#8: Memory Palace for Cardiac Murmurs

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In this episode I will describe exactly how I built my memory palace for cardiac murmurs, and offer a bonus at the end for the people in my online course.

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So let’s talk about murmurs.  My first organ block of second year was Cardiology, and the cardiac murmurs memory palace was one of my most frequently used palaces.  This is very high-yield for direct questions on step 1, and also for overall clinical picture questions.  For example, they won’t ask you a question about aortic stenosis, or tell you a patient has a history of aortic stenosis.  Instead, they will describe the findings on physical exam, and you have to use the information about the patient’s murmur to answer a related question, like why is this patient having syncopal episodes?

So when I took Cardiology, how did I approach the material on murmurs?  How does a person create a memory palace?

Step 1: (Pre-Lecture) Identifying the Most Important Information 

Step 1 is to identify the most important information, like I’ve talked about in my 5-Part Study Strategy Planner.  If you didn’t watch the video about my 5-part study planner, drop me an email at info@sholamd.com and I’ll send you the link.  And sign up for my mailing list so you don’t miss out next time!

As part of the first step of my study strategy, I read the course notes before lecture.  I created flash cards as I read, using Anki – and I did this as I read through the very first time, when everything was novel and fresh.  Based on the lecture notes, I thought about the broad categories that naturally separate the material.  For example, in thinking about heart murmurs, there are two major divisions: systolic murmurs and diastolic murmurs.  Now, every school’s curriculum is different, so there may be things that fit into this category that your professor has decided to leave out of his or her lecture.  For example, when I learned about heart murmurs, the lecturer didn’t talk at all about Patent Ductus Arteriosus (PDA).  That came later, when we did embryology.  This inconsistency between different schools is where First Aid comes in.  

You’ll need to use First Aid to find out if there are placeholders that need to be in your palace – spaces that you kind of reserve knowing that later on, you’ll fill in that information when your school’s curriculum presents it to you.  So even though you might not be hearing about PDA right now, when you do learn about that murmur, there’s a place for it in the murmur palace.  If you miss it, that’s okay.  I’ve put things on the ceiling of my memory palaces, or hanging out a window.  But if you plan ahead, it just makes things easier. So those are the parts to the first step of my study strategy, Identifying the Most Important Information.  To recap, Step 1 includes reading the lecture notes, creating questions, and skimming First Aid.

Step 2: (Pre-Lecture) Organize the Material into a Framework

As I’ve said before, there are a few different ways to organize material into a framework, but my favorite is the Memory Palace.  So let’s really talk specifics.  Here’s an overview of how I built my memory palace for cardiac murmurs.  There are the systolic murmurs, the diastolic, and PDA, which overlaps the two because it is both systolic and diastolic.  

You’ll need to look at all the information that needs to be in your memory palace, and decide where you want to build your palace.  For me, with murmurs, I used an office building that I worked in right after college.  It had two major divisions with a bridging area, and the right number of sub-spaces for each murmur.

So I knew that I would put the systolic murmurs in the corner where the marketing staff used to sit, and the diastolic murmurs over by the conference room.  PDA was right between the two in a little room where we kept the promo CDs, because that’s a systolic and diastolic murmur.  By looking at First Aid, I knew I would need 5 rooms in the systolic area, two rooms in the diastolic area, and one connecting space for PDA.  That was five rooms in the systolic area – Aortic Stenosis, Mitral/Tricuspid Regurgitation, Ventricular Septal Defect, Mitral Valve Prolapse, and Hypertrophic Obstructive Cardiomyopathy; and two in the diastolic area – Aortic Regurgitation and Mitral Stenosis.  With PDA in the connecting space.  So once I had the overall map laid out, and knew which room I would use for each murmur, I started to fill in the details.

I hadn’t been to lecture yet, so I hit the high-yield: things that were in First Aid and also in my course lecture notes.  For Aortic Stenosis, for example, I put 5 buzz words into my palace: Crescendo-decrescendo, Ejection click, “Pulsus parvus et tardus”, SAD (Syncope, Angina, and Dyspnea on exertion), and Paradoxical splitting.  For crescendo-decrescendo I had my boss turning up and down the music.  Stay tuned to the end of the podcast when I’ll tell you how you can get access to the rest of my buzz words for the murmurs palace.

As I was doing this, I was documenting everything in Word.  It is so important to document your palaces.  Make sure you know what each visual trigger is supposed to signify, otherwise later on you’ll be asking, why was that supermodel running on a treadmill?  Also, when it’s time to study for boards, it will be so quick and easy to refresh the knowledge because you’ve written everything out.  Now, I can’t tell you my entire palace because I put a lot of inappropriate things in there.  Like, the boss was kind of an ass, so that was perfect for Aortic Stenosis (AS). That went in the boss’s office in the corner, which worked out well because it’s really the most important murmur, and it got the big corner office.  That is one of my milder images.  Remember images work better if they are funny, sexual, or profane, and I would always make my images more outlandish or dirty if I ever forgot them.  After a while, some of them were pretty graphic, and that’s okay!  This palace is just for you.  You can make it however you want, as raunchy as you want, as long as it helps you remember it at test time.

For those of you signed up for the Memorize More Medicine course, you’ll have access to a PDF that lays all of this out, along with the rest of my buzz words for each murmur type.  And there will be a few extra slides that I just want to touch on briefly.

Steps 4 and 5: Memorizing and Applying

You’ll see a concepts slide.  Having a vivid, well-organized memory palace only helps if you can back it up with conceptual knowledge.  I wrote a few ideas for questions you should be talking through with your study group.  These are things that aren’t well-suited for a memory palace, but that are high-yield for Step 1 and for the wards. The first one, for example, is “What happens to the pressures in the four chambers of the heart with each murmur?“  That’s something you can’t really put into a palace, but you need to understand it to really use your palace well.

Next you’ll see a slide with helpful mnemonics and “frequent friends.”  These are the recurring images that will appear in a few different places in your overall palaces, so it’s good to make them vivid and become familiar with them.  For example, Marfan syndrome is in my Aortic Regurg room.  He’s a frequent friend, so I have a single image, and use it every time.  For me, it was a patient who I saw first year and he was striking, with two rows of teeth, and classic Marfanoid appearance.  So every time that I have something related to Marfan, he’s there.  It’s easy for me to scan my palaces, across every organ system, and think about where I’ve seen him.  Aortic regurg, MEN2b, berry aneurysms.  When I get a multiple choice question on boards that deals with Marfan associations, this is easy for me.

And the final extra slide is practice questions.  I searched and found a good free online resource for practice questions on cardiology, and wrote down just the numbers related to murmurs.  If you remember my 5-part study strategy, practice questions are a key component.  So definitely use these!

I’ll be creating more memory palace templates as part of my online course, and sharing a few abbreviated versions in this podcast.  If you aren’t signed up for the course yet, please visit MemorizeMoreMedicine.com.  And if you didn’t know about the course because you’re not on my mailing list, visit sholamd.com to sign up.  At sholamd.com you can also see a transcript of this episode.

Thanks for being with me today.  I hope this podcast helped illustrate the mechanism for making memory palaces.  See you next time!

Listen to the podcast here!

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