Novelist E.M. Forster once said, “Unless we remember, we cannot understand.” With patients’ lives and well-being often at stake, it’s imperative that health-care professionals understand the material from their training, whether it be on compliance topics such as adhering to HIPAA law or more performance-related topics such as taking steps to reduce hospital readmissions. Furthermore, helping employees remember the important information they learn in training helps them do their job better, creating a win-win situation for the employee and their client. The estimated percentages of how much information learners forget after the initial learning period varies, with most estimates falling between 75 and 98 percent. Fortunately, there are strategies for significantly improving memory retention after training.
The Forgetting Curve
Retention is defined as “the fact of keeping something in one’s memory.” German psychologist Hermann Ebbinghaus first scientifically studied memory and in 1885 published a book about it called “Memory: A Contribution to Experimental Psychology.” To this day, memory researchers still used Ebbinghaus’ approach to testing memory—presentation of things to memorize, waiting for a designated amount of time, then seeing how much one remembers about the things. Ebbinghaus originated the concept of the “forgetting curve.” The forgetting curve slopes downward over time from the moment one learns the material and has 100 percent retention, to 40 percent retention after just a couple of days. While the percentage of retention continues decreasing, it happens at a slower rate as time elapses. Of course, the exact slope of the forgetting curve for a specific situation depends on a variety of factors, such as the difficulty of the material presented, the method of presentation, and the state of the learner when receiving the material (e.g., stressed vs. relaxed).
Retrieval and Spaced Repetition
Retrieval is defined as getting and bringing something back. Studies consistently show that retrieving knowledge after obtaining it improves learning and retention. Information retrieval presented at intervals over time, or “spaced repetition,” should be delayed after the initial learning, making the information less accessible in one’s memory than if the review were immediately after learning. While there is a debate about the optimal repetition schedule for retrieving knowledge that achieves maximum retention, researchers agree that effective repetition schedules typically include information retrieval spaced out in the days, weeks, and months following initial learning.
General Strategies to Improve Memory Retention After Training
- Reintroduce material. After a care provider takes a course, it’s helpful if he or she receives some form of instruction about that content again. This could be offered in one of many ways such as a mini-module, questions related to the content, or an in-person demonstration related to the content. Reintroducing the material helps preventing the learner from finishing the initial course and never thinking about the material again. Ideally, the material is reintroduced in a different form than it was first introduced. For example, if the content was explained methodically in a step-like fashion, reintroduction could consist of a case study where the knowledge is applied in a realistic scenario.
- Activate the information. When recalling information, it’s important to engage the brain in an active way. For example, instead of just rereading the material, answer a question about the material. This targets the neural connections, a key component to retaining the material in the long term. Retrieving information from a learner’s memory to answer a question usually involves more work than reviewing course material and often forces the learner to use his or her knowledge in a new context.
- Use spaced repetition. Incorporating increasing intervals of time between material review is called spaced repetition. This strategy takes advantage of the spacing effect and engages the learner when he or she can most use the review—around the time just prior to being most likely to forget the material. In published articles and online lectures, Dr. Robert Bjork from the UCLA Bjork Learning and Forgetting Lab has emphasized that learners who engage in spaced repetition will outperform those who learned in a traditional one-time format.
Learner Experiences with Memory Retention Questions
In a study we recently conducted at the Relias Institute, we asked health-care professionals from four organizations about their experiences with Relias’ retention tool, BrainSparks. BrainSparks are multiple choice questions delivered to learners after they complete a training to re-engage the their memory on key topics to improve retention of the material. We discovered that:
- 80 percent of learners enjoy receiving and answering retention questions.
- 90 percent of learners believe they have a high additional level of knowledge from receiving and answering retention questions.
- 70 percent of learners desire retention questions in the future.
Keep Retention in Mind
It is important to consider retention when planning training for employees. By employing some of the strategies named here—reintroducing the material, activating the information, using spaced repetition—learners may remember more of the knowledge gained during training. Additionally, our study on retention questions indicates learners may be eager for memory retention tools. With the vast amount of information continually imparted to health-care professionals, highlighting and targeting the key topics using retention strategies is one way to help ensure these learners remember the necessary information when a situation calls for that knowledge.
M. Courtney Hughes, Ph.D., MS, is the senior researcher of Healthcare at Relias Institute and author of “2017 State of Staff Development and Training: A National Perspective on Healthcare Performance Improvement.”