Fig. 1. Dr Price Kerfoot, Rabkin Fellow in Medical Education  Associate Professor of Surgery, Harvard Medical School

I might have interviewed Dr Price Kerfoot of Spaced-Ed for the Open University module H807, ‘Innovations in E-learning’ a year ago.

• I finally caught up with him this afternoon two weeks into the Spaced-Ed transmogrification that is Qstream.
• We used Skype.
• Clear barely broken sound. Sharp video in colour.
• It worked.

It was a fascinating discussion.

• I should have asked to record and done so.
• Next time. I’m sure the conversation has only just begun.
• Though armed with a set of questions used in TMA02 of H807 non were necessary. I’d prepared them to follow a narrative flow, and that is what we did.

He is a passionate educator and e-learning entrepreneur.

I suspect we will continue to hear a great deal about him – he has a passion for education, reminding me of the late Randy Pausch, even the Robin Williams character from Dead Poets Society; there is an unstoppable, engaging warmth backed by a profound intellect.

The narrative

Price had finished his surgical training when he went into education, an odd elective he admits, but one that through circumstances and surely an innate interest has proved fruitful.

What is the problem?

Learning outcomes from first year medical students were poor.

Why, in US terms, spend $1000 dollars on a course only to find a year later that the traditional methods of acquisition and retention of knowledge has failed.

No problem, no fix.

Price looked to web-based teaching to create learning modules. Two concepts were devised, the spacing of questions proved successful. This is from one of a dozen papers authored by Kerfoot and his team; each one, naturally, a worthy, academic, professional appraisal.

Two reports are cited as we talk, one on the effect on the hippocampus of rats, another on phosphate levels in fruit flies. These papers  are readily available. What I admire and respect is that everything he does is investigated thoroughly – no sensationalism, just the facts.

There is physiological evidence that ‘spaced learning works’.

This matters:

1. you want something that works,
2. you want something that will justify the investment.

We give it away, academics in the US are commercially savvy.

• Its as if in the UK academics (individuals and institutions) are like bachelors and spinsters, whereas in North America they are eager to marry.
• The research has shown that the Spaced-ed approach improves patient outcomes the goal it was found that cancer screening of patients improved by 40% for the year spaced-education was introduced.
• In 2006 the methodology was submitted by Harvard for a patent application. Entrepreneurs and venture capital companies were also approached.

It’s a shame the Spaced-Ed blog hasn’t been maintained, though you’ll get some further insights here.

What began as continual education in medicine has expanded.

If you go to the Spaced-Ed website there are all kinds of courses you can take, typically 20-30 questions of the multiple choice type fed to your laptop, smartphone or iPad. Writing these multiple choice questions is an effort and requires skill to get right.  I can admit to wanting to create what I thought would be a simple set of questions relating to teaching swimming but the correct construction of the questions, let alone the creation of appropriate images has held me back.

It isn’t as easy to get this right as it looks.

You don’t want to feed your audience lame questions, nor do you want to overstretch them.

There is also some negative feelings about multiple-choice, perhaps we have all had negative experiences at school. I personally remember what we described as ‘multiple-guess’ that was so often used in Chemistry classes. Though clearly effective, not enough people have been persuaded to pay for these sets of questions, even a dollar or so.

The challenge, has been to move on from asynchronous to synchronous, real time learning, including video and other rich media.

The new platform promoted as Qform is an Facebook App and Twitter-like in its approach.

People elect to follow a Qstream which goes out to everyone. You join in collectively, rather than alone, which creates a sense of participation and competition. If I understand this correctly, as I’m yet to give it a go, you pose a response to an open question that others read. You then vote on the various responses given.

As Price  enthused about the platform I thought about Skype and Elluminate, even forum threads. I wonder if we could all organise to be online and go to one of these threaded conversations to turn an asynchronous environment into a synchronous one. Harvard is also the home of Rotisserie, which rotates a threaded conversation between online learners to ensure that everyone has a turn… and of course Facebook.

Gamification is the key. You respond in a way that other s like and you get points for it and your name appears on a leader board.

Rich content and a range of responses is what’s new. And its live And its competitive

And so Qstream delivers synchronicity and a sense of community Price also talked about how to make it possible for answers to questions to become searchable in Google – I guess with the inclusion of the right metadata. I didn’t need to say it to find I’m told the more controversial responses would generate the most responses. Now it’s starting to sound like the format of the Oxford Union Debating Society – I guess Price went along there at some stage too.

By listening to two sides battle it out you form your own opinion.

One final statistic – 85% of those studying urology in North America (that’s the US and Canada) are using Dr B Price Kerfoot’s 23 question Spaced-ed multiple choice Q&A.

The competitors are

• Quora
• Stackoverflow
• FormSpring 

Fellowship Project: 

Optimizing education in urologic disease: The development of a validated assessment tool and web-based teaching application to improve educational outcomes in urologic teaching to medical students

Dr. Price Kerfoot received an AB in molecular biology from Princeton University in 1989, a BA/MA in Human Sciences from Oxford University (Balliol College) in 1991, an MD from Harvard Medical School in 1996, and an EdM at the Harvard Graduate School of Education in 2000. Dr. Kerfoot completed a two-year term on the Residency Review Committee (RRC) for Urology, is a Fellow of the Academy at HMS, and through a two-year grant from the American Foundation for Urologic Disease, recently completed a multi-institutional randomized controlled trial of web-based teaching to medical students.

Dr. Kerfoot recently received a 3-year VA Research Career Development Award during which he will perform a randomized trial to investigate whether care patterns of VA practitioners can be optimized using web-based educational interventions.

Top Five Medical Apps at Harvard Medical School

REFERENCE

Kerfoot, B, & Brotschi, E 2009, ‘Online spaced education to teach urology to medical students: a multi-institutional randomized trial’,American Journal Of Surgery, 197, 1, pp. 89-95, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Matzie, K, Kerfoot, B, Hafler, J, & Breen, E 2009, ‘Spaced education improves the feedback that surgical residents give to medical students: a randomized trial’, American Journal Of Surgery, 197, 2, pp. 252-257, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Kerfoot, P, & Sheppard, M 2009, ‘AUA Spaced Education Program Aism to Improve Global Urology’, Auanews, 14, 1, p. 18, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Kerfoot, B 2009, ‘Learning benefits of on-line spaced education persist for 2 years’, The Journal Of Urology, 181, 6, pp. 2671-2673, MEDLINE, EBSCOhost, viewed 1 February 2013.

Kerfoot, B, Kearney, M, Connelly, D, & Ritchey, M 2009, ‘Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial’, Annals Of Surgery, 249, 5, pp. 744-749, MEDLINE, EBSCOhost, viewed 1 February 2013.

Kerfoot, B 2010, ‘Improving Education for the 21st Century’, Auanews, 15, 6, p. 22, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Long, A, Kerfoot, B, Chopra, S, & Shaw, T 2010, ‘Online spaced education to supplement live courses’, Medical Education, 44, 5, pp. 519-520, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Kerfoot, B, Fu, Y, Baker, H, Connelly, D, Ritchey, M, & Genega, E 2010, ‘Online Spaced Education Generates Transfer and Improves Long-Term Retention of Diagnostic Skills: A Randomized Controlled Trial’, Journal Of The American College Of Surgeons, 211, 3, pp. 331-337.e1, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Kerfoot, B, Lawler, E, Sokolovskaya, G, Gagnon, D, & Conlin, P 2010, ‘Durable Improvements in Prostate Cancer Screening from Online Spaced Education: A Randomized Controlled Trial’, American Journal Of Preventive Medicine, 39, 5, pp. 472-478, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

Kerfoot, B, & Baker, H 2012, ‘An online spaced-education game for global continuing medical education: a randomized trial’, Annals Of Surgery, 256, 1, pp. 33-38, MEDLINE, EBSCOhost, viewed 1 February 2013.

Shaw, T, Long, A, Chopra, S, & Kerfoot, B 2011, ‘Impact on clinical behavior of face-to-face continuing medical education blended with online spaced education: A randomized controlled trial’, Journal Of Continuing Education In The Health Professions, 31, 2, pp. 103-108, Academic Search Complete, EBSCOhost, viewed 1 February 2013.

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