What can medical education take away from a USA Memory Champion?!

In 2006, Joshua Foer won the USA Memory Championships by, among other things, memorizing the order of a 52 card deck in a staggering 1 minute and 40 seconds. Other events in the competition included remembering the most names of strangers and reciting the most lines of poetry. Perhaps more astounding is that Foer had been covering the event as a journalist in 2005 and, in just one year, had trained himself to the level of USA champion.  Foer chronicled his incredible journey in a New York Times bestseller, Moonwalking with Einstein, and a famous TED talk watched over 250,000 times.

Medical students are often told during the first-week of school that studying will be “like drinking water from a firehose”. Indeed, the pace and volume are certainly ramped up in comparison to college. While a 4-unit class at UC Santa Barbara would cover 30 hours of material over a 10-week period, exams at my medical school typically engrossed 35 hours of lecture crammed into a mere 2 weeks. Breaking down the lectures, I found between 15-20 testable details in each lecture making for 525-700 items to learn for each exam. Tracking the hours I spent studying for an exam showed I was spending about 75 hours in order to memorize up to 700 testable points. The fact that Foer could memorize the arbitrary order of a 52 card deck in under 2 minutes was thus certainly fascinating to me.

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What does Foer’s memory journey teach us about learning in medical school? In part one of a three part series; I dive into why we forget names so easily and how Lance Armstrong helped one student learn pharmacology.

The Baker/baker Paradox: Or, Why We Forget Names So Easily

Ever wonder why we can forget a person’s name instantly after meeting them? Foer uses the Baker/baker paradox in a CNN article to explain a possible reason: “A researcher shows two people the same photograph of a face and tells one of them that the guy is a baker and the other that his last name is Baker. A couple of days later, the researcher shows the same two subjects the same photograph and asks for the accompanying word.

The person who was told the man’s profession is much more likely to remember it than the person who was given his surname. Why should that be? Same photograph. Same word. Different amount of remembering.

Given the exact same word, our minds are more likely to remember the occupation of baker because the memory invokes several memories, namely, the smell of food in the oven, the stains on a white apron, the imagery of bread rising. The name “Baker”, however, is linked only to the person’s face and is easily forgotten. As Foer writes, “If you want to make something memorable, you first have to make it meaningful.”

So how can we apply this principle to learning in medical school? In a recent Fast Company article, MD/MBA candidate and co-founder of Osmosis, Shiv Gaglani, explains how Lance Armstrong helped him make learning pharmacology meaningful: “In 1996 Lance Armstrong was diagnosed with stage three testicular cancer, and given less than a 40 percent chance of survival. Despite this, he actually declined the front-line therapy involving bleomycin because (as an increasingly prominent professional cyclist) he did not want scarred lungs… Now, whenever I think about bleomycin my mind immediately jumps to Lance Armstrong not wanting to jeopardize his athletic career, and thus the side effect of pulmonary fibrosis. I can bet that if I ever prescribe the drug to a patient I’ll be sure to closely monitor their lung function.”

Gaglani took a seemingly arbitrary connection, bleomycin and pulmonary fibrosis, and found a way to make it meaningful. In comparison to pure brute memorization, this method of association is not only a more effective way to study for an exam, but also a more concrete way to keep ideas in mind when treating future patients. Looking back at all the hundreds of drug side effects I learned by brute memorization during first-year, there are barely any I can recall from memory now. However, the ones that I do remember are from patients I saw in clinic: a woman worried about involuntary movements (tardive dyskinesia) due to her anti-depressant prescription or a man complaining of nightmares from his arthritic medicine. By having a context, these connections are solidified in my mind much more strongly than weak associations I made during the school year.

However, one of the limitations of making details memorable based on patients is the limited patient interaction during the first two-years of medical school. There can be up to 700 details to memorize in the two weeks leading up to each exam and I simply won’t be able to see 700 patients in this time. Learning all that information requires a more systematic approach that organizes and contextualizes all the information needed to be known for an exam (something that the Osmosis app is actively working on). After trying a few different study techniques during the school year, I found a lot of success in my basic sciences classes with a study technique I dubbed “Concept-Based Tables”:

Concept Based Table

Here’s how “Concept Based Tables” work:

• Lecture notes and slides are processed to find testable points and compile them into a word document.

• Each of these testable points is organized into categories: professor, lecture, and topics/concept within each lecture.

• Testable topics are given a short write-up that explains the topic within the context of the lecture along with key associations (e.g. Hereditary Thrombocythemia is due to a missing AUG7 gene leading to inefficient TPO translation).

• Topics are color-coded by lecture or by topic to help visually group similar items.

• Language within the tables was focused on high-yield associations and key differentiating details.

Two huge benefits from this method were the systematic ability to organize a huge amount of information into easy-to-read tables and contextualization of each testable point within the exam. When faced with a tough question on an exam, I would look for key words in the question stem and start “searching” my memory for the location of the topic in a concept-based table (CBT). For example, if a question mentioned Diphtheria toxin, I visualized the topic being in a lecture on transcription and translation- making it easier for me to remember the toxin inhibits Elongation Factor-2, a protein involved in translation.

Dipheria Toxin

With CBT, the 700 items to memorize weren’t just a random list of associations anymore, but rather, an organized and highly contextual group of interconnected ideas and concepts. This structure, combined with deliberate practice, gave me a visual concept map in my head I could search through on test day. I’d print out these tables and test myself by folding the paper and recalling the context/notes of each testable topic. When I couldn’t recall the “notes” associated with a topic, I’d look at the overall concept as a hint. This made for a great group-review tool as well, providing a quick cheat-sheet with which my classmates and I could quiz each other. By making the details associated with each topic more meaningful, we had also made them more memorable.

Beyond the Baker/baker Paradox

In part two and three of the “Memory Hacking” series, I’ll explore the “art of memory” and deliberate practice, both key concepts essential to effective memorization. Connect with me via @RNguyenMed to find out more.

Note: this article was originally published on The Almost Doctors Channel.

[Featured image from Flickr user hans s]