This study aimed to explore the impact of spaced E-learning on Basic Life Support (BLS) knowledge and the satisfaction of nursing students. Spaced learning was chosen as the intervention method, believed to be superior to mass learning [15]. Spaced learning has demonstrated its effectiveness in various fields, including medical sciences [27], mathematics [28], and has been associated with improved knowledge acquisition, retention, skills, competencies, and overall student satisfaction [29, 30] .
The results of this study indicated that BLS training improved in both groups, with the intervention group (spaced learning) showing a greater increase in knowledge, in line with similar studies investigating CPR training. Patocka et al. (2019) compared spaced learning with massed learning in teaching CPR to emergency medical service (EMS) providers, showing improved three-month retention of skills in the spaced learning group [29]. Similarly, in a study by Ferguson et al. (2019), atrial fibrillation training through Mobile spaced education led to higher knowledge and awareness scores among nurses [31]. Beyond CPR, other studies explored the efficacy of spaced learning in various medical fields, such as laparoscopy training [32], microsurgery methods for medical students [33] anesthesia in neurosurgery among anesthesia students [34] and symptom management among nursing students [35]. These studies collectively demonstrate the acceptability and efficacy of mobile distance learning, enhancing both learning outcomes and the ability to apply knowledge in clinical practice.
The not significant increase in BLS knowledge observed in the control group between time 2 and time 3, in contrast to the decrease in knowledge seen in the intervention group during the same period, can be attributed to the spacing effect and the dynamics of memory retention.
The spacing effect, a well-documented cognitive phenomenon, suggests that spreading out learning over time leads to better long-term retention compared to cramming information in a single session. In this study, the control group underwent massed learning in a single three-hour session, likely resulting in a more immediate but less enduring increase in knowledge. On the other hand, the intervention group engaged in spaced learning across three one-hour sessions, allowing for more effective encoding and retention of information over time.
The impact of time and the number of sessions on students’ knowledge scores suggests that knowledge repetition through content review and multiple post-tests enhances retention. Moreover, conducting sessions in multiple segments allows students to better understand the content and seek clarification on unclear topics, as supported by previous research [15, 23]. Longitudinal studies have emphasized the need for repeated CPR training throughout nursing education to maintain knowledge and skills [36]. In this study, spaced learning consisted of three one-hour sessions, with the duration of classes directly influencing learning outcomes. Shorter sessions of 10 to 20 min appear to be more effective, aligning with students’ preferences for shorter, frequent classes over lengthy sessions [37]. This a suggestion for further research to examine the effects of shorter class duration.
Furthermore, the study revealed a high level of student satisfaction with the online course in both groups, with no significant difference between them. Also, Teo et al. study reported no significant differences in satisfaction scores between the two groups of mass and spaced learning in microsurgical procedures [33]. Studies by Dabiri et al. (2019) and Watchmaker et al. (2019) corroborated this finding, highlighting high satisfaction with spaced learning [38, 39]. Reasons for this satisfaction include reduced mental fatigue, enhanced comprehension, more engaging learning experiences, and improved long-term retention [19]. The utilization of various teaching methods and new approaches by instructors also contributes to student satisfaction. After COVID-19 pandemic, the effectiveness of alternative educational methods, such as simulation, educational videos, and games, in teaching clinical topics was highlighted [5].
Limitation
Data were collected from one center, so it affects the findings’ generalizability. In December, we encountered the challenge of coordinating the training days of our online course with the schedule of the 2022 FIFA World Cup. We devised polls in collaboration and coordination with students to determine the most suitable time for conducting classes in Telegram groups. The final limitation was we measured the BLS knowledge of nursing students, not their skills. So, comparing the knowledge application in the real clinical environment between the two groups is suggested.
Implications
The findings of this study carry several practical and educational implications for the field of nursing education and beyond:
Enhancing CPR Training: The use of spaced E-learning for CPR training offers a promising avenue for improving the quality and effectiveness of training for nursing students. Implementing this approach in nursing curricula can help ensure that students acquire and retain essential life-saving skills.
Long-Term Retention: The study underscores the importance of regular CPR training sessions throughout the nursing education journey. Institutions should consider incorporating spaced learning approaches to promote long-term retention of knowledge and skills.
Online Education Integration: In the post-COVID-19 era, online education has gained prominence. Nursing schools and institutions should explore the integration of spaced E-learning methodologies to enhance students’ learning experiences, irrespective of whether classes are conducted in person or online.
Effectiveness of Spaced Learning: This study reaffirms the efficacy of spaced learning as a teaching methodology. Educators and instructional designers can adopt this method in various academic disciplines, particularly for complex topics requiring knowledge retention.
Student Satisfaction: The high levels of student satisfaction with spaced E-learning emphasize the importance of using innovative teaching methods that not only facilitate learning but also create engaging and enjoyable educational experiences. Instructors should consider diversifying their teaching strategies.
Use of Technology: The study underscores the role of technology in modern education. Institutions should continue to invest in and promote the use of online platforms and digital resources to support spaced learning initiatives.
Research and Innovation: The study highlights the value of research and innovation in education. Future research can delve deeper into the impact of spaced learning on various topics and different educational contexts, contributing to the advancement of teaching and learning practices. In addition, it is recommended that future studies investigate the effects of spaced learning over different time durations of classes and intervals between sessions; explore differences based on gender, ethnicity, etc.; and focus on skills-based content. The adoption of spaced learning is recommended for face-to-face classes and various theoretical and practical subjects in nursing education.
In conclusion, this study provides valuable insights into the potential benefits of spaced E-learning in nursing education. By considering the implications outlined above, nursing schools, educators, and institutions can embrace innovative approaches to curriculum design, teaching methodologies, and technology integration, ultimately enhancing the quality of education and, most importantly, the quality of patient care.
