Research Studies

Spaced Learning (Brain Sparks®) on Employee Retention of HIPAA Practices

Learning Management and Training
Research Studies

The Impacts of Scenario-based Online Training and Retrieval-based Learning on Health Care Professionals’ ability to Identify HIPAA Violations in Social Media.


Retrieval is defined as getting and bringing something back1. Studies consistently show that retrieving knowledge subsequent to obtaining that knowledge improves learning and retention2-3. Information retrieval presented at intervals over time, or “spaced repetition,” should be delayed after the initial learning, making the information less accessible in one’s memory than if the review were immediately after learning4-5. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) included national standards for protecting patient health information privacy6. According to HIPAA, any communications regarding personally identifiable patient information must be secure and transmitted only to permissible parties. Social media communications create abundant possibilities for the improper sharing of personal health care information, putting both the patient privacy and health care organization compliance at risk7.


We conducted a randomized (by organization) controlled trial examining the impact of spaced learning on healthcare professionals’ retention of an online training on HIPAA and social media use. Fifty-seven learners from four community health organizations completed a pre-assessment, an online training course, a post-assessment, and a 90-day follow-up assessment. The online training course consisted of a 30-minute course titled, “HIPAA Do’s and Don’ts: Electronic Communication and Social Media,” that taught learners to identify actions on social media that could result in a HIPAA breach. The three assessments took about 10 minutes each and collected demographic, attitude, social media use, and knowledge data. The knowledge questions included both general and scenario-based questions and the attitude questions focused on confidence levels in identifying HIPAA violations and motivation levels for learning about the topic. Learners (n=20) from two of the four organizations were sent six retention questions via email over a two-month period after taking the online training. Learners (n=37) from the other two organizations did not receive retention questions in the two months following the training.


On average, across all learners, knowledge about HIPAA and social media increased significantly from pre-assessment to post-assessment, but was not sustained at 90-day follow-up. There was no significant difference in knowledge retention at follow-up between the retention question intervention group and the control group.  Most learners reported they enjoyed receiving retention questions, believed they gained knowledge retention from the questions, and desire follow-up retention questions with future online training courses.

Figure 1: Social Validity Survey Responses


Although participants that completed Brain Sparks reported that they enjoyed them, the version of Brain Sparks 1.0 did not significantly retain knowledge over time. Six questions delivered over the period of two months may not help maintain knowledge retention. Learners may remain confident in their knowledge in the few months after an online training despite not maintaining the immediate knowledge gained from the training. This increased confidence level is of concern for professionals in healthcare and other disciplines who may erroneously believe they know and understand important concepts without questioning themselves or seeking the additional training they need. We recommend further research to determine effective spaced repetition strategies to help ensure learners maintain the knowledge they gain through online training. Relias is currently looking at creating Brain Sparks 2.0 to address these findings.

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An article in Training magazine discusses this study and the importance of training for memory retention.


  1. Retrieve [Def. 1]. (n.d.) In Oxford Dictionaries Online, Retrieved July 26, 2016, from
  2. Karpicke, J. D., & Grimaldi, P. J. (2012). Retrieval-based learning: A perspective for enhancing meaningful learning. Educational Psychology Review24(3), 401-418.
  3. Carpenter, S. K., Cedpeda, N. J., Rohrer, D., Kang, S. H. K., & Pashler, H. (2012). Using spacing to Enhance Diverse Forms of Learning: Review of Recent Research and Implications for Instruction. Educational Psychology Review, 24(3), 369-378.
  4. Brown, P. C., Roediger, H. L., & McDaniel, M. A. (2014). Make it stick. Harvard University Press.
  5. Karpicke, J. D., & Roediger III, H. L. (2007). Expanding retrieval practice promotes short-term retention, but equally spaced retrieval enhances long-term retention. Journal of Experimental Psychology: Learning, Memory, and Cognition33(4), 704.
  6. S. Department of Health and Human Services. Retrieved July 26, 2017, from
  7. Cain, J. (2011). Social media in health care: the case for organizational policy and employee education. American Journal of Health-System Pharmacy68(11), 1036.

Read more about this research


M. Courtney Hughes PhD, MS

Senior Researcher, Relias


Training Magazine June 2018

Research Partner

One Hope United; Lutheran Child and Family Services