Journal of Continuing Education in the Health Professions (08/14/25) Wang, Ting; Morgan, Zachary J.; Bazemore, Andrew; et al.

Spaced repetition improves both learning and metacognitive accuracy — the ability of clinicians to align confidence with actual knowledge — with the greatest benefits seen after two exposures to the same material, research shows. In a study of 16,751 family physicians in the American Board of Family Medicine's Continuous Knowledge Self-Assessment program, participants completed the quarterly assessments and rated their confidence after each question. The analysis focused on questions first answered incorrectly but later answered correctly. Physicians were randomized to receive either exact repeated questions or “clone” questions covering the same concepts, once or twice over time. Confidence increased significantly for repeated questions, with moderate gains after a single repetition and large gains after two. Clone questions also improved confidence but to a lesser extent. Male and younger physicians tended to report higher confidence overall. These findings suggest that integrating two spaced repetitions of key content into continuing medical education can strengthen clinicians' self-assessment skills and potentially lower the risk of diagnostic errors.

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