Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills

Abstract

Purpose. To examine the effect of instructional format on medical students' learning of ECG diagnosis. Method. Two experiments employed different learning and practice methods. In the first, students were randomly allocated to one of two instructional approaches, one organized around features (e.g., QRS voltage) and the other around diagnostic categories (e.g., bundle branch blocks), followed by a practice phase. In the second experiment, the instruction was standardized, and students were randomly allocated to one of two practice phases, either “contrastive” where examples from various categories are mixed together, or “non-contrastive” where all the examples in a single category are practiced in a single block.Results. In the first experiment, there was no significant differences in students' diagnostic accuracy on novel ECG examples. In the second experiment, students exposed to the contrastive approach in the practice phase had superior diagnostic accuracy (46%) compared to 30% accuracy for the non-contrastive session, p < 0.05).Conclusion. These experiments highlight two important features in the design of instructional materials. First, learning around the features of the problem (analogous to problem – based learning) may have no advantages over learning the category. Second, the design and organization of deliberate practice can result in significant learning gain.

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References

  1. Albanese, M.A. & Mitchell, S. (1993). Problem based learning: A review of literature on its outcome and implementation issues. Academic Medicine 68: 52–81.

    PubMed  Google Scholar 

  2. Avrahami, J., Kareev, Y. et al. (1997). Teaching by examples: implications for the process of category acquisition. Quarterly Journal of Experimental Psychology 50A: 586–606.

    Article  Google Scholar 

  3. Bransford, J.D., Brown, A.L. & Cocking, R.R. (1999). How People Learn: Brain, Mind, Experience and School. Washington, DC: National Academy Press.

    Google Scholar 

  4. Colliver, J. (2000). Effectiveness of problem based learning curricula: Theory and practice. Academic Medicine 75: 259–266.

    PubMed  Google Scholar 

  5. Ericsson, K.A. & Charness, N. (1994). Expert performance: Its structure and acquisition. American Psychologist 49: 725–747.

    Article  Google Scholar 

  6. Fincher, R., Abdulla, A. et al. (1988). Computer-assisted learning compared with weekly seminars for teaching fundamental electrocardiography to junior medical students. Southern Medical Journal 81: 1291–1294.

    PubMed  Google Scholar 

  7. Gick,M.L.& Holyoak, K.J. (1980). Analogical problem solving. Cognitive Psychology 12: 306–355.

    Article  Google Scholar 

  8. Guest, C.B, Regehr, G. & Tiberius, R.G. (2001). The life long challenge of expertise. MedicalEducation 35: 78–81.

    Google Scholar 

  9. Kingston, M. (1979). Electrocardiograph course. Journal of Medical Education 54: 107–110.

    PubMed  Google Scholar 

  10. Klayman, J. & Brown, K. (1993). Debias the environment instead of the judge: An alternative approach to reducing error in diagnostic (and other) judgment tasks. Cognition 49: 97–122.

    Article  PubMed  Google Scholar 

  11. McKenzie, C.R.M. (1998). Taking into account the strength of an alternative. Journal of Experimental Psychology: Learning, Memory & Cognition 24: 771–792.

    Google Scholar 

  12. Needham, D.R. & Begg, I.M. (1991). Problem-oriented training promotes spontaneous analogical transfer: memory-oriented training promotes memory for training. Memory and Cognition 19: 543–557.

    Google Scholar 

  13. Norman, G.R. & Schmidt, H.G. (1992). The psychological basis of problem based learning.Academic Medicine 67: 557–565.

    PubMed  Google Scholar 

  14. Norman G.R. & Schmidt, H.G. (2000). Effectiveness of problem based learning curricula: Theory, practice and paper darts. Medical Education 34: 721–728.

    Article  PubMed  Google Scholar 

  15. Stretton, T., Hall, R. & Owen, S.G. (1967). Programmed instruction in medical education. British Journal of Medical Education 1: 165–168.

    PubMed  Google Scholar 

  16. Ten Cate, O. (2001). Whatever happened to the student? Advances in Health Sciences Education 6:81–88.

    Article  PubMed  Google Scholar 

  17. Underwood, D.A. (1993). Clinical Electrocardiography: Self-assessment and Review. Pennsylvania, PA: W.B. Saunders Company.

    Google Scholar 

  18. Vernon, D.T.A. & Blake, R,L. (1993). Does problem based learning work? A meta-analysis of evaluative research. Academic Medicine 68: 550–563.

    PubMed  Google Scholar 

  19. Walton, H.J. & Matthews, M.B. (1989). Essentials of problem based learning. Medical Education 23: 542–558.

    PubMed  Google Scholar 

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Correspondence to Geoffrey R. Norman.

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Hatala, R.M., Brooks, L.R. & Norman, G.R. Practice Makes Perfect: The Critical Role of Mixed Practice in the Acquisition of ECG Interpretation Skills. Adv Health Sci Educ Theory Pract 8, 17–26 (2003). https://doi.org/10.1023/A:1022687404380

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  • learning
  • practice