#10: 5 FAQs about the Memory Palace

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The “memory palace” is a technique that has been used since ancient times to memorize large amounts of material in a short amount of time. I used it in medical school to score high on Step 1 and Step 2 and match into dermatology. Since it completely changed my life, I created an online course to teach it to other people, and in this post I’m going to share some tidbits from that course. You will hear the answers to 5 FAQs questions from listeners to my Med Student Edge podcast.

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  1. How do I come up with new maps for everything?

Med students who are new to the memory palace sometimes feel like there is way more stuff to memorize in medical school than they can possibly come up with mental maps for.  But this misses a fundamental understanding of how and why the memory palace works.  You create a memory palace based on a location you know well.  You are never having to “come up” with locations for your palaces.  The locations should be places that you know like the back of your hand.  That’s why the memory palace works.  Visuospatial relationships are hard wired in your brain, and by putting new material with “back of your hand” material, you fast-track the new material into your long-term memory.

Now, if you think about it that way, how many locations do you know very well?  I challenge you to sit down and brainstorm a list.  You will be shocked at how many you come up with; in fact, you’ll probably get bored and stop writing long before you run out of places.  Here’s a starter list that is pretty universal: your childhood home, your grandparents’ houses, your college dorm rooms and apartments, your current apartment, friends’ houses, local playgrounds and parks, museums, places from your past like high school and grade school, favorite restaurants, camps you attended as a child, your medical school building, the hospital, clinics you’ve worked in, places you’ve volunteered.  I’m getting tired just listing all of these!  The list of places you know well is honestly endless.  And just by living you are adding new places all the time.  Going to a new restaurant this weekend?  Try to pay attention to the layout so you can use it for a palace!  Going over to a friend’s place for the first time?  Make note of the layout and any weird decorations that will help you remember the rooms.

Creating memory palaces becomes a way of life, because it forces you to pay closer attention to your surroundings.  It becomes fun the more you use it and the better you get!

 

  1. How do you come up with new mnemonics?

I want to be clear that coming up with mnemonics is different from using the memory palace.  To me, when medical students talk about mnemonics, they are thinking of things like “Some Lovers Try Positions That They Can’t Handle” to remember the carpal bones in the hand.  The memory palace isn’t the same.  The memory palace takes images and puts them in locations to help you remember facts.  For example, if you are trying to remember cardiac murmurs, you have a separate room for aortic stenosis and aortic regurgitation.  In the aortic stenosis room you put things like crescendo-decrescendo and radiation to the carotids.  In the aortic regurgitation room you put things like widened pulse pressure.  Coming up with the images should be easy: it’s really free association.  Perhaps for carotids you think of carrots.  Or 3-carat diamond rings.  Or caro, the coffee substitute.  The important thing about the free association is that it needs to be sticky.  If you find yourself forgetting what an image means, or that an image is in the room at all, you need to go back and revise.  I’ll talk more about that a little later.

So, when you’re talking about mnemonics like the memory palace, I have something I call the “First Golden Rule of Mnemonics” and it is to always make your own mnemonics.  You can’t use someone else’s memory palace or visual mnemonic, like Picmonic.  For a mnemonic to stick, you need to create your own.

But, when it comes to trying to memorize a list, where you don’t need understanding as much as straight memorization of a list (like the carpal bones in the hand), save yourself time and headache by stealing someone else’s.  You’re not the first med student to have to memorize that same list.

In fact, if you look up the Wikipedia entry for “medical mnemonics,” you will be astounded.  People have been coming up with medical mnemonics since the beginning of medicine.  If you can’t remember the essential amino acids, Google it.  You will find “PVT. TIM HALL always argues, never tires” and you don’t have to make your own mnemonic.  For straight list memorization, always try that first.  It will save you lots of time and mental energy.

And now my “Second Golden Rule of Mnemonics.”  If you need to hear it twice, throw it out.  If someone else’s mnemonic fails – that is, if you forget it twice – you should throw it out and create your own mnemonic.  I mean, the point of a mnemonic is that it’s supposed to be easy to remember, right?  If you forget it twice, you might forget it during Step 1 and you can’t afford to take that risk.  So throw it away and come up with your own.  There are lots of strategies for doing that.  You can create an acronym, using an online scrabble helper, which was always my favorite way.  The problem with that, though, is that you’ll have so many acronyms that often it’s hard to remember what the A stands for – is it aorta? arrhythmia? atrial?  But it at least can be a memory trigger.  Some people use pictures, rhymes, associations, vulgarity…there are tons of ways to create mnemonics.  I have a whole 10-minute podcast about this, (sholamd.com) so I’ll direct you there if you want to hear more about creating mnemonics.

  1. Does this eventually become second nature?

Like I said before, this eventually becomes a way of life.  You start paying more attention to your surroundings.  You start using “throwaway” palaces to remember what you need at the grocery store.  Your working memory becomes stronger, and your capacity to create clever, sticky images becomes greater.

At the beginning, though, it will feel like a strange and costly investment of time.  Standing on the other side of it, though, I can guarantee you that this investment pays for itself many times over.  To this day, as a derm resident, I am still using my memory palaces to study, last year for Step 3 or to refresh information on a patient before rounds.  I strongly encourage you to write out all of your memory palaces.  While the memory palace technique makes facts stick better and longer, memories that aren’t used are always extinguished – that’s just human physiology.  So eventually even if you built an amazing palace, you’ll start to forget info you don’t use regularly.  If you build an amazing palace and write it down, you can refresh it quickly and it will come back to you easier.  I have a 200-page Word document with all of my palaces from medical school.  I add things to it when I need to, and I can quickly search it for key words when I need to refresh something.  It has been a lifesaver and I hope that when you get past step 1, step 2, and graduate from medical school you have an amazing resource like this, that you’ve built for yourself over the years.

  1. What if I forget something in my memory palace?

I learned about the memory palace technique in a book called “Moonwalking with Einstein” by Joshua Foer.  It’s a great book and I encourage you to read it, or at least to watch his TED talk.  In that book, he says, “Our brains are programmed to find two things interesting and therefore memorable: jokes and sex.”  If you keep forgetting a certain image, go back and change it so that it is either funnier or sexier.  There will be things that you need for step 1, and that you just can’t seem to remember.  You’ll have to keep upping the ante, until you have things in your memory palace that you would never talk about with another human being.  That’s ok!  Your memory palace is just for you, and you never need to show or tell anyone your images.  As long as they help you remember, your images can be whatever you want them to be.  Do whatever you need to ensure that you remember key facts when it comes to Step 1.

 

  1. How do I put numbers in my palace?

Numbers are low-yield.  The memory champs use the “major system” or other elaborate number systems, but I have found that in medical school, numbers are very low-yield.  I do suggest having a working knowledge of the major system.  This is a system invented by Johann Winkelmann, where each number gets a phonetic sound.  It’s good to have knowledge of this system for the few times where you might need it, but overall memorizing numbers for Step 1 is a waste of your time.  The test will not frequently ask, for example, how many hours it takes for staph to reach toxic levels for food poisoning. But they will want you to know in general that staph and b. cereus cause food poisoning faster than other bacteria.

Bonus Question #6: How do I know what to put into the palace?  There’s so much stuff to memorize.

If you are trying to put every word of First Aid into a palace, you will fail.  Remember that your palace is to augment your understanding and help when you just can’t seem to remember a fact or a list.  If you try to put too much into a palace, it will be a cluttered mess that won’t help you on test days.

The first thing is to try to understand as much as you can about the disease states, so that you don’t need memory tricks.  Remember, boards writers create questions to tease out memorization from understanding and application.  Second, keep your memory palaces clinical and board-relevant.  Put elements in that you miss on practice questions – those are high-yield and will be meaningful to you specifically.  Finally, if you have an important concept that comes up repeatedly and is high-yield (e.g. whether a condition causes hyper- or hypokalemia) you should create a meme.  For me, hyperkalemia was Callie from Gray’s Anatomy and hypokalemia was a hippo.  I used them over and over in too many palaces to remember.  It has helped me many times on Steps 1/2/3, shelf exams, etc.

As you can see, the memory palace is a complex technique and requires some forethought, strategy, and practice.  I hope that this article gave you a solid idea about how to use the memory palace.  I’ll keep teasing out elements of the strategy on my podcast, and I’m always happy to answer questions you may have at info@sholamd.com.

 See you next time!

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