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Abstract Although accurate interpretation of the standard 12‐lead electrocardiogram (ECG) is fundamental to diagnosing heart disease, several prior studies report low accuracy rates among medical students, residents, and practicing physicians. The objective of this study was to determine if an online ECG Perceptual and Adaptive Learning Module (ECG PALM) is an efficient instrument to teach ECG interpretation. The ECG PALM consists of 415 unique ECG tracings with associated pretest, posttest, and delayed tests, each using 30 additional ECGs to gauge the effectiveness and durability of training. Between 2013 and 2015, a total of 113 third‐year and 156 fourth‐year medical students and 34 first‐year, 41 second‐year, and 37 third‐year emergency medicine residents completed the PALM and associated tests. We measured two mastery criteria: accuracy, the percentage of correct interpretations, and fluency, the percentage of images interpreted accurately within 15 seconds. The ECG PALM produced statistically significant improvements (0.0001 < p < 0.0045) in student and resident performance for both accuracy (effect size = 0.9 to 3.2) and fluency (effect size = 2.5 to 3.1) following training ranging from 46 ± 24 minutes (R3s) to 88 ± 32 minutes (third‐year medical students). Medical students and residents performed significantly better on a test the year following training (delayed test) than those without prior ECG PALM training (pretest). The fluency of R3 residents in classifying the 15 diagnostic categories was less than 60% for nine of the 15 diagnoses and greater than 80% for only one. Following PALM training, fluency was higher than 80% for seven of the 15 categories and less than 60% for only two categories. Accuracy in recognizing ST‐elevation myocardial infarctions (STEMIs) was high both before and after PALM training for R3s, but fluency was only 64% for anterior STEMIs on the pretest, increasing to 93% following PALM training. These observations suggest that the ECG PALM is an effective and durable supplemental tool for developing mastery in interpreting common ECG abnormalities. 

Spacing presentations of learning items across time improves memory relative to massed schedules of practice – the well-known spacing effect. Spaced practice can be further enhanced by adaptively scheduling the presentation of learning items to deliver customized spacing intervals for individual items and learners. ARTS - Adaptive Response-time-based Sequencing (Mettler, Massey, & Kellman 2016) determines spacing dynamically in relation to each learner’s ongoing speed and accuracy in interactive learning trials. We demonstrate the effectiveness of ARTS when applied to chemistry nomenclature in community college chemistry courses by comparing adaptive schedules to fixed schedules consisting of continuously expanding spacing intervals. Adaptive spacing enhanced the efficiency and durability of learning, with learning gains persisting after a two-week delay and generalizing to a standardized assessment of chemistry knowledge after 2-3 months. Two additional experiments confirmed and extended these results in both laboratory and community college settings. 

Adaptive generation of spacing intervals in learning using response times improves learning relative to both adaptive systems that do not use response times and fixed spacing schemes (Mettler, Massey & Kellman, 2016). Studies have often used limited presentations (e.g., 4) of each learning item. Does adaptive practice benefit learning if items are presented until attainment of objective mastery criteria? Does it matter if mastered items drop out of the active learning set? We compared adaptive and non-adaptive spacing under conditions of mastery and dropout. Experiment 1 compared random presentation order with no dropout to adaptive spacing and mastery using the ARTS (Adaptive Response-time-based Sequencing) system. Adaptive spacing produced better retention than random presentation. Experiment 2 showed clear learning advantages for adaptive spacing compared to random schedules that also included dropout. Adaptive spacing performs better than random schedules of practice, including when learning proceeds to mastery and items drop out when mastered. 

Adaptive learning systems that generate spacing intervals based on learner performance enhance learning efficiency and retention (Mettler, Massey & Kellman, 2016). Recent research in factual learning suggests that initial blocks of passive trials, where learners observe correct answers without overtly responding, produce greater learning than passive or active trials alone (Mettler, Massey, Burke, Garrigan & Kellman, 2018). Here we tested whether this passive + active advantage generalizes beyond factual learning to perceptual learning. Participants studied and classified images of butterfly genera using either: 1) Passive Only presentations, 2) Passive Initial Blocks followed by active, adaptive scheduling, 3) Passive Initial Category Exemplar followed by active, adaptive scheduling, or 4) Active Only learning. We found an advantage for combinations of active and passive presentations over Passive Only or Active Only presentations. Passive trials presented in initial blocks showed the best performance, paralleling earlier findings in factual learning. Combining active and passive learning produces greater learning gains than either alone, and these effects occur for diverse forms of learning, including perceptual learning. 

Research has shown that estimation of correlation from scatter plots is done poorly by both novices and experts. We tested whether proficiency in correlation estimation could be improved by perceptual learning interventions, in the form of perceptual-adaptive learning modules (PALMs). We also tested learning effects of alternative category structures in perceptual learning. We organized the same set of 252 scatter plot displays either into a PALM that implemented spacing in learning by shape categories or one in which the categories were ranges of correlation strength. Both PALMs produced markedly reduced errors, and both led trained participants to classify near transfer items as accurately as trained items. Differences in category organization produced modest effects on learning; there was some indication of more consistent reduction of absolute error when learning categories were organized by shape, whereas average bias of judgments was best reduced by categories organized by different numerical ranges of correlation.