Repetition, Repetition, Repetition

Need a refresher course on advanced cardiac care? An introduction to music theory? A lesson on making a mean cocktail?

All this and more is yours for the taking on SpacedEd, a new online learning site that utilizes the benefits of spaced education, a patented methodology developed by B. Price Kerfoot, Ed.M.'00, after years of research and trials on his medical colleagues.

Based on the theories of German psychologist Hermann Ebbinghaus, whose work in the late 1800s focused on memory, Kerfoot's own exploration into spaced education began in earnest toward the end of his medical residency when he received a grant to investigate online education. The goal was twofold: could online learning, delivered and repeated in spaced intervals, be used as an effective teaching tool; and could it improve knowledge retention beyond the typical classroom experience?

As Kerfoot discovered, the answer was yes on both counts, and he now has a wealth of documented research to prove it. Harvard patented the spaced education method in 2006 and SpacedEd, the company, launched as a start-up two years later. In July, the first batch of online courses -- the majority of which are free -- were opened to the public in 30 topic areas, with names like iPhone Tips, Swine Flu Facts, and Physical Exam Essentials. Another 170 offerings are currently in development.

"Spaced education methodology is content neutral," says Kerfoot, a urologist at VA Boston Healthcare and an associate professor of surgery at Harvard Medical School. "It can be used to teach Arabic to troops in Iraq or to teach a variety of subjects to schoolchildren."

For that reason, SpacedEd CEO Duncan Lennox calls it democratized learning. "Everybody who signs up as a learner is also an author," he says, "and anyone can come and build a course." (He created a couple, including one called SAT Basic Algebra.)

And they have. In the first four months since its launch, SpacedEd has attracted educators, physicians, and firefighters to its site, offering a $100 incentive payment to all who create a course. For those courses that charge a fee, which currently range from $1.99 to $9.99, 60 to 80 percent of the proceeds return to the author.

How it actually works, Kerfoot explains, is fairly simple. Users who sign up for a medical course, for example, may receive clinical case scenarios along with a series of questions via e-mail. Once the information is read and the posed questions answered, users are immediately able to learn whether their response was correct, as well as how their fellow participants fared on the same question. Information and questions are sent at regular intervals, such as two questions sent every two days. Once the questions are answered correctly twice in a row, he says, the queries are retired and no longer repeated. If answered incorrectly, the questions are repeated every 12 days until the information is committed to memory.

"With the spacing effect, if you take information in small amounts and repeat it, it encodes that information in your memory. The second part is the testing effect, and some interesting papers show us that just by presenting people with information and then testing them on it, it encodes the information," says Kerfoot. "The repetition adapts to the learner based on whether they answer their questions correctly. The focus is on mastery and retention of the material."

Among the compelling research uncovered along the way, Kerfoot cites a study of 85 care providers that showed spaced education could reduce their inappropriate cancer screenings by 26 percent over a 36-week course period. In another trial of 720 urology trainees in the United States and Canada, Kerfoot was able to demonstrate "a good transfer of learning" as a result of the spaced education program, with 78 percent of participants stating a preference for spaced education over another online education module.

Eventually, Kerfoot sees other educational benefits. The site could help prevent summer learning loss, he says, or supplement the curriculum teachers are using in class. It could also be used by teachers to help assess student knowledge and learning patterns.

Currently, blogs on the SpacedEd website allow learners and educators to converse with one another, which serves Kerfoot's goal to "harness" the collaborative component of this educational environment.

"What we have found is that spaced education is remarkably well accepted by learners, from students to practicing physicians," says Kerfoot. "We know it works. Other websites have bells and whistles, but nothing to prove their efficacy. We have that."

Go to www.spaceded.com to learn more.

Illustration by Jeff Hopkins, Ed.M.'05