Abstract
BackgroundSAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled) is a flashcard-type behavioural instructional methodology, involving one-minute learning trials that function both as practice and assessment, used to facilitate the development of fluency in a behaviour.The primary research question was whether SAFMEDS engenders improvement in performance beyond that conferred by usual teaching. A secondary research question was whether SAFMEDS is an effective method of producing fluency in Electrocardiogram (ECG) interpretation.MethodsA pilot study was conducted to determine sample size required to power the pragmatic randomised controlled trial (RCT). For the subsequent RCT, participants were randomly assigned to a “usual teaching” control group (n = 14) or the SAFMEDS intervention group (n = 13), with the recognition of 15 cardiac conditions on ECGs (e.g., atrial fibrillation, complete heart block) targeted. Intervention group participants’ performance was tracked over eight weeks as they worked towards achieving the fluency criterion. Percentage accuracy in ECG interpretation was assessed at baseline and post-test for both groups. An ANCOVA was conducted to assess for differences in the performance of the intervention and control group at post-test while controlling for the baseline performance of participants. At post-test, the numbers of participants achieving fluency within the intervention group was examined.ResultsA large effect size of SAFMEDS (partial η2 = .67) was identified when controlling for the effects of baseline performance. At post-test, the intervention group significantly outperformed (M = 61.5%; SD = 12.1%) the control group (M = 31.6%; SD = 12.5%, p < .001). In total, 7 of 13 intervention group participants achieved fluency. Participants required an average of 51.9 one-minute trials (SD = 18.8) to achieve fluency.ConclusionsSAFMEDS offers a useful adjunct to usual teaching within medical education. Further research could assess whether learning retains, is stable, and transfers to clinical practice.
Highlights
SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled) is a flashcard-type behavioural instructional methodology, involving one-minute learning trials that function both as practice and assessment, used to facilitate the development of fluency in a behaviour
The primary research question of this pragmatic randomised controlled trial (RCT) [19] of the application of SAFMEDS to teaching ECG interpretation was: does SAFMEDS engender any improvement in performance beyond that conferred by usual teaching? A secondary research question was: is SAFMEDS an effective method of producing behavioural fluency in ECG interpretation?
The participants randomly assigned to the intervention group received a brief introductory teaching session on ECG interpretation, the SAFMEDS intervention, and the medical school’s usual teaching on ECG interpretation, which included clinical rotations through cardiology and a 2-h small-group tutorial on ECG interpretation from a consultant cardiologist
Summary
SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled) is a flashcard-type behavioural instructional methodology, involving one-minute learning trials that function both as practice and assessment, used to facilitate the development of fluency in a behaviour. Fluency looks like automaticity in behaviour, correct responding without hesitation, or effortless performance [1]. Interventions targeting behaviour fluency: 1) are typically criterion-referenced, meaning that learners work towards achieving a pre-determined ‘expert’ standard that is time-based [5]; 2) are focused on providing learners with opportunities to practice the behaviour, a key element of the learning process often absent in educational programs [6]; and 3) involve both continuous measurement of behaviour and performance feedback for the learner [5, 6]. One interventional strategy used to produce fluency is the SayAll-Fast-Minute-Every-Day-Shuffled (SAFMEDS) methodology
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