In this episode I will address the question “What if I forget everything?” At the end you will be able to download “8 Tips for Long Term Memory” which you can use as a to-do list to optimize your memorization early on in medical school.
A slight tangent to start: I recently did a guest blog post at KevinMD.com, if you don’t read it yet, check it out. It’s a website where physicians discuss relevant topics, and it might give you some good talking points on your 3rd and 4th year rotations. Anyway, my post was the most popular of the week, which I’m just tickled pink about. It’s called, “A physician respects the low-yield. See how that changed her life.” It’s about how even though I obsess about separating high-yield from low-yield, including in this podcast, I still ultimately appreciate what the low-yield brings to my life. So go to KevinMD.com and check that out.
Ok, back on topic. A while back, I asked some medical students what caused them the most anxiety. I got this great response: “That I will forget everything the day after each exam, or that I will forget everything the day OF the exam, which would lead to missing the passing cutoff and result in remediation, ultimately leading me to a specialty I hate in the middle of Nowhere, New Mexico and being miserable.”
Wow. That sounds so familiar. That’s really the fear of most medical students. You are investing so much, and it would just be devastating to have something go majorly wrong. And we are learning so much, and along with that forgetting so much. Now, I love this topic. The science of memory is just fascinating. In college, we could get away with cramming. While I was at Harvard, I crammed with the best of them. I would stay up all night learning everything, then crash mid-afternoon after the exam, go out that night and dance the rest of my memories away. Everything was gone by the day after the exam. Medical school just does not work like that. Everything is cumulative. And think about it: do you want your mom’s doctor to be the goof-off who crammed cardiovascular the night before?
What this question is really getting at is the difference between short-term memory and long-term memory. Like I said, the science of memory is fascinating, but let’s keep this focused on what you can use immediately to memorize more medicine, faster. You need a way to create better, stickier, more meaningful long-term memories. I have eight specific suggestions for doing just that.
#1, and these are not in order of importance. Test yourself. I’m looking at a 2009 paper by Larsen and colleagues (http://www.ncbi.nlm.nih.gov/pubmed/19930508) called “Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial.” The researchers took two groups of residents. The first group took tests on status epilepticus and studied a review sheet on myasthenia gravis. The second group took tests on myasthenia gravis and studied a sheet on status epilepticus. When they tested the groups for recall 6 months later, the people who had taken repeated tests on a subject scored 13% higher than the people who studied the same review sheet multiple times. This is why flash card programs like Anki, which use spaced repetition, work well. Practice questions serve this function too. Whatever you are studying today, find a way to test yourself on it.
#2: Teach. Teaching is a form of active engagement, which has been proven to help create long-term memories. Research shows that teaching invokes the neural motivation and reward pathways. (http://www.ncbi.nlm.nih.gov/pubmed/21346504). I am a huge proponent of having a study group, never made up of your friends, where you are challenged to teach each other the material, especially concepts. Interestingly, this practice also reinforces learning for another reason: it creates stress.
That brings us to #3: Stress. You need to embrace and manage stress. Research has shown that stress can facilitate synaptic potentiation in the brain, which means that it reinforces learning. But too much stress will do the opposite. (http://www.ncbi.nlm.nih.gov/pubmed/24113652) Well, it’s actually much more complicated than that because new research shows that different kinds of memory can be helped or hurt by cortisol levels…oh, but see, I’m nerding out again. Don’t get too stressed, you’ll remember things better. Easier said than done, right? I’ll talk about stress management in a future podcast.
#4: Sleep. I know this is also pretty obvious, but I had to say it. Listen to this quote from Friedlander et al 2011: “There is increasing evidence of the importance of rest/sleep for the consolidation of memories and the enhancement of their representations from working memory stages into a long-term stable form.” Wow, isn’t that exactly what you need? It happens when you sleep. Ok, but if we accept that you are going to be sleep deprived, I mean, this is medical school, at least know that you can improve your performance by sleeping strategically. That same paper says that downtime is key between intense study sessions. So, for every 50 minutes of intense studying, take 10 minutes off to watch cartoons. Or study a few hours then take a nap. Those things help consolidate your memories.
#5 is the last lifestyle issue: Exercise. Argh, I hate to tell you these things because I sound like your mom, but I just want to present you with the actual evidence to compel you to take care of yourself in medical school, because it will actually help you do better on Step 1. Ok, exercise. I read two abstracts on this that just blew my mind. Radahmadi et al 2015. They took 70 rats and stressed them for 21 days so that they were chronically stressed, kind of like med students. Then, they broke them into groups. The group that was stressed and then ran on a little mouse treadmill did better on memory tests than the group that was stressed and then just got to rest. Wow! But there’s a trick. Another paper, Roig et al 2013, was a meta-analysis and found that acute exercise, meaning a 30-65 minute spurt, had moderate to large effects on long-term memory while chronic exercise had no effect. I love this paper, because it gives me an excuse not to exercise regularly. That’s not really what the paper said – they talk about the benefits of chronic exercise for memory processing but I’m not trying to hear that. 30 to 65 minutes of exercise right before an intense study session, and not every day but randomly. I like that, and you can use that today. (http://www.ncbi.nlm.nih.gov/pubmed/23806438,
Okay, moving away from self-care into some real med student kind of stuff.
#6: Break lists into chunks. (http://www.ncbi.nlm.nih.gov/pubmed/23746292)
Chunking is grouping information into clusters, which increases the capacity of your working memory and makes it easier for it to be transferred into long-term memory. This is the idea that if you need to memorize a number, like 25896438, it is easier if you remember two numbers, 2589 and 6438. Obvious. For the memory nerds like me out there, it’s interesting that there is debate about whether human capacity is 4 or 7 numbers, but I just read a cool paper from 2013 that shows that by using four chunks of four, you can increase working memory to 16 units. So for our purposes, that means that when you get a long list of the possible causes of pancreatitis, say, it’s best to group them into 4-member sub chunks.
#7 is Use mnemonics. Mnemonics work by linking new information with facts that are already in your long-term memory. There’s actually a service called Picmonic (http://www.ncbi.nlm.nih.gov/pubmed/25933070) and I just read one of their research papers that found 208% increase in retention at 1 month post-learning when students used their system. That sounded pretty great but then I scrolled down and saw that the authors all had a financial interest in the company. Okay. I’m not sure what to believe there, but I definitely believe that mnemonics and memory tricks help.
But the golden child of mnemonics, to me, is #8, the memory palace. You have to learn the memory palace technique. You may have heard this called the Method of Loci or Sherlock Holmes called it his “Mind Palace.” I was reading a paper recently that said that 9 out of 10 people who compete in memory competitions use this strategy, and they do not have higher IQs than the matched controls. So the people who can remember the most stuff in the world use this. You know it is my promise to help you memorize more medicine, faster. This is the technique I used myself, and I want to teach the world how to use it too, so I have a video about it on my website sholamd.com. Please go there and let me teach you how to memorize everything and more importantly, how to make sure you don’t forget it. This is my secret weapon that helped me graduate at the top of my med school class. I know you are going to love it. (http://www.ncbi.nlm.nih.gov/pubmed/12483214, http://www.ncbi.nlm.nih.gov/pubmed/25039085)
Ok, I hope this podcast has helped answer the question “What if I forget everything?” I tried to give you some starting points for enhancing your long-term memory so that you don’t just forget everything you’ve learned when it’s time to take step 1, take your shelf exams during third year, or take care of patients as a resident and practicing physician. You can download these 8 tips as a PDF that you can refer back to, in the show notes on sholamd.com. I put a few extra thoughts in there, and the Pubmed links to the papers I referenced too. Think of this tip sheet as your to-do list. If you put each of these 8 elements into practice, you will be far ahead of the pack when it comes to exams and boards. If you have a comment or question reach out to me at sholamd.com. I will see you next time!