACP

On New Year’s Eve, did you make a “New Year’s resolution?” If so, have you managed to keep it? While most resolutions fail, successful ones often involve small, sustainable improvements. Consider this common resolution: to exercise regularly and build strength. A successful individual would not visit the gym for 8 hours daily for the first week of January and then claim to have accomplished their resolution for the year. Instead, a successful plan would involve frequent brief visits to the gym, incremental increases in workout challenge, and strategic rest between sessions.

Now, imagine a different resolution: to increase your knowledge of a new subject before the start of next year. Like the gym goal above, it would be unwise to spend the first week of January reading every available book on the subject and expect to remember the information one year later. So why does our traditional educational system promote this approach? 

Cramming: A Student Problem or a System Problem?

We know that students often “cram” for exams. But why? Our experience tells us that students generally do not claim to enjoy spending long hours cramming the night before an exam. Instead, they cram because they have been rewarded with positive exam grades throughout their academic career. Course material is “massed” into units that seem logical to our minds, with comprehensive exams at the end of each unit. Using cramming as a tool, students pass the exam (often with flying colors), and we move on to the next topic—often with too little time devoted to revisiting previous material. Unfortunately, our educational system reinforces the behavior we caution students to avoid.

Spaced Retrieval: Sharing Ideas and Tools for Transformation

Spaced retrieval, when students revisit information just before it is forgotten, fosters retention. By revisiting information at an interval that makes recall challenging but successful, information can be remembered more easily in the future.^1-2 As pharmacy educators seeking to promote student retention, we must share ideas and tools that help us incorporate spaced retrieval into our teaching. One such idea was discussed previously on Pulses involving using review questions on Access Pharmacy® at adaptively spaced intervals. Additional technological tools that promote spaced retrieval are available for free. One such tool is Anki, a platform that uses user-generated flashcards and adaptive spacing based on learners’ ability to recall information. A study conducted at the Boonshoft School of Medicine at Wright State University measured Anki’s impact on first-year medical students’ academic performance. Through a cohort-control study involving 130 students, the research observed that Anki users scored higher on all exams, including comprehensive and course-specific tests.³

Brain Training: An Intervention at Our Institution

We implemented a small change within our third-year lab courses through a series of activities called “Brain Training,” which analogizes learning with physical exercise. We reformatted existing content, including practice quizzes and cases, to create an interactive page (the “Brain Training Gym”) within our learning management system. Students visit this page asynchronously between lab sessions and choose self-paced activities that allow them to retrieve information related to the top 200 medications, therapeutic guidelines, and calculations. Additional exercises involve applying previously learned therapeutic concepts to analyze asynchronous patient cases. Points are allocated to each exercise based on its length and complexity, and students must earn a prescribed number before checkpoints spaced throughout the semester. Students submit a checkpoint report form logging their activity completion and points earned which is later verified by course coordinators to ensure accountability. To promote spacing, a maximum of two exercises per day are permitted, and students are not allowed to complete the same type of activity twice on the same day. Students are encouraged to revisit each exercise at an interval that makes recall challenging but successful. Since the implementation of brain training, our institution’s NAPLEX pass rates have increased. This was certainly a result of multiple factors. Still, our small intervention helped boost the retention of information valuable for NAPLEX while exposing students to study techniques superior to cramming. 

Committing to Small Changes for Big Results

Change can be hard, as demonstrated by the number of failed New Year’s resolutions. While brainstorming ways to reimagine our entire educational model is admirable, overhauling our system is a daunting task. Instead, why not focus on opportunities to make small changes within your course? Like your New Year’s resolution, these small sustainable changes are more likely to persist.

As educators, we know that our traditional retention models could be more effective. We have been discussing this, and now it is time to act. With many tools available to us, we can introduce small changes that can add up to big results. 

What small change can you make this year to improve student retention?

 References:

1. Brown PC, Roediger HL, McDaniel MA. Make It Stick: The Science of Successful Learning. Cambridge, MA: Belknap Press; 2014.
2. Kang, SHK. Spaced Repetition Promotes Efficient and Effective Learning: Policy Implications for Instruction. Policy Insights Behav Brain Sci. 2016;3(1):12-19. doi:10.1177/2372732215624708.
3. Gilbert MM, Frommeyer TC, Brittain GV, et al. A Cohort Study Assessing the Impact of Anki as a Spaced Repetition Tool on Academic Performance in Medical School. Med Educ. 2023;33(4):955-962. doi:10.1007/s40670-023-01826-8.

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Author Bio(s):

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Pulses is a scholarly blog supported by a team of pharmacy education scholars