The Science Behind Qstream

Scientifically Proven to Work

Spun out of Harvard Medical School, Qstream uses an “interactive spaced education” methodology, a scientifically proven approach that increases knowledge retention from 3 months to 2 years, and changes even ingrained on-the-job performance.  Qstream incorporates “spacing” and “testing” into a simple, mobile delivery platform to produce results that have been proven through many rigorous, peer-reviewed clinical trials.

The Forgetting Curve

The assumption that if you learning something it is retained and can be recalled is simply false.  This has been proven many times.  Forgetting is a natural, physiological occurrence and must be factored into the teaching and learning process.

This phenomenon was documented as early as 1885 when German psychologist and learning pioneer Hermann Ebbinghaus published his findings about learning.

The forgetting curve describes the dramatic drop off in knowledge retention over time.  Studies show that in as little as 30 days, 79% of knowledge is forgotten.  It is simply a matter of how the human brain works.

The Spacing Effect

Spaced education is a proven way to combat the forgetting curve.  The spacing effect indicates that you can significantly increase knowledge retention if you present information and reinforce it over spaced intervals of time.

There is a proven neurophysiological basis for the spacing effect.  Learning over time enhances memory and the survival of new neurons.  It increases the efficiency of the uptake of information and encodes the information so that it is preferentially retained.

The Testing Effect

Testing is not just a dipstick that measures knowledge.  Testing, or retrieval practice, is an active learning process that can dramatically improve knowledge retention when combined with immediate answer feedback. This process is known as the testing effect.

Studies comparing the testing effect to passive learning without testing (reading, watching a video) and conceptual mapping (drawing diagrams to relate concepts) show that testing is the most effective approach.

Qstream Really Works

Numerous, peer-reviewed clinical trials have been to conducted to test the effectiveness of spaced education and Qstream.  These rigorous clinical trials show that Qstream significantly improves knowledge retention, on-the-job performance, and learner engagement.

Spaced education was initially developed and then rigorously studied by Dr. B. Price Kerfoot (Associate Professor, Harvard Medical School) as a method to improve the long-term knowledge retention of medical trainees.

In over 10 large randomized trials completed to date, spaced education has been found to:

• Improve knowledge acquisition
• Increase long-term knowledge retention (out to 2 years)
• Change behavior
• Boost learners’ abilities to accurately self-assess their knowledge.

In addition, spaced education is extremely well-accepted by learners.

The spaced education methodology is content-neutral and thus can be utilized to learn most anything. Potential applications range from teaching geography to school children to documenting competence in accounting skills among small business owners. The full multi-media capabilities of the Internet can be harnessed to create a rich and effective learning experience.

On-Going Research Studies

• Adaptive Spaced Education to Assess and Improve Knowledge of Clinical Practice Guidelines: a Randomized Trial.
  (trial involves 1470 physicians in 63 countries)
• Adaptive Spaced Education for Longitudinal Progress Testing of Medical Students.
  (trial involves 724 students at 3 US medical schools)
• Adaptive Spaced Education for Longitudinal Progress Testing of Urology Residents.
  (trial involves 932 urology residents from the US and Canada)

Completed Research Studies – data under analysis

• Interactive Spaced Education for Longitudinal Progress Testing of Medical Students: A Multi-Institutional Randomized Trial
  (a 34-week trial involving 1067 students at 4 US medical schools)
• Spaced Education Versus Web-based Modules for Teaching Histopathology Diagnostic Skills to Urology Residents: A Randomized Controlled Trial.
  (a 45-week trial involving 724 urology residents across the United States)
• Interactive Spaced Education to Improve Clinicians’ Screening for Prostate Cancer: A Randomized Controlled Trial
  (a 36-week trial involving 95 clinicians in northeastern Veterans Affairs hospital system.)

Published Research Studies (most recent listed first):

Kerfoot BP, Kearney MC, Connelly D, Ritchey ML. Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial. Ann Surg, 2009 May;249(5):744-9.

Kerfoot BP. Learning benefits of online spaced education persist for two years. Journal of Urology, 2009 Jun;181(6):2671-3.

Matzie KA, Kerfoot BP, Hafler JP, Breen EM. Spaced education improves the feedback that surgical residents give to medical students: a randomized trial. Amer J Surg 2009: 197(2), 252-257.

Kerfoot BP, Armstrong EG, O’Sullivan PN. Interactive spaced education to teach the physical examination: a randomized controlled trial. J Gen Intern Med. 2008; 23(7):973-8.

Kerfoot BP, Brotschi E. Online spaced education to teach urology to medical students: a multi-institutional randomized trial. Amer J Surg 2009;197(1):89-95.

Kerfoot BP, Armstrong EG, O’Sullivan PN. Impact of item clustering on interactive spaced education. Medical Education 2008; 42: 1115–1116.

Kerfoot BP. Interactive spaced education versus web-based modules for teaching urology to medical students: a randomized controlled trial. J Urol 2008; 179, 2351-2357.

Kerfoot BP, Baker HE, Koch MO, Connelly D, Joseph DB, Ritchey ML. Randomized controlled trial of spaced education to US and Canadian urology residents. J Urol 2007; 177, 1481-1487.

Kerfoot BP, DeWolf WC, Masser BA, Church PA, Federman DD. Spaced education improves the retention of clinical knowledge by medical students: randomized controlled trial. Med Educ, 2007: 41:23-31.