Tag: medical students

LINKING
There are a number of methods for memorizing lists:  The Link method, the Peg method, the Memory Palace, and Acronyms.

The Link method involves memorizing a list by creating a ridiculous association between one word or idea and the one that follows on the list.  For instance, the American Cancer Society lists 7 symptoms that could be a sign of cancer:

1.  A change in bowel or bladder habits
2.  A sore that does not heal
3.  Unusual bleeding or discharge from any place
4.  A lump in the breast or other parts of the body
5.  Chronic indigestion or difficulty in swallowing
6.  Obvious changes in a wart or mole
7.  Persistent coughing or hoarseness

To remember these, you might want to:

1.   Start with a bowel and bladder which are normal but then erupt suddenly into explosive diarrhea and peeing all over. (Change in bowel or bladder habits)
2.  The fecal matter lands on someone, producing a huge 12 inch sore on the person’s face that persists forever.  (Sore that does not heal)
(The purpose here, of course, is not to make fun of cancer, but to create a vivid link between one item on the list an the next.  Making the sore huge adds to the memorability.)
3.  The sore erodes through the body, causing unusual bleeding and discharges everywhere. (Unusual bleeding or discharge from any place)
4.  Some of the bleeding remains under the skin causing lumps in the breast and elsewhere. (Lump in breast or elsewhere)
5.  The patient eats those lumps and gets chronic indigestion and difficulty in swallowing due to one of the lumps getting stuck in the patient’s throat. (Chronic indigestion or difficulty in swallowing)
6.  The patient enlists the help of a mutant wart hog and a mole to try to remove the stuck lumps.  (Obvious changes in a wart or mole)
7.  That doesn’t go over well, and the patient ends up with an injured lung and trachea. (Persistent coughing or hoarseness)

Of course, the above mnemonic is crude, repulsive, unprofessional, and puerile, which are good features.  The drama facilitates the remembering of  important clinical signs.  You could probably do better creating your own mnemonic.  What is important is that the associative links are striking and memorable.  It also helps to review them to fix them even more solidly in memory.  After a while, with repetition, a remembered list will not require the ridiculous association for recall; it is just remembered.

DITTIES
 Our memories are stronger for words set to to music or rhythm, a reason for the effectiveness of advertising jingles.  For instance, in remembering the cervical nerves that elevate the diaphragm, the ditty is  “C3,4,5 keep the diaphragm alive.”

And, in recognition of “poor dendal” (pudendal nerve) from the previous blog: “S,2,3,4 keeps the penis off the floor.”

There is not enough space on this blog to list all the excellent ditties and other mnemonics in medicine, but you can find an extensive list by googling “medical mnemonics.”

SUBSTITUTE WORDS AND PICTURES
One of the hurdles of medical school is learning a new vocabulary and new images, such as those in anatomy.  Try to distort the difficult word or picture into something familiar.  For instance, to remember the anatomy of a typical vertebra, you might visualize it as a snowman petting a moose.  The  moose (rib), snowman’s head (spinous process),  arms (transverse process) breasts (superior articular processes), and pockets and petting site (facets) are part of the vertebral/rib anatomy and are easier to remember when changed into something you already know and can easily visualize. You don’t have to learn what a snowman is.  You already know that.  You can use what you already know to pose or distort  it in a ridiculous manner that helps you remember an important anatomical structure.

Of course, before setting out to remember a picture, it helps to ask whether it is worth remembering the picture to begin with.  Someone once presented a distorted picture of the penicillin molecule as a way to  remember its structure.  But is the structure worth learning?  That is something that might be easier to just look up rather than remembering.

Apart from pictures, distorting  difficult vocabulary words helps memory.  For instance, back in medical school one of my classmates casually remarked that he remembered the function of the pudendal nerve as “poor dendal.”  The pudendal nerve innervates the genitalia, and poor dendal’s pudendal nerve was severed and could no longer function as he wished.

The next blog post will discuss ditties as a memory aid.

Please feel free to comment on any of these posts.

RIDICULOUS ASSOCIATIONS
 Although you are serious about medicine, do not dismiss the value of  using ridiculous associations as an important memory tool.  We remember things better when they are very unusual, vivid, very enlarged, humorous, sexual, or just plain ridiculous.  The more ridiculous and exaggerated, the better the retention. While a rhinocerus, a bottle of Corona beer and a bottle of Nyquil, when considered individually, are hardly unusual,  if you saw a sniffling rhinocerus holding a bottle of Corona beer in one hand and a bottle of Nyquil in the other, an overall ridiculous association among the three, you would be unlikely to forget that the rhinovirus and coronaviridae cause the common cold.

Imagine three pillars (Roman numeral III) inside one eye, keeping the eyelids apart, and the number “7” acting as a hook to pull down the upper lid of the other eye.  This helps to remember that cranial nerve III opens the eyelids, while cranial nerve 7 closes the eyelids.  Here we combine visualization with ridiculous associations.

While you can always use other people’s mnemonics, it may stick best when you invent your own; let your imagination run wild; medical students are very creative.  While it may take a little extra time to invent the association, it pays off in retention.

VISUALIZATION
People remember better when they visualize.  Forgot where you left your glasses?  If you make a point of visualizing them when you put them down, you are more likely to remember where you left them.  It is similar with learning anatomy.  Try to spend a few more seconds visualizing, fixing in your head, the anatomy, or for that matter any other picture, before going on.

It is easier to first learn anatomy through conceptual line drawings than through photographs of dissected specimens, with all that fascia to muddy the conceptual view.  When I was an ophthalmology resident, I found books that showed photos of actual ocular anatomy dissections relatively useless compared with books that showed conceptual pictures, particularly line drawings.  We are very visual learners, and it helps when we can visualize things as a whole.

Many years ago, before the print era, people used memory techniques extensively, because there were no books.  Now, with books and Internet searches, it seems memory methods are less in favor, since we rely on the information in print, as extensions of our brains.  However, there still is much basic material that needs to be memorized.

Eleven memory methods useful in medical study:

1. Understanding
2. Visualization
3. Ridiculous associations
4. Substitute words and pictures
5. Ditties
6. Linking
7. Peg method
8. Memory Palace
9. Chunking
10. Acronyms
11. Hands on

UNDERSTANDING

Understanding should not be underrated as a memory method.  Why go to the trouble of trying to memorize isolated facts when the facts could easily be deduced from a simple rule or understanding of the issue?  For instance, muscles generally connect one bone to another across a joint.  Why memorize which muscles in a region lie more deeply when one can apply the simple logic that the shorter muscles lie deeper.  Thus the muscles that span 1 vertebra lie more deeply than those that span 2-4 vertebrae, which lie more deeply than those that span 5 or more.

The neuroanatomic pathways are remembered more easily with the simple rule that the first part of the name generally indicates where the pathway comes from, while the last part of name indicates where the path is going.  Thus, the corticospinal path travels from the cerebral cortex to the spinal cord;  the spinothalamic tract travels from the spinal cord to the thalamus; the spinocerebellar tract travels from the spinal cord to the cerebellum, etc.  Understanding principles and rules reduces the need for rote memorization.

A valuable way to learn a wealth of new medical terms is to recognize their Latin and Greek roots.

I remember the case of a nurse who had chronic uveitis (an inflammation of the middle layer of the eyeball), who was admitted with the inability to void.  She had been taking atropine eye drops, a parasympathetic inhibitor to keep the iris open, so that it would not stick to the lens.  Understanding that atropine eye drops can also enter the circulation systemically, where it could act on the bladder to impede bladder contraction, enabled the ophthalmologist to understand the cause of the inability to void and to correct the matter with an alternative approach to the uveitis.  It was an understanding of the drug’s potential effect, rather than a nonexistent caution in a drug reference that it may paralyze the bladder, that was helpful in resolving the issue.

In pharmacology, it can be cumbersome trying to learn one drug after another.  After a while they all tend to meld into one another as a confusing jumble.  However, there are principles that govern the effects of each class of drugs.  If you know the principles, there is no need to memorize the individual effects of each drug.  Each drug in the class will have effects that resemble those of the other drugs.  It may be better to learn the general principles and focus on those effects that distinguish one drug in the class from another, if we deem those effects important to memorize.

In memorizing the manifestations of a disease, it may help to emphasize any quality that is pathognomonic, namely that is specific to that disease.  For instance, neurologic weakness in a limb generally is either the type where there are overactive reflexes and no muscle atrophy, or the type that has underactive reflexes and significant muscle atrophy.  There is one disease, amyotrophic lateral sclerosis (Lou Gehrig’s Disease), where there is a combination of overactive reflexes and profound atrophy in the same muscles.  If you see that, you have virtually made the diagnosis of ALS.  Remembering a pathognomonic feature, a feature that distinguishes a condition from all others, can enable the clinician to quickly arrive at the diagnosis.  Similarly, remembering the specific effect of a drug that distinguishes it from others can help in choosing it as a drug of choice.

Other memory techniques will be discussed in the next posts.