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Chiropractic Journal of Australia : CJA December 2013
140 Chiropractic Journal of Australia Volume 43 Number 4 December 2013 retention of these core concepts a year after they took the course did not achieve a minimum pass mark of 63%, and the average score was 57.8%. The results have been repeated by others.8,9,11 D'Eon assessed the retention of three aspects of an undergraduate medical degree (immunology, physiology and neuroanatomy) after an interval of 10-11 months. The courses were taught in frst year and then reassessed in the second year. It was found that the loss of knowledge for immunology and physiology (17.6% and 19.4% respectively) was similar to what has been found in previous studies for the general sciences. However, the retention of neuroanatomy was not as good, with only 47.5% of the knowledge retained.8 Mateen and D’Eon completed a study on fnal year medical students that had been taught the neuroanatomy course two years previously in frst year. The results from this study demonstrated a 60% loss in knowledge after a period of two years.9 We were motivated to study the retention of knowledge in neuroanatomy because of the limited research published specifcally on this science subject, and in order to compare the knowledge retention of chiropractic students with the available results. To the best of our knowledge, we are the frst to conduct this research. Our study hypothesised that chiropractic students would have a better retention of neuroanatomy knowledge when compared to students of other health disciplines. We found that, indeed, chiropractic students had a higher retention rate of 65%, better than the results published and in line with the results for the sciences generally. What is the reason for our unique fnding? It may be that the published data we are comparing our results to, are not representative of the situation and that more research needs to be done on this particular subject. However, if we assume that the published results are correct and neuroscience is not as well retained by students, it is incumbent on us to speculate as to why this subject should be handled differently in the brain, and then it is necessary to suggest reasons for our unique fndings. The answer may relate to the intrinsic cognitive load that the neurosciences represent. In order to create schemas for storing information in long-term memory, information must be processed in working memory.18 The ease with which this can be done depends on the nature of the subject. Neuroanatomy is a diffcult subject to conceptualise and manipulate, both because it is very content dense, with a large vocabulary load, and because it has to be conceived of in a 3-dimensional way. It represents a high "working memory load" with many interacting parts that cannot be held readily in working memory,18 making understanding of the information a prolonged process. We speculate that this makes neuroanatomy a more diffcult subject to commit to long-term memory. Why then would our chiropractic students be better at retaining the information? We believe that this can be attributed to the use of the acquired knowledge in other areas of the chiropractic course. This seems all the more likely when one considers that the Masters cohort, which would have used this knowledge to a greater extent than those students who went into third year, did the best of all, with a 20% higher knowledge retention rate compared to that of the 3rd year student cohort (74% and 57% knowledge retention rates respectively). It has been acknowledged that practical application and review of material aids in the retention of knowledge.5-7,12 It is therefore plausible that neuroanatomy is not as well retained if there is not much opportunity or need for recall of this information. Review of previously learnt material (directly or indirectly related to a topic) can enhance recall, and thereby improve knowledge retention.12 Thus, recursive teaching and practical application, such as in a dissection course,7 or a post-graduation course,6 has been shown to improve the retention of knowledge. Last investigated knowledge retention in dental students, and found a decrease in the retention of most modules between 2nd and 4th year with the exception of oral biology and physiology. This is because this material was re-enforced as relevant to the 4th years' further studies.5 These results and the results found in this current study supports the notion that the more relevant the information, the better it is retained. A good understanding of neuroanatomy is important in the diagnosis and treatment of patients by both medicine and chiropractic students and clinicians. Our 4th year students were using and applying information in a clinical neurology unit in 2012. In chiropractic, in particular, there is an emphasis on the relationship between the optimal functioning of the musculoskeletal system and the nervous system, because chiropractors work on the vertebral column, and in close proximity to the spinal nerves that emerge from the spinal cord and which run to the muscles of the body. Understanding the neuroanatomy and neuropathology results in a better outcome in treatment and a clearer understanding of prognosis for the patient. This necessary interplay between knowledge and diagnosis should theoretically increase the retention of neuroanatomy knowledge; we believe this to be supported by the results of this study. There were limitations in this study. The assessment of the retention of information depends upon the tool used to measure it, and is therefore also limited by this tool, which in our study, and in most other studies, is the theoretical examination and the content included therein. Our study used a selection of multiple choice questions in a questionnaire. The use of multiple choice questions to test content retention have been a standard outcome measure used in the literature,10 and the use of a questionnaire is a valid method of assessing whether knowledge has been retained.5,19 The use of a questionnaire allows for factual knowledge to be tested in a simple but effective way, whether the questions are randomly selected from previous material;9 selected in a non-random way for clinical signifcance8,11 or developed for the purpose of the assessment.5,6,17 Our study utilized 15 multiple choice questions taken from the previous exam, a process similar to that used in previous studies.7-9,11 As the study wanted to look into the retention of knowledge of neuroanatomy as it had been previously taught, the questions were randomly selected to avoid bias for what may have been considered clinically relevant by the authors. This method of using multiple choice questions has not been found to threaten internal validity, thus yielding relevant measureable results.5,19 However, we were limited in the number of questions we could ask, as the time allowed in the tutorial time was necessarily short. A complete representation of the knowledge learnt may not have been refected in the questionnaire. NEUROANATOMY RETENTION McCOY et al
CJA September 2013