Assessing the effectiveness of spaced repetition learning in radiology medical education

To evaluate the educational impact of an image-rich, case-based neuroradiology spaced repetition (Anki) flashcard deck on neuroradiology knowledge and image interpretation confidence among third-year medical students during their Neurology clerkship.

In this pilot, prospective observational cohort study, third-year medical students across four consecutive four-week Neurology clerkship cohorts completed pre- and post-clerkship surveys and a 10-question neuroradiology assessment. A 59-card Anki deck (89.8% image-based) aligned with clerkship and USMLE Step 2 objectives was provided to all students in each cohort. Anki deck use was voluntary, and students were categorized as "users" or "non-users".Outcomes included changes in test scores, perceived confidence, and specialty interest. Anki usage was quantified by total review count. Paired t-tests and Spearman rank correlations were performed to evaluate associations between Anki usage and outcomes.

Twelve students completed paired surveys (7 users, 5 non-users). Overall perceived confidence increased significantly across all participants (p < 0.0001), with greater gains among Anki users compared with non-users (3.29 ± 1.38 vs 1.40 ± 0.55; p = 0.011). Neuroradiology test scores improved overall for the combined cohort (p = 0.026), without significant between-group differences. Anki usage was strongly associated with improvement in confidence (Spearman ρ = 0.79, p = 0.002), but not with test score change. Users rated the deck favorably (mean 6.43/10), and the majority of users recommended the deck to other students.

In this pilot study, an image-rich neuroradiology Anki deck implemented during the Neurology clerkship was associated with greater improvements in perceived, self-reported image interpretation confidence, though not with objective knowledge test performance, and was well received by students. Given the small sample size and voluntary, non-randomized design, these preliminary findings warrant confirmation in larger studies before definitiveconclusions about educational value are drawn.