#3: Mnemonics (or, How Can I Possibly Learn All this Material, Part 2)

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In this episode I will continue to address the question “How can I possibly learn all this material?” by talking about mnemonics.

As you know, it is my promise to give you something in every episode that you can use immediately to memorize more medicine, faster.  In the last episode we talked about reducing the volume of material you have to learn, and I gave you a guide with tips on how to use First Aid the right way.  In this episode I am giving you a tip sheet with my best ideas for finding and creating medical mnemonics.

So we started with this question “How can I possibly learn all this material” and in the last episode I said that you can either reduce the volume of material, such as by using First Aid to separate high-yield from low-yield, or you can increase your ability to absorb and retain that material.  That’s the goal of mnemonics.  Mnemonics are simply memory devices, and have been used by medical students since the beginning of time.  To go deeper into the theory behind it, mnemonics actually help you move information from short-term memory to long term-memory.  There’s a whole science behind memory that you can really nerd out about but for today let’s just focus on what you need to know to increase your medical school success. 

Here is my best tip about mnemonics, and one that I learned by trial and error and want to share with you to save you from having to figure it out on your own.  I call it the first golden rule of mnemonics.  And here it is. Always make your own mnemonics.  It’s so important I’ll say it again.  Always make your own mnemonics.  The reason is obvious – because it will stick better – but I want to share a story with you as well.  My dear friend in medical school, I’ll call him Matt.  I saw him after class one day and he was super-excited because he had just paid, paid money, for a service that makes picture mnemonics for students – I don’t want to say the name because I have nothing against them but you probably know who I’m talking about.  Anyway, this was at the beginning of the block and he ended up failing that block.  Matt’s story to me was a huge red flag, kind of like a reverse testimonial.  Now I know that maybe he would have failed anyway or maybe he bought those picture mnemonics because he was struggling already.  But the point remains, it didn’t work.  Now, there are published papers showing that a visual mnemonic system does work, but if you look at the disclosures in those papers, you’ll see that they are funded by the company that sells the visual mnemonic system.  Oh my goodness!  The fact is, you’ll retain more if you make your own mnemonics.

That said, you are trying to reduce volume, and spending two hours a day making acronyms is not a great use of your time.  I think it’s okay to look up some inspiration online.  But you need to follow what I call the second golden rule of mnemonics.  If you need to hear it twice, throw it out.  If you look up a mnemonic and think it’s great, but then the next day you can’t quite remember it and have to look it up again, just forget about it.  Throw it out.  It’s hard, but you have to do it.  It wasn’t sticky enough, period.  If it didn’t stick now, it’s certainly not going to be with you when you need it for Step 1 down the line.  Go back to rule #1 and make your own.  Now that’s not to say that learning mnemonics doesn’t require repetition, but the mnemonic itself should be sticky.  For example, if you have a mnemonic for the 12 cranial nerves, like mine is “Oh oh oh to touch and feel a girl’s very soft hands,” it may take some practice to remember what each of the letters stand for, you know is the first one olfactory or oculomotor?  But the mnemonic itself – the sentence – should stick.

Ok, now that we’ve established some ground rules, I want to talk about the four most common types of mnemonics that medical students use.  I’ve turned this into a “mnemonics tip sheet” which I posted on sholamd.com under the show notes.  I would download this and refer to it when you are studying and have a longer list of things you need to memorize. Hopefully it will give you some inspiration and some ideas.

#1. Acronyms and Sentences.  This is the classic for medicine. 

  • Example: the acronym SIG E CAPS for the depression criteria or the sentence I talked about before, “Oh oh oh to touch and feel a girl’s very soft hands” for cranial nerves.
  • Tip: If a list can be memorized in any order, use an online Scrabble helper to create the best word.  The way this works is you look at your list of say 5 things, and pick a letter that would best represent each one.  Then enter those into the scrabble helper with a question mark for a wild card letter.  The scrabble helper will spit out a bunch of ideas for words you could use, and since you have the wild card, it will help you figure out if you could make a small change to the letters and get a better acronym.  I always like examples, so I’ll give you a personal one. For my nutrition course, I had to memorize the risk factors for low birth weight.  The list was 
      • a mother who was underweight before the pregnancy  
      • a low pregnancy weight gain in women who are underweight or normal weight  
      • iron deficiency anemia early in the pregnancy  
      • certain maternal infections   
      • TAD use during pregnancy  
  • So I picked a letter for each one: U for underweight, G for gaining too little, I for iron deficiency anemia, I for infection, and D for drugs.  I entered these into the scrabble helper.  First problem – two I’s.  That’s never good in a mnemonic because you’ll get confused.  So I changed iron deficiency anemia to A for anemia.  By playing around with the scrabble helper, and being flexible, I created the mnemonic WAIT –  weight of the mom, anemia, infection, TAD.  
  • Caution: Avoid ABCD mnemonics, they are overused.  They all start to blend together.  I can probably think of five off the top of my head – there’s the ABCs of resuscitation, ABCD of reading a chest X-ray, ABCDE of melanoma, I don’t know, I could go on.

But let’s move to #2. Images.

  • Example: Localizing the Weber and Rinne hearing loss tests.  For the Weber test, the W looks like hair at the center of the head, while the R for Rinne looks like earlobes on the side.  If you want to see this visually, download the tip sheet at sholamd.com.  First Aid has a great image for the toxicity of chemo drugs.  Visual things just tend to stick in our minds better.
  • Tip and caution: you can pay for a graphic mnemonics service, but it is always best to make your own images.  If you can have a story to go along with it, even better – that’s called a memory palace.  I am creating a whole video series about memory palaces on my site, so be sure to check that out.

#3. Rhyming

  • Example: Nose, Hose, Fingers and Toes for where to avoid injecting epinephrine.
  • Tip: setting the mnemonic to music makes this work even better.  I remember there was this super-old hair metal band called Nelson, and they had a song “I Can’t Live Without Your Love and Affection.”  I converted that to “I Can’t Live Without my adrenal glands” and I still remembered it 4th year, so when the attending asked if anyone knew the name of a disease where your adrenal glands are completely absent, I had it – “Nelson’s syndrome.”  Everyone thought I was some kind of genius.  So songs work.

#4. Associations with real people or patients

  • Example: Lance Armstrong and testicular cancer.
  • Tip: Wikipedia is a great reference when you get stumped.  Almost every disease has a famous spokesperson.  You can picture them, associate the disease and various disease characteristics with that person.
  • Caution: If you use your own patients as associations, which is great because it really brings it to life, don’t write down names or discuss it with classmates.  This is a violation of patient privacy, and also it’s just not nice.

I’ll finish today with four lessons I’ve learned by making tons of mnemonics during medical school.  

First, a clever mnemonic does not replace understanding the concept.  Students make the mistake of thinking that having a list memorized will be enough to get a question right on a test.  Your professors know the tricks too, and if you are graded on a curve remember everyone else has the list memorized – they are all high-achieving med students just like you.  You need an edge, and that edge is knowing the concepts really well too.

Second, write out your mnemonics somewhere.  This will save you tons of time later.  Some people do it in First Aid, which as we talked about last time is the only thing you should write in the margins of that book.  I recorded mine in my flash card program.  Just make sure you have it somewhere because in a few months, you might need a refresher.

Third, numbers are generally low yield.  I spent so much time memorizing numbers.  If I had three questions on my entire Step 1 exam where numbers were in the multiple choice answers, I would be surprised.  

And finally, if you know something is really important, obscenity and shock work the best for making something stick.

Ok, I hope this podcast has given you some ideas about how to use mnemonics to increase your absorption and retention.  I created a “Medical Mnemonics Tip Sheet” summarizing what we talked about today, and you can download it from the show notes on sholamd.com/3download.  Start using this today – if you are struggling to remember something from a class, try creating a sticky mnemonic on your own.  It works!  If you have a question you’d like me to address, let me know at info@sholamd.com.  See you next time!

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