Interactive spaced-education to teach the physical examination: a randomized controlled trial

J Gen Intern Med. 2008 Jul;23(7):973-8. doi: 10.1007/s11606-008-0533-0.


Background: Several studies have documented that physical examination knowledge and skills are limited among medical trainees.

Objectives: The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed 'interactive spaced-education' (ISE) as a method to teach the physical examination.

Design: The design of the study is randomized controlled trial.

Participants: All 170 second-year students in the physical examination course at Harvard Medical School were eligible to enroll.

Measurements: Spaced-education items (questions and explanations) were developed on core physical examination topics and were content-validated by two experts. Based on pilot-test data, 36 items were selected for inclusion. Students were randomized to start the 18-week program in November 2006 or 12 weeks later. Students were sent 6 spaced-education e-mails each week for 6 weeks (cycle 1) which were then repeated in two subsequent 6-week cycles (cycles 2 and 3). Students submitted answers to the questions online and received immediate feedback. An online end-of-program survey was administered.

Results: One-hundred twenty students enrolled in the trial. Cycles 1, 2, and 3 were completed by 88%, 76%, and 71% of students, respectively. Under an intent-to-treat analysis, cycle 3 scores for cohort A students [mean 74.0 (SD 13.5)] were significantly higher than cycle 1 scores for cohort B students [controls; mean 59.0 (SD 10.5); P < .001], corresponding to a Cohen's effect size of 1.43. Eighty-five percent of participants (102 of 120) recommended the ISE program for students the following year.

Conclusions: ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Computer-Assisted Instruction*
  • Education, Medical, Undergraduate*
  • Educational Measurement
  • Humans
  • Physical Examination*