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Chiropractic Journal of Australia : CJA December 2013
Chiropractic Journal of Australia Volume 43 Number 4 December 2013 139 The mean final questionnaire (2012) scores for the combined cohort was 35.2 ± 14.0%. The HLTH 308 students had a mean score of 37.2 ± 15.2% compared to the HLTH 214 students which was at 33.4 ± 11.8%. The difference in the mean scores was not signifcant (p=0.1282) (Table 1) There was an overall significant drop in knowledge from the original exam (2011) to the questionnaire (2012) (p<0.0001). This represents a percentage drop of 35.8%, which shows a retention rate of approximately 65%. This retention rate was higher than the mean 47.5% given in the literature. Broken down into the two groups, the knowledge loss shown by the HLTH214 students was 43.6%, but it was only 26.6% for the students who had completed HLTH308 in 2011. So although there was no signifcant difference in mean fnal questionnaire scores (2012) when the two groups of students were compared, the HLTH308 group had not lost as much of their original knowledge as had the HLTH214 group. This data shows that while the students in HLTH308 did not perform as well initially in 2011 they did retain more neuroanatomy knowledge when tested again in 2012. (Figure 2). DISCUSSION Custers has referenced the long held and largely unsubstantiated belief that the basic sciences are not well retained from the preclinical to the clinical years of medical school. He cites examples in the early literature where it is said that anatomical details are forgotten because they are not useful for the 'Praxis des Lebens' (practice of life),10,14 or fall into "disuse atrophy,"15 but for which no evidence was given. Custer reviewed the literature on retention of a range of different subjects in school as well as university, and found that in fact the knowledge retention was between two-thirds to three-fourths after about a year. A review of the retention of the basic sciences learnt in medical school, after one year, revealed the same overall range of results.10 However, the results are not easy to interpret, as there is such variability in the study designs and it would also seem that the outcome varies depending on the specifc basic science tested. Furthermore, much recent research has suggested that knowledge retention in the basic sciences actually does not follow the Ebbinghaus curve. These studies report that there is not as sharp a decline in knowledge loss in the basic sciences compared to the trend indicated by the curve, suggesting knowledge is retained better in the sciences.6,16,17 Custers and Ten Cate reported very long term retention of knowledge by doctors for up to 55 years, and found that there was a linear decline in knowledge over this time period with a drop from 40% knowledge retained by graduates that had been practicing for a few months, to approximately 25-30% knowledge retained by doctors that had been in practice for 50 or more years.17 The only study in Custer's review on knowledge retention in an interdisciplinary course in the neurosciences, by Levine and Forman,11 stood out for its low knowledge retention rates. This study used a multiple choice examination based on the key concepts in the understanding of neurology. It was shown that the 62% of the medical students who were tested for their NEUROANATOMY RETENTION McCOY et al Table 1 COMPARISON OF THE DEMOGRAPHIC DATA AND TEST RESULTS FOR THE THIRD AND FOURTH YEAR (MASTERS') STUDENTS. Overall (n=121) 3th year (n=59) 4rd year (n=62) p-value Number of male students (%) 75 (63) 39 (66) 36 (60) 0.617 Number of mature age students (%)a 24 (20) 9 (15) 15 (25) 0.351 Number of ESL students (%) 37 (31) 18 (31) 19 (31) 0.856 First MCQ test, percentage score (SD)b 54.5 (15.8) 58.9 (12.3) 49.9 (17.8) < 0.001 Second MCQ test, percentage score (SD)c 35.2 (14.0) 33.4 (11.8) 37.2 (15.2) 0.126 ESL: English as a second language; MCQ: multiple choice question a Students aged 25 years and over b Test comprising the 40 MCQ in the fnal exam; Test scores from 158 students that did not “cross-over” c Test comprising 15 MCQ randomly selected from the frst test; Test scores from 121 students Figure 2
CJA September 2013