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25.07.2017 | Original Article | Ausgabe 4/2017 Open Access

Perspectives on Medical Education 4/2017

Evaluating the effect of instruction and practice schedule on the acquisition of ECG interpretation skills

Perspectives on Medical Education > Ausgabe 4/2017
Sandra Monteiro, Lindsay Melvin, Joshua Manolakos, Ameen Patel, Geoffrey Norman
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Electronic supplementary material

The online version of this article (doi: 10.​1007/​s40037-017-0365-x) contains supplementary material, which is available to authorized users.
Prior presentations: Oral presentation at the International Conference on Residency Education September 2013 and Canadian Conference on Medical Education 2016. Authors Contribution: The authors alone are responsible for the content and writing of this article. All authors contributed to the conception and development of the study.



Evidence of the benefit of distributed instruction and interleaved practice comes from studies using simple materials (e. g. word pairs). Furthermore, there is currently no evidence of the combined impact of these strategies in undergraduate medical education. The present study evaluated the impact of varying both instruction and practice schedules for the acquisition of ECG interpretation skills.


We conducted a 2 × 2 factorial study with two levels of instruction (massed and distributed) and two levels of practice (interleaved and blocked). A three-module introductory course in ECG interpretation was delivered to 80 first year medical undergraduate students. Students were assigned to one of four Instruction-Practice conditions: Massed-Interleaved, Massed-Blocked, Distributed-Interleaved and Distributed-Blocked. Learning was evaluated by a multiple choice quiz at the end of each module and a final multiple choice quiz at the end of the course.


End of module mean scores showed that distributed instruction was consistently superior to massed instruction (52% vs 42%, p < 0.01). However, there was no effect of practice and no interaction between teaching and practice methods. The delayed final test scores revealed an advantage for blocked over mixed practice (34% vs 24%, p < 0.05) and distributed over massed instruction (34% vs 24%, p < 0.05).


These results suggest that these popular strategies may have varying effects with complex learning materials. Further research is required to understand how these strategies affect the learning of simple and very complex skills.
Flow diagram of the study design
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