This document discusses the challenges medical students and physicians face in mastering and retaining medical knowledge. It notes that medical knowledge is often forgotten, even by experienced specialists and after training. It introduces Gunner Training as the first knowledge management platform created to help medical students master and maintain their knowledge for Step 1 through personalized spaced learning and review schedules. Studies show Gunner Training improves knowledge retention, with users gaining an average of 19.3% in recalled knowledge after 4 reviews and not forgetting information over 100 days. Member testimonials praise its effectiveness and efficiency.

1. Memory Science inMedical Education Frank Lau, MD Co-Founder & Chief Medical Officer GunnerTraining.com

2. “I feel like every timeI review something or learn something new, I forget something else.” – C.C., 2nd year medical student, University of Michigan Medical School The Challenge for Medical Students

3. The Challenge Persists for Residents Resuscitation, July 2009 70 Johns Hopkins pediatrics residents 66% failed to start timely CPR (basic life support) 95% of the residents had received this level of training 83% made errors during defibrillation (shocking the patient) 80% of the residents had been trained in defibrillation More years of training did not improve physician performance Medical knowledge is routinely forgotten, even by the best and the brightest.

4. The Challenge Persists for Attending Physicians Journal of Trauma, June 1996 60 practicing trauma physicians took the standard Advanced Trauma Life Support course, followed by an examination National course for managing traumas (car accidents, gunshots, stab wounds, etc) Immediate testing: 86% average score 6 months later, 50% failed 13 years after this study, no novel approaches to learning and retaining medical knowledge Basic, critical knowledge is routinely forgotten, even by experienced specialists.

5. Who Should Care? Medical Students Physicians-in-training (residents) Educators Foreign medical graduates Practicing physicians Patients Healthcare policy makers Patient safety advocates

6. The 2 Phases of Knowledge Acquisition Mastering the material Maintaining that knowledge

7. Mastering the Material We think we’re good at this We did well on the MCAT, we pass our exams But these are graded on a curve! Patient outcomes don’t work on a curve In reality, we do poorly at judging how well we’ve mastered specific topics

8. Mastery: The Problem

9. Mastery: The Problem All User Avg: 3.4

10. Maintaining Your Knowledge We rarely focus on knowledge maintenance Johns Hopkins study, the ATLS study Affects patient outcomes For Step 1, the review process involves re-learning a lot of material that you once knew but have since forgotten

11. Intro to Gunner Training The first Knowledge Management platform Created to help students master and maintain their Step 1 knowledge base Personalized: users choose which subjects to study  can correlate with school's curriculum Dynamic: custom review schedule changes according to student's forward learning Mobile: iPhone/mobile browser compatible No software installation required

12. Intro to Gunner Training Launched April 2009: Avg. member uses GT for 4.5 hours per week! Thousands of members Millions of data points We use this data and user feedback to continually validate and improve Gunner Training

14. Short intervals help you master that material

17. Short intervals help you master that material

19. Increases test-taking staminaApply 19 principles of efficient, effective learning

20. Contiguity, Dual code/Multimedia, & Coherence Effects

21. Segmentation & Manageable Cognitive Load

22. Cognitive Flexibility

23. Anchored Learning

24. Imperfect Metacognition, Generation Effect & Testing Effect

25. Feedback Effects & Negative Suggestion Effects

26. Goldilocks, Self-regulated Learning, and Exam Expectations

27. GT: MCQ Principles Desirable difficulties. Challenges make learning and retrieval effortful  improve retention Multi-part questions, on par with Step 1 question difficulty Cognitive Disequilibrium. Deep reasoning and learning is stimulated by problems that create cognitive disequilibrium, such as obstacles to goals, contradictions, conflict, and anomalies “2-jump” & “3-jump” questions

28. MCQs in Review Schedule

29. MCQs in Review Schedule

30. Spaced Learning in Gunner Training Personalized Review Schedule Generation

31. Spaced Learning In 1913, Ebbinghaus discovered that the best time to review something was just before it was forgotten Minimizes the amount of time spent learning Minimizes the number of times the same material must be relearned

32. Spaced Learning: Example Let’s say it takes 2 minutes to memorize the 15 bones of the wrist Reviewing this material if it’s not forgotten takes 30 seconds Re-learning this material if it’s forgotten takes another 2 minutes Without review, this information is forgotten in 4 days There is a test at the end of Day 6

33. Spaced Learning: Example Option 1: Review it every day Day 0: 2 minutes learning Day 1: 30 second review Day 2: 30 second review Day 3: 30 second review Day 4: 30 second review Day 5: 30 second review Day 6: 30 second review  Take the test Total time: 5 minutes Pros: In this approach, the knowledge is never forgotten Cons: Large burden of review  few people will adhere to this review schedule

34. Spaced Learning: Example Option 2: Cram for the exam Day 0: 2 minutes learning Day 1: no time spent Day 2: no time spent Day 3: no time spent Day 4: no time spent (knowledge forgotten) Day 5: no time spent Day 6: 2 minutes re-learning Take the test Total time: 4 minutes Pros: It’s “easy” – learn it once and re-learn it just before the test Cons: The knowledge is forgotten Cramming produces high stress Doesn’t work in clinical settings (no predetermined “test” date) Less effective as the volume of information goes up

35. Spaced Learning: Example Option 3: Spaced Learning Day 0: 2 minutes learning Day 1: no time spent Day 2: no time spent Day 3: no time spent Day 4: 30 second review Day 5: no time spent Day 6: Take the test Total time: 2 minutes, 30 seconds Compared to daily review (5 mins): 50% less time spent Compared to cramming (4 mins): 38.5% less time spent Pros: In this approach, information is never forgotten and time spent studying is minimized

36. Spaced Learning Works in Medicine 3 randomized, controlled trials at Harvard Medical School demonstrate that Spaced Learning improves retention of medical knowledge RCTs are the gold standard experimental methodology Published in: American Journal of Surgery, January 2009 Journal of General Internal Medicine, January 2008 Medical Education, January 2007

37. Basic Research on Spaced Learning The molecular mechanism behind Spaced Learning is an active area of research Cell, October 2009. Cold Spring Harbor & Mount Sinai School of Medicine The Phosphatase SHP2 Regulates the Spacing Effect for Long-Term Memory Induction Journal of Neuroscience, August 2009. McGill University PKC Differentially Translocates during Spaced and Massed Training in Alypsia Neuron, December 2006. Baylor College of Medicine Drosophila Mushroom Body Neurons Form a Branch-Specific, Long-Term Cellular Memory Trace after Spaced Olfactory Conditioning There is rock-solid science behind Spaced Learning.

38. Gunner Training Works!

39. Gunner Training’s Effectiveness: 2009 * * All data where user completed 4 reviews within the maximum time (115 days) ** Heteroscedastic, one-tailed t-test. Same results with paired, 2-tailed t-test.

40. Gunner Training’s Effectiveness: 2010 49%(p<0.000001)* * Heteroscedastic, one-tailed t-test. Same results with paired, 2-tailed t-test.

41. Gunner Training’s Effectiveness Avg time to 4th review: 26.4 days Max time to 4th review: 115 days Two major successes: 1) Knowledge isn’t lost during >100 days since initial review 2) 49% gain in retained knowledge

42. Gain in Mastery over Time

43. Member Step 1 Score (267!)

44. Summary GT is the first Knowledge Management specifically platform for medical students The application of 19 Learning Principles yields a highly efficient and effective program Users who follow our algorithms gain an average of 19.3% in ability to recall knowledge after 4 reviews Users don’t forget what they have already learned

45. Priced for Students

47. Member Testimonials “I'll definitely let the 2nd years in my school know about your program. I've already recommended the program to the Dean of Student Affairs at my school.” – J.W., 2nd year medical student “I absolutely loved this site. I didn't get far into the program because of time constraints, but I really wish I knew about it before starting 2nd year. It would've been amazing to use it while studying for the course. I used to study with RecallPlus and Anki during the course but found it so time consuming to make the cards, so you can say Gunner Training is just perfect.” – H.A., 2nd year medical student

48. Member Testimonials (cont’d) “Just wanted to say thanks to you guys for this excellent website you've set up. I've been using it for a few weeks now and I have gone out of my way to recommend it to a ton of people in my medical school class... this is a great way to do a first pass on USMLE specific [topics] in a way other question banks do not [provide]... the concept is fantastic. I’ve definitely seen an improvement in my grades with concurrent classes as well. – Robert, 2nd year medical student “This is just what the doctor ordered. I have been wasting a lot of time not knowing how to study and retain this information. Your web-site is amazing.” – Sybil, 1st year medical student

49. http://www.gunnertraining.com Use code “DMS10” for 25% off. Good from 11/5 through 11/11.