AUTHOR'S NOTE: Congratulations to all of our MS2 who recently took the dreaded USMLE 1 Exam! Unfortunately, much of medical school is about memorization, and believe it or not, there is a science to memorization. I learned this from one of our students, Gabrielle Schaefer, MS2, who describes her experience meeting a 'memory champion' and picked his brain for some memory tricks for Step 1, including cartoon images. As I spoke at the Comics in Medicine conference in Chicago a few weeks ago, it seemed fitting for her to describe her journey.
Right around the time I was beginning an epic five-week studying stint to prepare for STEP 1 of the Boards, Joshua Foer happened to be a guest on The Colbert Report (my go-to 20 minute study break). Joshua Foer is this ridiculously young and talented journalist who won the U.S. Memory Championships (yes this exists). If his name sounds familiar you may be thinking of Jonathan Foer, his equally talented older brother who is also a writer.
Anyway, Joshua Foer was promoting his recently released book "Moonwalking with Einstein: The Art and Science of Remembering Everything." The book is about memory and his adventures in the world of memory competitions. Apparently there is a small group of people who get together each year and have memory competitions which consist of several memory "events" including faces of strangers, poetry, random words, numbers, binary digits, stacks of cards, etc. Participants wear noise cancelling headphones and blinders (think sunglasses with two little holes drilled out) to reduce distracters as much as possible. After attending the U.S. competition as a journalist he wound up being tutored by and English memory master and winning the completion the next year (the U.S. memory scene is not very developed, the Germans are much more serious).
Foer stressed that memory champions are not born with extraordinary powers of memory. They training themselves to use some established memory techniques and are constantly developing new ways on remembering things. This intrigued me since I wondered if I could use some of these techniques to master the overwhelming volume of facts needed for the Boards. I started reading his book and loved it. It's very pop-science quick read. When chatting with one of my best friends who was studying for the Bar, she says, "Oh Josh Foer is giving a talk at this spot in Echo Park this weekend, let's go pick his brain for ideas." (I studied in Los Angeles).
So we went, and I managed to get up the nerve to ask him for any advice. In the most bizarre coincidence, he tells me that his wife is also a second-year medical student studying for the boards (bet she'll do just fine!). Since visual mnemonics are big in the memory world, he explained that when making a visual aid, the funnier, scarier, raunchier, and stranger it is, the easier it is to remember. He recommended trying to enrich the image with as much detail as possible. He also explained that, though these images help you remember, thinking up good ones takes a lot of creative energy and can be exhausting. That's one of the things you work on developing when training for a memory championship, the capacity to conjure up rich, creative images really quickly. He signed my First Aid for the Boards, and I went home and started using that idea by making cartoons (a la Micro Made Ridiculously Simple).
He was right, creative effort is draining. Sometimes, it took forever to think of something that would stick, but the stuff I made cartoons for is in the vault! Here is an example of a visual aid I made myself for a mucopolysccharidosis, Hurlers. In this image there is a gargoyle (Hurler's causes gargoylism) hurling a ball (Hurler's). He has a dark spleen and liver (spleno- and hepatomegaly) and rain clouds for eyes (clouded corneas). He is also panting and gasping because of airway obstruction. What I love about this picture is that if I can remember one part of the image (one thing about Hurler's) the rest of the image (the rest of the facts) come back to me.
The other nice thing I noticed is that on a lot of Boards questions you narrow it down to two answers, but it's been a while since you looked at that material and you are 70% sure you picked the right answer. If I made a picture like this I was sure, clouded cornea's goes with Hurler's, not the related Hunter's disease. I used some other techniques from the book: the "memory palace" for biochemical pathways; the "major system" to remember lab values. While memory tricks don't lend itself to everything, it was really helpful for stuff that is difficult to reason through (lysosomal storage diseases, embryology).
–Gabrielle Schaefer, MS2
Thanks to Gabrielle for describing her experience! And who said doodling in class never got you anywhere?
Vineet Arora, MD, is a Fellow of the American College of Physicians. She is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist, supervising internal medicine residents and students caring for general medicine patients, and serves as a career advisor and mentor for several medical students and residents, I also direct the NIH-sponsored Training Early Achievers for Careers in Health (TEACH) Research program, which prepares and inspires talented diverse Chicago high school students to enter medical research careers. This post originally appeared on her blog, FutureDocs.