Retention Of Basic Science Knowledge Research Articles

Exploring basic science knowledge retention within a cohort of undergraduate medical students in the United Kingdom: A longitudinal study.

Clinical reasoning is reliant on students having acquired a strong foundation in the basic sciences. However, there remains uncertainty regarding whether medical students are maintaining this knowledge over the span of their degrees. Therefore, this project aimed to assess long-term retention of basic science knowledge within a cohort of students from an undergraduate medical school in the United Kingdom (UK). This longitudinal study followed a cohort of students, from their first to final year. In their final year, participants sat a bespoke formative basic science knowledge assessment that utilised 46 single-best-answer questions. To examine for long-term attainment differences, these scores were compared with those achieved in first-year assessments. Of the eligible students, 40% partook in the study (n= 22). Comparing assessment scores highlighted an enhancement in overall basic science knowledge between first and final year (p< 0.01). Although most basic science domains remained unchanged between both time points, anatomy and physiology scores increased (p= 0.03 and p= 0.02, respectively), whereas biochemistry scores were the only ones to decrease (p= 0.02). This project provides insight into how well students are retaining the basic sciences during their studies. Underperforming science domains were identified, alongside pedagogical explanations for their individual shortcomings; for instance, students' perceived relevance of a domain is seen as a driver for its retention. Subsequently, a group of recommendations were derived to reinforce the most affected domains. The inclusion of more questions on the underperforming sciences, in clinically focussed assessments, is one such suggestion.

Development of an assessment technique for basic science retention using the NBME subject exam data

IntroductionOne of the challenges in medical education is effectively assessing basic science knowledge retention. National Board of Medical Examiners (NBME) clerkship subject exam performance is reflective of the basic science knowledge accrued during preclinical education. The aim of this study was to determine if students’ retention of basic science knowledge during the clerkship years can be analyzed using a cognitive diagnostic assessment (CDA) of the NBME subject exam data.MethodsWe acquired a customized NBME item analysis report of our institution’s pediatric clerkship subject exams for the period of 2017–2020 and developed a question-by-content Q-matrix by identifying skills necessary to master content. As a pilot study, students’ content mastery in 12 major basic science content areas was analyzed using a CDA model called DINA (deterministic input, noisy “and” gate).ResultsThe results allowed us to identify strong and weak basic science content areas for students in the pediatric clerkship. For example: “Reproductive systems” and “Skin and subcutaneous tissue” showed a student mastery of 83.8 ± 2.2% and 60.7 ± 3.2%, respectively.ConclusionsOur pilot study demonstrates how this new technique can be applicable in quantitatively measuring students’ basic science knowledge retention during any clerkship. Combined data from all the clerkships will allow comparisons of specific content areas and identification of individual variations between different clerkships. In addition, the same technique can be used to analyze internal assessments thereby creating an opportunity for the longitudinal tracking of student performances. Detailed analyses like this can guide specific curricular changes and drive continuous quality improvement in the undergraduate medical school curriculum.

Incorporation of a clinically oriented case study into a multi‐subject medical school block increased student engagement in a remote learning environment

At Texas Tech University Health Sciences Center School of Medicine, our curriculum begins with rigorous and fast-paced basic science blocks followed by clinical clerkships. During the first semester of the first year, medical students take a combined Biochemistry, Cell Biology and Histology block (called BCT) after successfully finishing an anatomy block. Historically, the medical students have had difficulties in both assimilating the amount of content presented and in appreciating how the topics covered in BCT help them better understand the pathophysiology and treatment of diseases. Further, because the COVID-19 environment prompted a change from a categorical to a Pass/Fail grading system and shifted the delivery of didactic material from in-person to remote learning, retention of student engagement became a priority. It has been demonstrated by others that using clinical correlations to teach basic science concepts is an effective way to enhance student engagement and retention of basic science knowledge. The primary hypothesis for this study was that student engagement and interest in basic science knowledge would be enhanced by the incorporation of a clinically oriented, case-based exercise. A second hypothesis was that students would be able to apply information provided during lectures to successfully complete it. The BCT block is 8 weeks long and consists of 3 units primarily focused on medical biochemistry (unit 1), cell biology (unit 2) and histology (unit 3). The case study, focused on diabetes, was designed to run as a “thread” through all of the units and build in complexity with each unit in order to better understand the pathophysiology of this disease. The case was revealed progressively in three units, each of which consisted of a portion of an hypothetical scenario and a matched, five-question quiz that was offered both at the beginning and the end of each unit. The correct answers were given to the students after completion of each post-quiz. To enhance student participation, 2% was added to their grade after successful completion of at least 3 quizzes. Comparison of the pre- and post-quiz data revealed that for units 1 and 3, students scored significantly higher on post-quizzes as compared to pre-quizzes (unit 1- 86% vs 48%, a 78% change, and unit 3- 66% vs 61%, an 8.9% change). For unit 2, there was a trend toward significance; however, the average post-quiz score (87% vs 83%, a 4.5% change) was not significantly different from the pre-quiz score (p=0.07). Students responded favorably to the exercise (as reported in an end-of-block survey), wherein it was ranked higher as a learning resource than any of the recommended textbooks or atlases. Collectively, these data reveal that addition of a case study effectively enhances students' learning of the didactic material as well as their ability to apply basic science knowledge to a clinical case-based scenario.

Collaborative Testing in Medical Education: Student Perceptions and Long-Term Knowledge Retention.

Collaborative testing blends collaborative learning and assessment, engaging small groups of students in answering exam questions as a team. Previous studies have shown that collaborative testing promotes increased student performance and short-term knowledge retention over individual testing alone. In this mixed-methods study, we examined the effects of collaborative testing on preclinical medical students' long-term retention of basic science knowledge, as well as students' approaches and perceptions of collaborative testing. Small groups of students consecutively experienced two conditions after their individual exams: collaborative testing, where they answered half of the exam questions together, and group exam review, where they discussed the other half of the questions with answers provided. Eight months later, students individually took a post-test that included a subset of the questions they had previously encountered in the context of collaborative testing and a subset of questions from group exam review. We found that both post-test performance and knowledge retained from initial individual exam to post-test were significantly higher for the collaborative testing condition. Qualitative findings suggest that knowledge retention was enhanced by collaborative processes and repeated knowledge retrieval elicited by collaborative testing. While students were appreciative of opportunities to discuss ideas and work as a team, many expressed negative opinions about not being certain of correct answers and experiencing interpersonal conflict in collaborative testing. We discuss implications of these findings to enhance design of collaborative testing opportunities and learning environments that support knowledge retention, productive views of authority and certainty of knowledge, and effective collaborative practice.

Peer Instruction-Based Feedback Sessions Improve the Retention of Knowledge in Medical Students

ABSTRACT Peer Instruction (PI) is an interactive teaching-learning process between colleagues and has been applied in various universities throughout the world. This active teaching methodology improves students’ performance and their capacity to resolve problems when they perform activities with their study colleagues. There are no systematic studies about the use of PI in assessment feedback. The aim of our study is to identify whether the use of PI on assessment feedback improves the retention of basic concepts in medical programs. For this study 226 undergraduate students (Y2 = 115, Y3 = 111) enrolled in a Brazilian medical school were invited to participate. After taking the regular exam (RE), the students of the control group (125) could individually receive feedback (review of the exam) from the professor according to the course routine, and the students in the study group (101) were invited to participate in an immediate intervention after the RE with a feedback developed session using the peer instruction teaching method. At the conclusion of the feedback session, the students again answered the post-feedback exam (PFE) so that we could identify any changes in the answers compared with the regular exam taken before feedback and 6 months later, we applied a diagnostic exam (DE) of identify whether the students retained the concepts covered in the previous exams. The control and study groups are statistically significantly different in the RE (p = 0.0014) and DE (p &lt; 0.000). The study group demonstrated better performance in both exams than the control group. When we gave feedback, using PI immediately after the exam, retention of basic science knowledge jumped to 39%, increasing by 15%. The students that had assessment feedback had the opportunity to discuss their misconceptions. These students had the highest number of correct answers with assimilate knowledge and fewer assimilation of wrong answers, therefore, students who received immediate feedback had less tendency to make the same conceptual errors. PI in the feedback was effective in improving retention of basic science knowledge.

Exploring the value and role of integrated supportive science courses in the reformed medical curriculum iMED: a mixed methods study.

BackgroundHeterogeneous basic science knowledge of medical students is an important challenge for medical education. In this study, the authors aimed at exploring the value and role of integrated supportive science (ISS) courses as a novel approach to address this challenge and to promote learning basic science concepts in medical education. ISS courses were embedded in a reformed medical curriculum.MethodsThe authors used a mixed methods approach including four focus groups involving ISS course lecturers and students (two each), and five surveys of one student cohort covering the results of regular student evaluations including the ISS courses across one study year. They conducted their study at the University Medical Center Hamburg-Eppendorf between December 2013 and July 2014.ResultsFourteen first-year medical students and thirteen ISS course lecturers participated in the focus groups. The authors identified several themes focused on the temporal integration of ISS courses into the medical curriculum, the integration of ISS course contents into core curriculum contents, the value and role of ISS courses, and the courses’ setting and atmosphere. The integrated course concept was positively accepted by both groups, with participants suggesting that it promotes retention of basic science knowledge. Values and roles identified by focus group participants included promotion of basic understanding of science concepts, integration of foundational and applied learning, and maximization of students’ engagement and motivation. Building close links between ISS course contents and the core curriculum appeared to be crucial. Survey results confirmed qualitative findings regarding students’ satisfaction, with some courses still requiring optimization.ConclusionsIntegration of supportive basic science courses, traditionally rather part of premedical education, into the medical curriculum appears to be a feasible strategy to improve medical students’ understanding of basic science concepts and to increase their motivation and engagement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0646-9) contains supplementary material, which is available to authorized users.

Longitudinal evaluation, acceptability and long-term retention of knowledge on a horizontally integrated organic and functional systems course.

Undergraduate medical education is moving from traditional disciplinary basic science courses into more integrated curricula. Integration models based on organ systems originated in the 1950s, but few longitudinal studies have evaluated their effectiveness. This article outlines the development and implementation of the Organic and Functional Systems (OFS) courses at the University of Minho in Portugal, using evidence collected over 10 years. It describes the organization of content, student academic performance and acceptability of the courses, the evaluation of preparedness for future courses and the retention of knowledge on basic sciences. Students consistently rated the OFS courses highly. Physician tutors in subsequent clinical attachments considered that students were appropriately prepared. Performance in the International Foundations of Medicine examination of a self-selected sample of students revealed similar performances in basic science items after the last OFS course and 4 years later, at the moment of graduation. In conclusion, the organizational and pedagogical approaches of the OFS courses achieve high acceptability by students and result in positive outcomes in terms of preparedness for subsequent training and long-term retention of basic science knowledge.

Retention of knowledge and perceived relevance of basic sciences in an integrated case-based learning (CBL) curriculum

BackgroundKnowledge and understanding of basic biomedical sciences remain essential to medical practice, particularly when faced with the continual advancement of diagnostic and therapeutic modalities. Evidence suggests, however, that retention tends to atrophy across the span of an average medical course and into the early postgraduate years, as preoccupation with clinical medicine predominates. We postulated that perceived relevance demonstrated through applicability to clinical situations may assist in retention of basic science knowledge.MethodsTo test this hypothesis in our own medical student cohort, we administered a paper-based 50 MCQ assessment to a sample of students from Years 2 through 5. Covariates pertaining to demographics, prior educational experience, and the perceived clinical relevance of each question were also collected.ResultsA total of 232 students (Years 2–5, response rate 50%) undertook the assessment task. This sample had comparable demographic and performance characteristics to the whole medical school cohort. In general, discipline-specific and overall scores were better for students in the latter years of the course compared to those in Year 2; male students and domestic students tended to perform better than their respective counterparts in certain disciplines. In the clinical years, perceived clinical relevance was significantly and positively correlated with item performance.ConclusionsThis study suggests that perceived clinical relevance is a contributing factor to the retention of basic science knowledge and behoves curriculum planners to make clinical relevance a more explicit component of applied science teaching throughout the medical course.

Very long-term retention of basic science knowledge in doctors after graduation

Despite frequent complaints that biomedical knowledge is quickly forgotten after it has been learned, few investigations of actual long-term retention of basic science knowledge have been conducted in the medical domain. Our aim was to illuminate the long-term retention of basic science knowledge, particularly of unrehearsed knowledge. Using a cross-sectional study design, medical students and doctors in the Netherlands were tested for retention of basic science knowledge. Relationships between retention interval and proportion of correct answers on a knowledge test were investigated. The popular notion that most of basic science knowledge is forgotten shortly after graduation is not supported by our findings. With respect to the full test scores, which reflect a composite of unrehearsed and rehearsed knowledge, performance decreased from approximately 40% correct answers for students still in medical school, to 25-30% correct answers for doctors after many years of practice. When rehearsal during the retention interval is controlled for, it appears that little knowledge is lost for 1.5-2 years after it was last used; from then on, retention is best described by a negatively accelerated (logarithmic) forgetting curve. After ≥ 25 years, retention levels were in the range of 15-20%. Conclusions about the forgetting of unrehearsed knowledge in this study are in line with findings reported in other domains: it proceeds in accordance with the Ebbinghaus curve for meaningful material, except that in our findings the 'downward' part appears to start later than in most other studies. The limitations of the study are discussed and possible ramifications for medical education are proposed.

Long-term retention of basic science knowledge: a review study

In this paper, a review of long-term retention of basic science knowledge is presented. First, it is argued that retention of this knowledge has been a long-standing problem in medical education. Next, three types of studies are described that are employed in the literature to investigate long-term retention of knowledge in general. Subsequently, first the results of retention studies in general education are presented, followed by those of studies of basic science knowledge in medical education. The results of the review, in the general educational domain as well as in medical education, suggest that approximately two-third to three-fourth of knowledge will be retained after one year, with a further decrease to slightly below fifty percent in the next year. Finally, some recommendations are made for instructional strategies in curricula to improve long term retention of the subject matter dealt with.

Role of Imaging in Medical Schools of Tomorrow

Abstract CT of the cadavers and on site 3-D ultrasound imaging significantly increase the amount of visual information and improve students' understanding of anatomy leading to more efficient assimilation of the basic science knowledge. In addition to cadaveric CT and ultrasound imaging, students are provided with normal and abnormal radiographic studies of living humans. The imaging modalities in Medical Image Library of Paul L Foster School of Medicine in El Paso, TX are X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Normal anatomy and pathology are demonstrated on different types of imaging studies which enables integration of the basic science material with relevant clinical examples. Recent advances in 4-D and Doppler ultrasound significantly enrich learning experience in embryology and physiology. Multidisciplinary approach using cutting edge medical imaging technology may improve students' retention of basic science knowledge throughout their medical school, residency training and beyond.

Retention of Basic Science Knowledge: A Comparison Between Body System-Based and Clinical Presentation Curricula

Background: When the University of Calgary implemented the clinical presentation (CP) curriculum in 1994, it was prospectively decided to administer the National Board of Medical Examiner's Comprehensive Basic Science Exam (CBSE) as a measure of students' basic science knowledge retention. Purpose: The exam performance from 2 classes (1995, 1996) of the previous system-based (SB) curriculum was compared to exam performance of 2 classes (2000, 2002) of the CP curriculum. Methods: Data analyses employed 2 statistical models (covariate multiple linear regression and hierarchical mixed effects), and effect sizes were computed. Results: Differences between CBSE mean scores produced by students from the SB and CP curricula showed a curricular effect on students' retention of basic science knowledge. However, preexisting differences between groups were found to be in the small-to-medium range. Conclusion: Evidence supporting the potential of schemes within a CP curriculum and their relation to basic science knowledge retention was observed. Effect size for the CP curriculum on students' retention of basic science knowledge was substantial; however, a notable part of that difference can be accounted for by extraneous and confounding factors. Further research utilizing more rigorous designs to investigate the relation between schemes and basic science retention is warranted.

The value of a questionnaire in assessing the acquisition and retention of basic science knowledge by dental students.

This cross-sectional study aimed to assess and compare, by performances in a questionnaire, the level of knowledge of basic medical sciences in 6th-form school pupils studying science subjects as entrance requirements to University and in 2nd, 3rd and 4th-year undergraduate dental students. A 40-part multiple response, true/false questionnaire, testing recall of factual knowledge in anatomy, biochemistry, physiology and oral biology, was used as the method of assessment. The results suggested that this simple format was an acceptable and useful method of assessment of the knowledge level of the study groups. The difference in scores of knowledge, expected to be higher in 2nd-year students compared to 6th form groups, was greatest in anatomy and oral biology, less in biochemistry and, unexpectedly, was not apparent in physiology. A difference in performance on the knowledge questionnaire was observed between 4th and 2nd year dental students, attributable primarily to decreased scores for 4th year dental students in biochemistry and, to a lesser extent, anatomy. The results obtained with this standardised test of factual knowledge recall may be of value to teachers compiling medical sciences courses for dental undergraduates and to those planning and evaluating new curricula with a less didactic approach.

Identifying Opportunities for Vertical Integration of Biochemistry and Clinical Medicine.

Objectives: Retention of basic science knowledge, as judged by National Board of Medical Examiners' (NBME) data, suffers due to lack of apparent relevance and isolation of instruction from clinical application, especially in biochemistry. However, the literature reveals no systematic process for identifying key biochemical concepts and associated clinical conditions. This study systematically identified difficult biochemical concepts and their common clinical conditions as a critical step towards enhancing relevance and retention of biochemistry.Methods: A multi-step/ multiple stakeholder process was used to: (1) identify important biochemistry concepts; (2) determine students' perceptions of concept difficulty; (3) assess biochemistry faculty, student, and clinical teaching scholars' perceived relevance of identified concepts; and (4) identify associated common clinical conditions for relevant and difficult concepts. Surveys and a modified Delphi process were used to gather data, subsequently analyzed using SPSS for Windows.Results: Sixteen key biochemical concepts were identified. Second year medical students rated 14/16 concepts as extremely difficult while fourth year students rated nine concepts as moderately to extremely difficult. On average, each teaching scholar generated common clinical conditions for 6.2 of the 16 concepts, yielding a set of seven critical concepts and associated clinical conditions.Conclusions: Key stakeholders in the instructional process struggle to identify biochemistry concepts that are critical, difficult to learn and associated with common clinical conditions. However, through a systematic process beginning with identification of concepts and associated clinical conditions, relevance of basic science instruction can be enhanced.

Use of NBME examinations to assess retention of basic science knowledge.

About 10 years ago results of the National Board of Medical Examiners (NBME) "Minitest," comprised of samples of questions from NBME Part I and Part II tests, indicated that the change in performance in the total basic science examinations would be minimal between the second and fourth years of medical school. By inserting samples of Part I basic science questions into Part II, large scale tests could be made of the change in performance. In two pilot projects, in a longitudinal study of the same students at a two-year interval, in a cross-sectional study of two groups of students at the same time, and in a comparison of performance of basic science questions in the Federation Licensing Examination (FLEX), the prediction of the minitest results was sustained. Overall performance on all basic science questions decreased only a little. However, the changes in the individual disciplines ranged from a consistent improvement in pathology to a substantial decrease in biochemistry. Pharmacology and behavioral sciences fluctuated between small increases and decreases. Physiology, microbiology, and anatomy decreased consistently, but not as much as biochemistry.