Rapid Learning

Memory Techniques for Med School #4 Substitute Words and Pictures

Pathologist explaining the differential diagnosis of a road kill
The fine art of pathological diagnosis

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.

Vertebra and rib seen as a snowman petting a moose

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.

Rapid Learning

Memory Techniques for Med School #3 Ridiculous Associations

Tired doctor fantasizing about how nice it would be to be in bed all day as a patient
“These lucky patients, sleeping all day.”

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.

Causes of common cold remembered as rhinocerus (Rhinovirus) holding a bottle of Corona beer (Coronavirus) in one hand and a bottle of Nyquil (common cold) in the other

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.

Function of cranial nerve 7 as a hook pulling down eyelid.  Function of cranial nerve III as 3 pillars holding eyelids open

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.

Rapid Learning

Memory Techniques for Med School #2 Visualization

Anatomy Dissection Lab - Cadaver thinking

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.

Rapid Learning

Memory Techniques for Med School #1 Understanding

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.

Rapid Learning

Is Memorizing Passe?

“There is too much to know and not enough time to learn it.” This is one of leading causes of stress in medical students.  One study indicated that if a first year medical student actually read everything that was assigned, the student would need to read more than 24 hours per day.

Medical school requires you to learn a large, new vocabulary and rote facts. We may ask why we must memorize so much when we can quickly search the Internet and elsewhere for what we want.  Computers excel at storing and retrieving isolated facts, but people are poor at this, so why not just rely on computers and Internet searches for our facts, rather than memorizing them?

Computers are poor at  understanding, but people excel at this.  Why not focus on what we do best, namely understanding concepts and using common sense?  Understanding is key. We need to apply understanding, not just a cookbook approach, to the patient.  Patients differ; no two cases are identical.  We need to use our understanding and good judgement. Hence the saying, “Medicine is both an art and a science.”

While understanding is very important, we do need to have in memory certain basic facts as a starting point for understanding.  In addition to studying for exams, we cannot approach clinical cases devoid of basic facts, and it would take too long to look up every fact from scratch.  It helps to remember what we can, but bear in mind that there are sources where we can look up facts when needed.

While we can’t remember every important fact,  we need to know where to look them up.  Three kinds of books are useful to medical students:

1.  Reference texts contain many facts, but understanding often gets lost in the forest through the trees.

2.  Board review books focus on facts that might be tested on the Boards, but these books, too, often do not impart understanding.

3.  There are small conceptual books that provide understanding in addition to key information that might be on exams and practical later in life.  Once one gains understanding, it becomes easier to learn new relevant facts, since they fit in, like pieces of a jigsaw puzzle fit into the overall picture.

Apart from books, Internet searches can find a wealth of  information, but you have to know how to search effectively.  General search engines, such as Google, not only find useful clinical information, but information that may be questionable or border on quackery or bias.  It helps to know that there are other search engines that are more geared to the professional medical audience.  These can be found on MedMaster’s search engine page or as a free download of the MedMaster MedSearcher program.  It is also important to know how to phrase the words in a search.

Certain memory techniques can help to quickly learn and remember facts and concepts and can help deal efficiently with the lack of study time. These methods will be explored in posts to follow, with particular consideration of the medical subjects where they may be best applied.

Please feel free to send your comments and suggestions.