Health Science Reviews

by Ashraf Moosa

University students spend much of their time studying and preparing for exams. The transition from high school to university can be quite challenging with the increased volume of work and demanding time pressures. Many students struggle to get through vast amounts of content before an exam. However, a solution touted by many is spaced repetition. The idea of spaced repetition has its origins in the late 19th century when Hermann Ebbinghaus proposed a ‘forgetting curve’ (Figure 1). He noted that “frequent repetitions are indispensable in order to make possible the reproduction of a given content” (Ebbinghaus, 2013). Spaced repetition is a learning technique usually performed with flashcards. Flashcards are repeated at intervals to consolidate learning. Newer or more difficult flashcards are shown more frequently, while older less difficult flashcards are shown less frequently. This supposedly makes learning
more effective and efficient. However, is there any scientific evidence to support this technique and might it be the magic bullet to solve students’ studying woes?

A study in Australia by researchers Anton Lambers and Adrian J. Talia sought to answer this question. Their study, titled: “Spaced Repetition Learning as a Tool for Orthopaedic Surgical Education: A Prospective Cohort Study on a Training Examination”, aimed to determine the effectiveness of spaced repetition learning in postgraduate surgical trainees studying for an orthopaedic basic sciences examination. The study consisted of twelve participants who were prospectively enrolled in the study and were provided with a set of 1400 practice flashcards to use through the learning program Anki. Anki is a free and open-source flashcard programme that uses spaced repetition algorithms to enhance learning. The programme is able to track studying habits. Thus, the researchers collected data on time spent using the Anki programme, time spent studying per day, number of reviews performed per day, total number of cards reviewed, and the maturity of studied cards. After the students had written the examination, the researchers collected each student’s examination score. The researchers could then correlate the time students spent studying and the number of flashcards they reviewed with their test scores.

Out of the 12 participants of the study, 11 passed the examination. That represents a 92% pass rate, which was much higher that the overall national pass rate of 67%. It would appear that the participants fared much better than others that had not used the spaced repetition technique. This goes to show that it was effective. It was also interesting to note that the participant that did not pass the examination had only undertaken 1 hour of study time on Anki. This was well below the average of 30 hours other participants had used the programme for. The researchers found a strongly
positive correlation between time spent on the Anki program and final examination score (Figure 2). This supported the researcher’s hypothesis that spaced repetition learning using a flashcard format is an effective study strategy for learning material for Orthopaedic examinations. However, one can more broadly conclude that spaced repetition learning is an effective learning strategy for any fact-rich subject.

Whilst the results of the study are promising, it is limited by its small numbers and the fact that it was not randomised which opens it up to selection bias. In addition, the participants may have employed other studying techniques in conjunction with spaced repetition to prepare for the examination. Despite this, the findings of this study may
be of particular interest to students and those in the education community. Spaced repetition learning offers a way to learn faster and more efficiently. This would be of benefit to time-poor learners who want to maximise their learning from the limited time they have to study. Additional research is needed to further elucidate the benefits of spaced repetition learning, but why not try it out for yourself and see if you find any difference in your results?

References:
• Ebbinghaus, H., 2013. Memory: A Contribution to Experimental Psychology. Annals of Neurosciences, 20(4).
• Lambers, A. and Talia, A., 2021. Spaced Repetition Learning as a Tool for Orthopedic Surgical Education: A Prospective Cohort Study on a Training Examination. Journal of Surgical Education, 78(1), pp.134-139.