“To repeat what others have said, requires education; to challenge it, requires brains.” Mary Pettibone Poole
Harvard Medical School has created an online platform, QStream.com, to deliver web-based health education courses in developing countries. The content is accessible via computer, laptop and mobile phone. The intention is a good one- to find a faster, more efficient, and less resource-dependent way to teach health workers in remote locations.
The approach is called “spaced” education and is entirely comprised of multiple-choice questions. Once a participant answers a question, the website provides a brief explanation of the correct and incorrect answers. It claims to deliver the questions to participants in an adaptive format and to reinforce those topics in which the participant needs additional help.
“Spaced” education is said to combine two core psychology research findings: the “spacing” effect (information that is presented and repeated over spaced intervals is learned and retained more effectively) and the “testing” effect (testing causes knowledge to be stored more effectively in long-term memory).
I first became aware of this instructional methodology when I was asked to review two “spaced” education courses, titled Innovative Financing of Health Professional Schools and Private Sector Participation in Pre-Service Health Education. Developed by CapacityPlus in collaboration with QStream, US AID was considering using these courses for private medical training institutions in Zambia.
There are a number of reasons why I advised US AID and its contracting agency, Banyan Global, against using these courses and this approach.
1. It takes the research on spacing and testing completely out of context. New learning has to be reinforced by revisiting it (we’ve known that for decades). However, each iteration should take the learning deeper- by having the learners do increasingly more complex things with what they have learned. Long term retention of information is significantly improved by testing learners…but only AFTER they have learned it!
2. This is still providing standardized content- because everyone who answers incorrectly gets the very same response. [If this were truly adaptive, there would be an explanation as to why a specific answer is incorrect, sending the learners back to try again- not simply telling them the correct answer!]
3. Q &A is not adaptive to the needs of different learning styles. People who need to listen, or see a demonstration, or discuss, or test out new knowledge or skills would find this very ineffective and frustrating for them. This Q & A approach is simply a lecture in disguise.
4. This can be a very frustrating approach if the learner keeps getting the answers wrong. It could easily shut down the person’s interest in learning and do damage to the person’s confidence in his or her own competence.
5. Q & A is typically used to check comprehension- AFTER the learners have actually learned something.
6. This methodology is explicitly focused on comprehension as the highest level of its learning: the last three lines of the paragraph under Who Are the Target Learners says that the course “draws on practices and analyses to provide participants with an understanding of factors bearing on the success of private sector health education and training…”
7. A training program where real learning occurs would start by ensuring learner comprehension and then give them real scenarios to work through (at the very least) so that they could get to analysis and evaluation levels of learning.
8. The answers to many of the questions are very obvious.
9. The answers to many questions are d, all of the above.
10. There is no learning happening, because for learning to occur, the participants need to be fully engaged and using their new knowledge or skills.
11. Learning also requires focused concentration, which is definitely not likely using a mobile phone.
12. Learning is also interactive, people learn from each other. Even good on-line courses have chat rooms and webinar interactions. This is a completely solitary approach.
13. Why should busy professionals waste their time with this Q & A when they could just read the content and be done with it?
14. The memory is emotional, that is why learners need to be emotionally engaged. Interactive participatory learning activities create full body memory, ensuring retention.
The only good thing I can say about this is that it provides a baby step away from lecture as the training methodology.
Have you had any experience with “spaced” education?
May your learning be sweet.