Online Learning Modules Based on Spacing and Testing Effects Improve Medical Student Performance on Anatomy Examinations

Recent studies demonstrated that spaced education enhances learning in various educational settings. However, the efficacy of spaced education for learning anatomy remains unknown. Spaced education is based on two main findings of the cognitive research: spacing effect (knowledge retains better when acquired in small pieces at spaced intervals) and testing effect (repeated testing improves knowledge retention). The aim of this study was to determine whether the use of a spaced education online learning tool improves medical student performance on written anatomy examinations. The online educational platform Cerego ( http://cerego.com ) was used to create a learning module (set) on the anatomy of the head and neck which is one of the most challenging topics for students as judged by low performance on related examination questions. One hundred and six first‐year medical students were provided with a set one week before the corresponding anatomy laboratory session. The Cerego platform allows assigning various goal levels for each set. Progress to the goal (0–100%) is measured by the frequency of use and the accuracy of responses to quiz questions. For this set, the goal level was set to 1 (achievable in one week). The relationship between the set usage data and the anatomy examination scores was analyzed. Student perceptions of the set were assessed through a survey. More than half of the Class (59 students) have used the set. Based on the percent of progress to the goal, the users were designated as High Users (19 students who had 50% or more progress to the goal) and Low Users (40 students who had less than 50% progress to the goal). Students who did not use the set were designated as Non‐Users (n=47). The student anatomy rank (average score of anatomy questions from 3 previous summative examinations) was not significantly different between the 3 groups. High Users performed significantly better than Non‐Users on anatomy examination questions related to the material included in the set. Performance on anatomy questions unrelated to the set (Control items) was not different between the groups. Set use was associated with improved overall anatomy grades of students who fell into the bottom half of the Class by the anatomy rank. Surveys have shown that the majority of students found Cerego sets useful and effective. Lack of time was reported as the most common barrier to using the set. This study shows that the use of online anatomy learning tools which utilize spacing and testing effects is associated with improved medical student performance on anatomy examinations. These results support the increased use of such learning tools as an adjunct to anatomy instruction in medical schools.