Medical Mnemonics: Suggestions to S8 I

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Mnemonics:
Suggestions
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By Ronald P. Fisher, PhO
the world the pterygomandibular raphe is or learning that the
capitis inferior does not
attach to the skull (I could have
sworn it did). Who cares about
those 7,486 persons in Johnny
Carson's audience? Why doesn't
sightful than they would like us
to believe.)
This article is a condensed
treatment of some of the most
effective mnemonics that can be
used by medical students to alleviate their pursuit of drudgery.
someone develop a technique
that we can use for learning important facts and names, like the
aryepiglottic fold?
Fortunately, all is not lost.
Psychologists,
as well as ordinary people, have known for
centuries about a host of mnemonics, or learning aids, that
Since space is limited, only a few
specific medical applications are
presented. However, the indus-:
trious reader should be able to
construct his or her own mnemonics from the general guidelines provided.
An expanded,
more complete version of these
medical mnemonics
will be
can assist us. Some of us tend to
cast aspersions on these mne-
available shortly in Fisher and
Goldberg's
Application
of
D
rudgery is having to spend
the next four years cramming an infinite
number of
Latin names-all of which have
a minimum of 17 letters-into
monics, claiming that they are
merely tricks: They permit immediate learning, but the learning does not last over long periods of time-at
least until
Learning
Theory to Medical
Education.
There are several universally
effective techniques that can be
applied at the time you are first...:,~':,,;
your hippocampus. Or is it the
reticular formation? Certainly
there must be a painless method
of learning all of those bones,
muscles, nerve pathways, drugs,
and so forth. What aoout those
memory tricks I've seen what'shis-name do on "The Tonight
Show,n where he remembers the
names of 7,486 persons in five
minutes? No, that's probably
OK for remembering Seymour
Goldman
(see more gold,
.,
man?), but It will surely never
work for remembering what in
medical boards are completed.
studying the material to help
In actuality, however, most of
consolidate
your knowledge.~~.~".
the mnemonics we know about
However, even after you have.;.
not only facilitate immediate
completed your reading of the
learning,
but also facilitate
textbook, there are some mainmemory over long durations.
tenance devices that you can use
Furthermore,
the techniques
to preserve the informat~on in
described here not only have the
your memory store. Finally,
support of some insightful old
there are some mental gymnaswives, but they have also been
tested empirically under rigorous laboratory controls. (When
The author is .-.Professor,
P~Chol?t gy, M
Fl forid ja
these laboratory controls are imD
r epartment o
ll U
.nternatjona
mcerSJ!/.
am .
plemented,
some old wives
Flolida.
prove to be considerably les.'iin-
..obliquus
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tics
that
you
can
perform
while
ceive
the
interrelation
among
may
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more
personally
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taking an exam to help retrieve
the learned information. I shall
treat these in turn.
the component parts, will facilitate your learning and remembering the individual components. The opposite kind of
ingful to you. In fact, the more
relevant you make the material
to your personal experiences,the
more e~fectiveyour learning will
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Organization
There are three basic principIes of learning that everyone
can and should apply when
studying text material: organization, chunking, and imagery.
Perhaps the most useful is organization, namely, understanding how various facts are just
different manifestations of one
learning, rote learning, in which
each fact is learned as an isolated unit, has the simplistic appeal of not requiring that one
learn additional information,
namely, the abstract principle
be.4 For exa~ple, if the spatial
array of the bones in the wrist is
very similar to a favorite abstract painting of yours, use the
painting as an idiosyncratic
technique to organize the wrist
bones. Since the painting has
personal meaning for you, it is
very unlikely that you will
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Th
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or
examp
e,
a
general pnnclple of muscle anatomy is that "when two muscles
o~erlap one another and run in
parallel, the shorter muscles
tend to lie deeper."! Learning
this one general principle obviates the need to memorize the
depth of each muscle separately.
Instead, you are left with the
simpler task of learning the
general principle and the few exceptions.
Another form of the mnemonic principle of organization
is to understand how various
facts are conceptually related to
one another, around some common function. In the medical
domain, note that the various
parts of the body are organized
around functional systems(e.g.,
the nervous system) or subsysterns (e.g., the autonomic nervous system), with common
goals and principles. Learning
the material in this fashion,
through an organizing system,
will prove to be more effective
than trying to memorize a set of
randomly ordered facts by rote.
In general, organized learning, in which the goal is to perStudent DOctor. Summer 1986
e
th
ree
b
.forget
a8tC
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pnn~ples oj learmng are
organization, chunking,
and imagery
around which the various facts
can be organized. Therefore, if
you try to learn the material by
rote memory, it will seem as if
there were less to learn. However, you will soon find that, as
the number of facts increases,
rote learning becomesmore and
more difficult. By comparison,.
organized learning is relatively
unaffected by the number of
facts that must be remembered.2
Furthermore, facts learned under a rote systemwill be forgotten faster than those learned
around some organizing principIe. Therefore, the time spent
learning the organizing scheme
will more than payoff in the
long run, especially if there are
many related facts to be
learned. 3
You should feel free either to
use the organizational scheme
employed by your textbook or
professor or to develop one that
it over
th
the
f
next
h
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you
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few
ld
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of Its mnemornc potentIal. In
practical terms, this means that
you will have to search actively
for some of these organizing
principles, especially the idiosyncratic ones, since they will
not be presented directly in the
text or lecture. This will undoubtedly require more effort
when studying on your part,
but, in the long run, developing
an effective organizing scheme
will promote more efficient use
of your time.
Chunking :.
The second general learning
mnemonic is chunking, or abbreviation. It is based on the intuitive.precept that it is easierto
learn one fact than many facts.
Thus, the goal of all chunking
mnemonics is to reduce the total
number of pieces of information
to be learned. This can be done
in a variety of ways. Probably
the most common method is to
combine the initial letters of
several related words to form
one organizing word. For exampIe, the three leg muscles that
are responsible for plantar flex-
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ion of the ankle are the GaSP
(gastrocnemius, soleus, and
plantaris); and the suprahyoid
muscles, a rather messy affair,
..always
SMuDGe (stylohyoid,
mylohyoid, digastric, and geniohyoid). As a last example,
note how the layers of the
SCALP (skin, connective tissue,
aponeurotic layer, looseconnective tissue, and pericranium)
take the drudgery Ot¥ of learn,.ing
all by themselves.
,~,~~:~-,?'. This specific technique will be
most. helpful. when you a~e
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learrnng short hsts of three to SIX
,
related concepts. Longer sequences will often not lend
themselves neatly to the formation of convenient words. Yoa
can sometimes circumvent this
problem, however, simply by
making up a short two- or threeword phrase with the available
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letters. For example, to remem"':_~~"!
ber the muscles involved in
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chewing, think about chewing
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properly when eating a MeaT
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MeaL-the chewing musclesare
the masseter,temporalis, medial
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pterygoid, and lateral ptery:::-';...;
goid. If the letters do not fit
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neatly into a short two- or three.'::~' ';
word phrase, try a slightly
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longer meaningful sentence.For
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example, to remember the car...' ~j
pal bones, use Goldberg'slrisque
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sentence: Scared lovers try posi, ..i
tions that they cannot handle
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(scaphoid, lunate, triquetrum,
;
pisiform, trapezium, trapezoid,
;
capitate, hamate).
.;
These chunking mnemonics
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will prove useful if you are given
j
the mnemonic or can construct
!
one without much effort. If an
!
appropriate chunking mneI
monic does not come to mind
~~
18
quickly, however, it is probably
a waste of precious time to spend
too long trying to construct one.
Imagery
The third helpful rule of
learning mnemonics is to try to
incorporate visual imagery. Psychologists know that pictures are
easier to remember than words,
and that instructing people to
centrate on the mental image
you are constructing. Keep the~~;~;::~
image in mind for five to ten sec-:!;:,;~:.:.;,-onds before proceeding to the
new learning. Images learned in
this fashion will virtually never
be forgotten.
More frequent, but shorter
d'
stu y ses~ons are
more efficient than
fewer long sessions
try to mentally picture events
improves their learning.s Therefore, when you create your own
mnemonic, try to generate one
that is easily visualized, as opposed to one that is abstract.
There is a myth that the more
bizarre the image is, the easierit
is to remember. It has beendemonstrated, however, that bizarre
images are no easier to remember than ordinary images.6,.j"
Therefore, just construct an image that is clear and not terribly
confusing.
Next, make sure that you visually imagine the scenario you
have just constructed. That is,
you must actually seeit, not just
think about it. For example, in
the GaSP mnemonic just mentioned, try to mentally picture a
man standing on tiptoe (plantar
ankle flexion) and gasping. You
will find this easiestto do if you
simply close your eyesand con-
Overlearning
Now that you have learned
the material thoroughly, what
can you do to prevent yourself
from forgetting all of those
facts? One obvious solution is;:;i~.f,.;~~
simply to rere~.dthe text. .'~ut,"
you may ask, how many times
can I read the same material? I
have already memorized it perfectly." First, there is no such
thing as having learned something perfectly. Even when you
think you have memorized a passageperfectly, you can profit from
further study (overlearning).
How can you know something
better than ..perfectly"? Need I
remind you of all those occasions
when you thought you knew the
material perfectly after having.~~~~.
read it, but drew a blank when
the test question appeared?
"OK, so I'll read the text a few
times.
Shorter Study Sessions
Does it make a difference
when I schedule these learning
sessions,or is ten hours of studying the same whether I do it in
two five-hour sessions or five
two-hour sessions?"It definitely
doesmake a difference. Youwill
almost always find that more
frequent, but shorter, study sessions are more efficient than
fewer long sessions.(This is particularly true in learning isolated units of information, like
Stud!.'nt DOctor.
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specific names. Larger groupings of conceptually related material will require longer sessions, since you will have to
learn not only the details, but
also how the material is conceptually organized.) In fact, you
will probably find that, if you
schedule the sessionsproperly,
you can learn more in less total
time. For example, you are
likely to learn more by scheduling four one-hour sessions
than in one massive five-hour
session.
In general, I recommend
studying for not much more
than one and a half hours before
taking a break. Before you leave
the studying for your break, it is
a good idea to- mentally review
what you have just read, just for
a few minutes, since that will
help to consolidate your knowledge of the material.
Periodic Review
One of the most effective
techniques that you can employ
to retard the forgetting
of
learned material is to periodically review it mentally. That is,
recall to mind, every once in a
while, some of the knowledge
you have acquired in the past
few days. This does not have to
be a formal session, but can be
incorporated into the little bits
of time that we have free every
day, as when waiting for a traffic light, taking a shower, or sitting through a TV commercial.
The act of trying to retrieve this
knowledge will effectively
strengthen it-even more than
an additional study session7and will also serve to warn you,
before the examination, of areas
StudentDOctor. Summer 1986
in which you need more review.
Testyourself, or have a friend
test you on the material you
have learned. This should be
done not only just before a major examination, but on a regular basis. This self-quizzing also
serves as a knowledgestrengthening device. Again, as
with the mental reviews, you
can work thesemini-quizzes into
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Test yourself on matenal
you have just learnedthis self-quizzing is also a
knowledge-strengthening
d .were
ev~ce
help dredge up all that stored
knowledge when it is required,
as in examinations? Part of the
solution will depend on how you
learned the material. If it was
learned in rote fashion, then an
effective retrieval technique is to
try to mentally reconstruct the
physical and psychologic context
in which you originally learned
the material.s For example, try
to remember where you were
studying, whether in the library
at your kitchen table, when
you originally learned the material; or, try to remember what
mood you were in at the time,
if you were happy or even if you
tired or upset.
If you learned the material by
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those little bits of time that
would normally be wasted.
As a final, very powerful but
somewhat time-consuming preventive against forgetting, try to
prepare a lecture on the learned
material. You don't have to actually give the lecture to an audience; you can present it to
your bedroom wall with equal
organizing it around some
meaningful concept, then, in
addition to reconstructing the
original learning context, you
can often figure out the desired
information from your knowledge of the related material.9
That is, you can sometimes figure out how a component of a
system works by knowing how
the other components of the systern operat~ and by knowing the
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effectiveness.However, you will
no doubt find that the act of preparing a lecture will force you to
organize the material and will
thereby consolidate it. All teachers will testify that they know
the lecture material more thoroughly after having presented it
than before. (There's probably
something about making a fool
of yourself in front of your students that alsoservesasa powerful motivator.)
Retrieving Information
Finally, what can be done to
goal of the System.For example,
knowing that flexors and extensors work in pairs will allow you
to figure out the function of the
biceps brachii (elbow flexion) if
you know that it is paired with
the triceps (elbow extension).
Note that this ability to figure
out or construct knowledge from
related information, as opposed'
to simply memorizing it, can be
attained only when you have
originally learned the inform ation as an organized set of interrelated facts. When you learn
the information in rote fashion,
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Summar
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As
quick
a
effective
construct
1 d
now
e
it
quent
long sessions.
To minimize
.HierarchIcal
orgettmg,
try to rehearse
mentally
at intervals
during
the day.
y
Finall
refresher,
learning
.3. Bo,;er GH" Clark MC, Lesgold A)'I, et al:
retrIeval schemesin recall of categorized word lists. Journal of Verbal Learning and.::..~
Verbal Behavior 1969;8:323-343.
f
ge.
the
most
techniques
duce
are
when
Y OU need
to
P ro-
4. RogersTB, Kui.per NA, Kirker. \\'s: Sel.f-ref-
,
erence and the encoding of personallnformauon.
the
information,
construct
the
try.
original
to
re-
learning
5.
Paivio
A:
Holt,
Rinehart
..York.
those
that
(lookmg
tween
.:
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use
for
organIzatIon
facts)
be-
chunking
total
(reduc-
Information
codes),
(
constructmg
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mo r e
studying
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sort,
to
related
help
figure
and
make
general
out
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knowledge
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material
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Verbal
A
Scientut
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Processes.
1971;
a mnemOniC
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and the paradox
of interference.
chology
1978;10:438-464.
re-
SOMA
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J Exp
1983;9:130-138.
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2. Smith EE, Adams N, Schorr D: Fact retrie,'al
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New
102-103.
Geiselman RE, Fisher RP, ~lacKinnon DP, et
al: Eyewitness memory enhancement in the police
intervi~'v: Cognitive retrieval mnemonics versus
hypnotISm. J Appl P31jchoI1985;70:401-412.
9' FIShernn
. aI
"" Cuervo A :" ' I emory for phYSIC
features of discourse as a function of their rele-
References
Goldberg S: CliniCal Anatomy ,\fade Rld,culowl y Simp le. Miami, MedMaster, 1984; 26.
but
h
er
GH
and
& Winston,
1971;10:562-567.
.8.
Im-
learned
in frequent
ower:
Imagery
7. Hogan RM, Kintsch W: Differential
effects of
study and test trials on long-term recognition and
recall. Journal of Verbal Learning and Behacior
imagery
1
B
American
Into
and
a ges) .The
.~:
any
"
smaller
,
environment
mterrelations
J
Pers Soc PsychoI1977;35:677-688.
"II/.I""IIII),I"'."""""",I'II'f.
"'Ie,n
Cogn]