Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial.

Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. METHOD: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. RESULTS: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. CONCLUSION: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

Chromatic properties of the colour-shading effect.

The 'colour-shading effect' describes the phenomenon whereby chromatic variations affect the magnitude of perceived shape-from-shading in luminance patterns. A previous study showed that in mixed colour-plus-luminance sine-wave plaids, impressions of depth in the luminance component were enhanced by non-aligned chromatic components, and suppressed by aligned chromatic components [Nature Neuroscience 6 (2003) 641-644]. Here we examine the chromatic determinants of these effects. Colour contrast was defined along the cardinal axes of colour space in order to isolate the L-M and S-(L+M) post-receptoral chromatic mechanisms. We found no difference in the potency of L-M-only and S-(L+M)-only gratings, either for enhancing or suppressing perceived depth. Moreover, the magnitude of depth-suppression was no different for any combination of depth-enhancing and depth-suppressing cardinal directions. Finally we tested whether the visual system carried the assumption that natural shading is tinged with blue, by measuring perceived depth in a colour-plus-luminance grating that was made to appear either bright-yellow/dark-blue or bright-blue/dark-yellow. However there was no difference in the magnitude of depth-suppression between conditions, suggesting that the visual system does not make any assumption about the colour of natural shading. Taken together, the results suggest that while the colour-shading effect is highly sensitive to colour contrast, it is agnostic with respect to colour direction.