“I can’t wait for this test to be over so I can forget everything!”
Maybe you’ve heard this in your classroom. Maybe you’ve even thought it yourself. Still, it can be frustrating for EMS educators to hear that students are anxious to shed the knowledge, skills, and attitudes we’ve worked so hard to help them acquire. That’s why the key to understanding how to improve long-term retention and performance lies in understanding the curve of forgetting and helping students stretch that curve out.
Forgetting is an important part of the learning process, helping the brain filter out the trivial information and retain what’s important. In this series of articles, we’ve discussed several ways the brain helps identify and better encode important information, such as information associated with strong emotions. An excellent method is to focus on retrieving and using key information repeatedly over greater and greater spaced intervals. Your brain decides that, if you have to recall and apply it, it must be important and should be more readily accessed.
In a companion article on spaced learning techniques, we discussed late 1800s German psychologist Hermann Ebbinghaus and his research on how to improve encoding and recall of information. Ebbinghaus studied not only the learning curve (how quickly students took up new information) but also the forgetting curve (how quickly they lost the ability to recall that information if it went unused). Among his findings Ebbinghaus discovered that if key information was presented again to students at regular intervals after they initially learned it, not only did this “refresh” the information, it actually slowed the forgetting curve, helping students retain the information for longer. This effect was increased even more if students were not presented with the information directly but were asked to retrieve it themselves through quizzes and tests or by using it in new learning or practical applications. One study of students studying anatomy and physiology using a combination of spaced retrieval and practice showed retention improvement between 35% and 60%.
Spaced retrieval is not simply a matter of repeating the same skill or recalling the same fact. It should involve retrieving the skill or information to apply in a new situation. For example, after learning and testing on respiratory system anatomy and physiology, we could simply wait a week and have a review quiz of the same material, or we could ask students to recall what they learned and apply it in a new way—by asking, for example, if heart failure is a condition where blood’s not adequately pumped to/through the lungs, how does this affect respirations? Not only does this force retrieval of knowledge about the structure and function of the respiratory system, it forces application of this information and builds new knowledge from it, creating new links and access points. This, in turn, makes it easier to retrieve later and build even more knowledge and applications.
Spaced retrieval can also help with another challenge of this era of rapidly evolving knowledge in emergency medicine. Taking the opportunity to ask providers to retrieve and apply information they’ve acquired through in-service and continuing medical education programs can not only help them build stronger connections with the information, it can help ensure that when they go to retrieve information on a topic, they aren’t pulling out and using old, outdated information.
Focus on the Application
While the term testing can bring up negative implications, focusing on functional retrieval to help apply useful information is generally seen as a good thing. For that reason, whether presenting a scenario in writing or a simulation in person, it can be best if the focus is on recalling, applying, and building on previously learned material. The closer you can help the student get to properly recalling the knowledge, skills, and attitudes and effectively applying them in a realistic scenario, the more learning connections are made, and the more the forgetting curve is stretched out.
In the field opportunities abound for mentors, supervisors, and educators to use spaced retrieval and application techniques. Formal or informal call reviews are a great chance to not only see what we remember but to check out what is new and how best to apply it all.
Be careful not to start playing Trivial Pursuit. The idea behind spaced retrieval is not to “stump the chump” by seeing if they can remember inconsequential information, but rather use a real-life example where recalling and applying possibly forgotten EMS knowledge can be of significant benefit. This is the key to creating a learning opportunity that is both enjoyable and effective.
Butler AC, Raley ND. The Future of Medical Education: Assessing the Impact of Interventions on Long-Term Retention and Clinical Care. J Grad Med Educ, 2015; 7(3): 483–485.
Dobson JL. Retrieval practice is an efficient method of enhancing the retention of anatomy and physiology information. Advances in Physiology Education, 2013; 37(2): 184–191.
Holmboe ES, Durning SJ, Hawkins RE. Practical Guide to the Evaluation of Clinical Competence. Elsevier Health Sciences, 2017.
Larsen DP, Butler AC, Roediger HL. Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial. Medical Education, 2009; 43(12), 1,174–81.
Rommie L. Duckworth, LP, is a dedicated emergency responder and award-winning educator with more than 25 years working in career and volunteer fire departments, hospital healthcare systems, and public and private emergency medical services. He is currently a career fire captain and paramedic EMS coordinator.