The research
The evidence behind Mosaic
In the most cited review of study techniques (Dunlosky and colleagues, 2013), only two techniques earned the top utility rating: practice testing and distributed practice. Mosaic is built around both, plus a few techniques with moderate evidence that suit clinical learning well.
Practice testing
Bringing information to mind from memory strengthens it more than re-studying it does. The effect has been replicated across decades, subjects and settings (Roediger & Karpicke, 2006). In a trial with 40 paediatric and emergency medicine trainees, topics they were tested on scored 39% six months later, against 26% for topics they studied from a review sheet (Larsen et al., 2009). Even a wrong guess helps, as long as you see the right answer straight after (Kornell et al., 2009).
Distributed practice
The same study time spread over weeks beats the same time crammed into one sitting (Cepeda et al., 2006). The longer you need to remember something, the wider the gaps should be (Cepeda et al., 2008). Mosaic's flashcards space your reviews automatically, bringing each card back around the time you'd start to forget it.
Self-explanation and elaboration
Explaining why an answer is right, and why each alternative is wrong, deepens understanding (Chi et al., 1989). The 2013 review rated this moderately useful. That's why AKT writing asks you to explain every option.
Connection and reflection
Each prompt in the connection notebook draws on a different piece of evidence.
- Linking to what you know, and to your own patients
- New learning sticks better when it builds on what you already know (Ausubel, 1968). Experienced clinicians hold much of their knowledge as "illness scripts" built from patients they've seen, and linking new learning to real patients helps build them (Schmidt & Rikers, 2007).
- Noticing when your thinking changes
- Mistakes you were confident about are the ones most likely to be corrected once you see the right answer (Butterfield & Metcalfe, 2001).
- Explaining it to a colleague or a patient
- Explaining from memory, or preparing to teach, deepens understanding (Chi et al., 1994; Koh et al., 2018). The benefit seems to come from the recalling, so try it without your notes.
- Asking what you're left wondering
- Asking your own questions helps understanding (Rosenshine et al., 1996), and we remember more of what we're curious about (Gruber et al., 2014). Doctors are often poor judges of their own gaps, though (Davis et al., 2006), so the curriculum dashboard and Quick Test help you check.
- Noticing how it made you feel
- Emotion shapes what we notice, how we read it and what we do about it, in learning and in practice (McConnell & Eva, 2012).
- Committing to one action
- Planning when and where you'll act makes you more likely to follow through (Gollwitzer & Sheeran, 2006). In a study of 207 family doctors, those who wrote down a change they meant to make were more likely to make it, judged by their prescribing (Wakefield et al., 2003).
There's much less evidence that written reflection on its own improves learning, and much of what exists is theory (Mann et al., 2009). That's why the prompts are short and specific, and why you only need to answer two or three.
One caveat. Much of this evidence comes from laboratory and classroom studies. Studies in postgraduate medical education are encouraging, but there are fewer of them. We think building on the best evidence available is better than building on habit. Even so, no app makes learning effortless, and we won't claim this one does.
Got an invite code?
Create your account, then start wherever suits you: a flashcard deck, your first question, or a connection from this week's clinic.
Go to Mosaic