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Proven by science. Based on data. Validated by research.
Knowledge retention and behavior change that impacts outcomes
Qstream uses an interval reinforcement methodology that is scientifically proven to increase knowledge retention by up to 170% and durably change behaviors with measurable impact on outcomes. Co-founder Dr. B. Price Kerfoot is recognized as a spaced education pioneer and has run over 20 rigorous, peer-reviewed clinical trials on Qstream’s technology, proving it works over and over again. Here’s how…
The Forgetting Curve
The assumption that if you learn something new it is retained and can be recalled is simply false. Forgetting is a natural, physiological occurrence and must be factored into the sales training process. This phenomenon was documented as early as 1885 when German psychologist 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.
Read Dr B. Price Kerfoot’s Blog – Can Qstream Be Used to Teach New Material?
Interval reinforcement is a proven way to combat the forgetting curve. The spacing effect explains how 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. Reinforcement through the application of knowledge 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.
More than 20 peer-reviewed clinical trials have been conducted to test the effectiveness of the Qstream methodology. The solution’s underlying approach was initially developed and then rigorously studied by Harvard Medical School Associate Professor, Dr. B. Price Kerfoot, as a “spaced education” method designed to improve the long-term knowledge retention of medical trainees.
These rigorous clinical trials show that Qstream’s approach significantly improves knowledge retention, on-the-job performance, and user engagement.
The interval reinforcement methodology is content-neutral and can be utilized to build knowledge of almost anything. The full multimedia capabilities of the Internet can be harnessed to create rich and effective user experiences.
Read Dr B. Price Kerfoot’s Blog – How Long Do the Benefits of Qstream Last?
Medical Education in Review. 2019 May;29 53(9), 886–902.
Spaced education via an online platform offers a scalable CPD format that can increase clinical knowledge and change practice. This study was performed to determine the effectiveness of the spaced education CPD programs to change targeted clinical knowledge and practice(s) to improve patient outcomes.
Gyorki DE, Shaw T, Nicholson, J, Baker, C, Pitcher M, Skandarajah A, Segelov E, Mann GB.
Educational programs are frequently developed to improve the knowledge of medical trainees. The impact of a program may be limited if there is no follow-up to reinforce the message. Online Spaced Education (SE) has been developed to address this limitation. This study was performed to assess whether an SE program would improve the impact of a didactic seminar.
Using spaced education to improve interns’ teaching skills is a potentially powerful intervention that improves interns’ enthusiasm for teaching and teaching effectiveness. The changes are mirrored in students’ ratings of interns’ teaching skills and interns’ attitudes toward teaching.
This pilot study in Ethiopia demonstrates that the spaced education methodology is acceptable and effective for the acquisition of knowledge in a low-resource context for course participants with a clinical or public health background and moderately reliable Internet access.
Shaw TJ, Pernar LI, Peyre SE, Helfrick JF, Vogelgesang KR, Graydon-Baker E, Chretien Y, Brown EJ, Nicholson JC, Heit JJ, Co JP, Gandhi T.
This randomized trial at two Harvard teaching hospitals showed that the spaced education methodology improved both the self-reported confidence and patient-safety behaviors of resident physicians in a simulated scenario, compared to control residents receiving traditional online training (online slide show followed by a quiz).
Involving 1470 physicians in 63 countries, this randomized trial demonstrated that the spaced education methodology with game mechanics can substantially improve guidelines knowledge and is a well-accepted method of global CME delivery.
This trial involved 731 students at 3 US medical schools and showed that the spaced education methodology combined with game mechanics is an effective and well-accepted means of teaching core content and is a reliable and valid method to assess student knowledge.
Involving 931 urology residents from the US and Canada, this trial demonstrated that the spaced education methodology combined with game mechanics is a reliable and valid means to assess residents’ knowledge and is a well-accepted method by which residents can master core content.
This randomized trial among 246 clinicians provides evidence that spaced education following a live CME course can significantly increase the impact of a face-to-face course on providers’ self-reported global clinical behaviors. This study won the 2012 Award for Excellence in Research, from the Journal of Continuing Education in Health Professions, recognizing “the best research article published in JCEHP” in 2012.
This 34-week randomized trial involving 1067 students at 4 US medical schools demonstrated that the spaced education methodology can identify poorly performing students and improve their longer-term knowledge retention by 170%.
Kerfoot BP, Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR.
This 108-week randomized trial involving 95 clinicians in 8 northeastern hospitals showed that the spaced education methodology durably improves the prostate cancer screening behaviors of clinicians by 40%. This is the first study demonstrating that spaced education can durably impact the behaviors of participants.
Kerfoot BP, Fu Y, Baker H, Connelly D, Ritchey ML, Genega EM.
In this 45-week randomized trial involving 724 urology residents across the United States demonstrated that the spaced education methodology generates transfer of histopathology diagnostic skills and substantially improves their long-term retention.
This randomized trial among 480 clinicians demonstrated for the first time that the spaced education methodology is an effective and well-accepted form of graduate- and continuing-medical education and is a promising new methodology to improve knowledge of clinical practice guidelines.
This study analyzed whether the learning gains among the residents in our 2007 spaced education trial persisted after two years. They did! These results are particularly striking since these residents’ on-the-job training over these 2 years would have worked to erode any knowledge differences between the cohorts that were attributable to the spaced education methodology. Given this, the ability to demonstrate a knowledge difference between cohorts 2 years after the spaced education intervention is remarkable.
This randomized trial employed the spaced education methodology to improve the feedback that surgical residents give to medical students. The medical students were blinded to which residents received the spaced education. Even so, the students (the blinded, down-stream receivers of the feedback) reported that the feedback given by residents who received the spaced education was significantly more frequent and of higher quality.
This 18-week randomized trial among medical students at Harvard demonstrated that the spaced education methodology can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.
This pilot randomized trial among 97 medical students at Harvard showed that moderate clustering of content within the spaced education methodology does not have a large effect on learning and retention. A substantially larger trial (128–788 students for 0.8 power) is needed to investigate if clustering has a small-to-moderate impact on learning and retention.
This randomized trial demonstrated that, within the compact time frame of a clinical clerkship, spaced education is equivalent to web based teaching in short-term learning gains and in acceptability by medical students. In addition, the study found that ISE is able to generate substantial improvements in knowledge from one cycle to the next.
This randomized trial among 537 residents across the United States and Canada demonstrated for the first time that the spaced education methodology improves the acquisition and retention of clinical knowledge.
Kerfoot BP, DeWolf WC, Masser BA, Church PA, Federman DD.
This is the first randomized of the spaced education methodology. The study demonstrates that spaced education consisting of clinical scenarios with questions and explanations distributed weekly can significantly improve students’ retention of medical knowledge.
“Learning retention, asynchronous coaching, a scalable learning model. The benefits of training and coaching a dispersed workforce are huge!”
G2 — Ed Flahive, Senior Digital Learning Specialist at MilliporeSigma
“The support from Qstream staff is invaluable. The gamification aspect is extremely engaging and the in-depth analytics is unmatched.”
G2 — Anonymous G2 Reviewer
“I have seen a very positive impact in retention and users are happy to use this platform to consolidate learnings.”
G2 — Jorge Fragoso, Global Medical Learning and Capabilities Development Lead at Sanofi
“Training our group on thousands of products that we sell is hard. Retaining the information is even harder. Short bursts of learning make it easy for learners to absorb the information.”
G2 — Chris Dissler, eLearning Developer at Infinite Electronics
“Very impactful and transformational approach to microlearning. We are addressing our needs of identifying knowledge gaps in our field force and being able to use the data coming from Qstream to focus the actions needed to close those gaps.”