There are many tools I’ve used this past semester to study and help remember content to pass exams. With one week (now one day as I edit this) to next semester, let’s crack open the toolbox and see what worked. There’s a science to science but there’s also a science to studying, remembering, learning, and passing exams. So let’s tear apart note-taking, what makes a bad mnemonic, and the logic behind flashcards. Maybe I can uncover some new and insane way to help remember information (spoiler: I have).
Let’s talk.
StoryNotes
So here’s what I call StoryNotes: I take a PowerPoint deck (or any information) and process it. As a whole, how many sections does it include, what is going to fit nicely into a table, what is going to need some mnemonics to remember, etc. And then I just type it into plain language and try to maintain it like a stream of consciousness. It’s informal, self-aware, full of jokes, mnemonics, and observations. Even though I make these mainly for myself, I type like I’m teaching the information which is the best way to learn. If PA school is harnessing water from a firehose with a coffee straw, this is my way of getting rid of that water as fast as possible in bite size chunks, and using the fire hose to water the plants, if you will.
StoryNotes have another big benefit. The creation of something I can refer back to in the future if really valuable and has paid off already. You can’t really revisit Anki cards in the field. Here’s an example of StoryNotes.
The gold standard for me would be to create my notes before class so it’s like “Okay, this is my take from this content, now let’s reconcile it with what the professor has to say and maybe, just maybe, I can participate in class a little more and understand more.” Because that’s my biggest weak point: really understanding what is in front of me and being able to talk about disease processes as a whole. So that’s my #1 goal for the Spring. I don’t think I can pull this off for every single class, but I’ll try my best to do it for CMPP (my main class).
So StoryNotes are sort of the first pass of studying. What comes next, the real crux is the actual studying which for me is Anki. At the core it’s really just free recall and spaced repetition.
Enter the Matrix
Probably the most profound tool I’ve come across are tables within Google Docs, what I call Matrices. Now, I don’t handwrite my notes, but a powerful benefit of handwritten notes is spatial recall; you remember where and how large on the page the information is. Matrices work in a similar way. If you are comparing some disease processes, putting them all in a table so they can compare and contrast and live next to each other just works wonders. It helps narrow down multiple choice questions. If you don’t remember “What is” you might remember “What’s not” and that could get you the point.
Upon studying for finals, when going over Acute Bronchitis, Bronchiolitis, and RDS of the Newborn, my mind traveled right back to the matrix I made weeks and weeks ago. I didn’t remember everything but I remembered the big picture stuff. Just like with a Memory Palace, I can’t think about some of these concepts without thinking about the location in the tables. It’s pretty wild stuff. Here are some examples of Matrices from this semester:
Acronyms
I think the most infamous acronym mnemonic I’ve come across is: CLUBBING, which “spells” out the causes of digital clubbing:
Cyanotic Heart Disease, Cystic Fibrosis
Lung Cancer, Lung Abscess
Ulcerative Colitis
Bronchiectasis
Benign Mesothelioma
Infectious endocarditis, idiopathic pulmonary fibrosis, idiopathic, inherited
Neurogenic Tumors
GI Diseases: Cirrhosis, Regional Enteritis (Crohn’s)
At first glance… it looks like an absolute mess, but it’s actually not as chaotic as it appears. The second B meaning “Benign Mesothelioma” is so bad it’s good and actually quite memorable. The cool thing about acronyms is that you can encode whatever you want in each letter. “B” could make you think of honey which could lead to an H word.
The most important question here is… well how do you learn this acronym? You can either learn the entire thing all at once, learn each of the 8 terms separately, or put it into bursts or runs. The problem with learning the entire thing all at once, is I can master 6/8, but if I keep getting caught up on “Benign Mesothelioma” I have to keep repeating the entire flashcard, and that’s wasteful. Learning 8 separately is probably the best: “Hey, here’s the other 7, but one is missing, what’s missing and how does that fit into the other 8?” I opted for a hybrid approach and broke it runs of 3, 3, and 2. The value to an acronym, besides telling you there’s 8 in total and giving you the first letter, is to always present and recall the information in the same order. So this process worked and I got the exam question correct. Here’s what the Anki card looked like:
One acronym mnemonic I created that I’m particularly proud of is for the functions of the liver. The liver does… a lot. At first I had a bunch of image occlusions on the slide of the functions, but it just wasn’t working because I wasn’t reciting the functions in the same order every time. I could have tried doing it in sequential runs, like with CLUBBING, but I realized this was really important to know long-term, so I did something else.
I created both an acronym and a memory palace / story to go with it and I even embedded mnemonics within mnemonics. So my “cardinal” acronym was: ABUStIES. I’ll see if I can recall what they all stand for right now, months after I’ve seen this content:
A = Angiotensinogen
B = Bile & Bilirubin
U = Urea Cycle
St = Storage of CV-GIF
C - Copper
V - Vitamins? Yes, but A, D, K, B12
G - Glucose (as Glycogen?)
I - Iron
F - Fiber Fats
I = Immune Factors
E = Excretes Waste
S = Synthesizes ACT
A - Albumin
C - Clotting Factors
T - Thrombopoietin
Okay so I recalled almost all of that, just mistaking Fiber for Fats, and missing which vitamins. I recalled part of the memory palace to complete it. Adding in CV-GIF and ACT also didn’t slow me down at all. This is pretty powerful stuff. It’s worth noting that I included “St” along with “S” to not confuse the two S words. This does create the possibility that I might think the the “t” of “St” could mean another item starting with “T” but I’ve never gotten tripped up on that.
So this is like a “super mnemonic” because it combines two methods and I think it’s almost completely full-proof and obviously long lasting.
Acrostics
I talked about acrostics a bit in my last blog but they’re worth mentioning here. Notable examples I’ve encountered:
She Always Likes Friends Over Papa, Sister and Mama, the branches of the external carotid artery
TOSS My Gravy Spoon, Darling, the infra and suprahyoid muscles of the neck
Ooh, ooh, ooh to touch and feel very good velvet, such heaven (or any of the dirty variations), for the cranial nerves
With infinite respect to their authors, these are all… really bad. EDIT: I’ve been thinking about my wording here. My phrasing admittedly is a bit sensationalist. I think it’s important to make a clarification here (and I also feel bad and don’t want to offend anyone). I don’t have a problem with these mnemonics, and if you Google them you can find them all over the place. What’s most interesting to me is how often do we evaluate silly mnemonics like this? Who wrote them? Who cares? To me, the science of mnemonics is incredibly interesting but also incredibly niche. So I think there’s a lot of value to take a step back and say “Hey, is there a way to rewrite these mnemonics to make them more effective?” Anyways:
During this semester I rewrote the first two:
I changed this first one to ST-AP FA-LING Out-Of PA, St. Max, which is kind of a hybrid acronym/acrostic. ST: Superior Thyroid, AP: Ascending Pharyngeal, FA: Facial, LING: Lingual (this and facial are “switched”), Out Of: Occipital (Two Os make me think of eyes = occipital), PA: Posterior Auricular, St: Superficial Temporal, Max: Maxillary.
I kept TOSS which stands for Thyrohyoid, Omohyoid, Sternothyroid, Sternohyoid but pictured the first two sitting on top of two Sterno burners. The second part stands for: Mylohyoid, Geniohyoid, Stylohyoid, Digastric which I turned into: My Genie’s Stylin’ Digs or My Genie’s Stylist Digs Bellies (because digastric has two bellies). Notice how similar those words are to what they are representing. Swapping “Gravy” for “Genie” to stand for Geniohyoid is a no-brainer.
I hate the cranial nerve mnemonic so much. The first three words are the exact same! The cranial nerves are so important to remember, I created a memory palace using the layout of Dunder Mifflin from The Office. Even six months after its creation, I remembered almost all of it.
There’s one I created for the hormones of the Anterior Pituitary that I’m proud of: The Flute Lute Theater Act Professionally to Grow to Milan.
As you can see, the secret with acrostics is to make the words as similar as possible to the words they represent. That’s huge.
Term vs. Definition
When making a flashcard, there are two big questions: Do I answer the term or the definition or both? For example: Side 1: A localized suppurative staphylococcal skin infection originating in a gland or hair follicle. Side 2: Furuncle. I usually keep it in that fashion, and answer the term instead of reciting the definition. But what about this one: Side 1: Early varicella, herpes, poison ivy. Side 2: Examples of Vesicles. For that one, it’s probably in my best interest to list the three examples of vesicles. I might just start associating “poison ivy” with vesicles and miss “early varicella” on an exam question. However, I think that takes up too much processing power. As long as I read the entire question and definition, it should be fine.
Here’s another example. Side 1: Pt presents to the clinic with abnormally deep, regular, "sighing" respirations. What kind of breathing is this? What could they have? Side 2: This is classic Kussmaul. Causes are DUMP: Diabetic Ketoacidosis (DKA), Uremia, Metabolic Acidosis (Three acidic conditions) Pneumonia Which actually can cause respiratory alkalosis, along with Sepsis. Sick = fever = tachypneic = blowing off CO2. Again, it would be easier to list the causes first and answer with the term, but I chose the hard way. I think the important thing here is to try and make connections and not make the seemingly arbitrary list not so arbitrary.
Cloze Clues
There’s another really interesting question that I’ve been playing with, and that’s “How much of a hint can I get away with?” Here’s an example:
ABX indication for pts with acute cholecystitis:
{{c1::Elevated WBCs: If WBC >12.5}}
{{c1::Fever: Clinical findings of Temp >101.3}}
{{c2::Air in GB or GB wall - Perforation!}}
{{c2::Elderly or Immunocompromised}}
So I see that I need four different things (and risk recalling them in a different order each time) But what if I rewrote this card as:
{{c1::Elevated WBCs: If WBC >12.5}} (LAB VALUE)
{{c1::Fever: Clinical findings of Temp >101.3}} (VITAL SIGN)
{{c2::Air in GB or GB wall - Perforation!}} (RADIOLOGY FINDING)
{{c2::Elderly or Immunocompromised}} (AGE / PATIENT POPULATION [2])
Is this going to inhibit my learning? My hypothesis is… probably not. I’m still recalling the answers but I think I’m cutting out the unneeded brain power. I actually think every Cloze should have an associated context or hint.
Here’s another example I’ve been playing with:
Within the context of Acute Liver Failure: So the cause of thrombocytopenia is due to something called {{c1::splenic}} sequestering OR: splenic {{c1::sequestering}}.
“Due to something called” is very generic. If I left it at that and had to recall “Splenic Sequestering” as a whole I’d probably have to look at that card quite a few times. Why not just present half of the answer? I think as long as I am recalling part of the answer, I’ll still remember it.
Memory Palaces / Roman Rooms
For the record, I’m editing this blog on vacation in Rome. Today’s my off day as I spent yesterday hiking the 200 steps of the Petraio in Naples, a neighborhood built around a massive staircase, up to Castel Sant'Elmo where I was met with an incredible view of Naples, Mount Vesuvius, and the Tyrrhenian Sea. I’m in my hotel room now, a Roman room, blogging about the Roman Room. That’s pretty neat.
I spent a lot of time in the year prior to my PA studies on memorizing the Top 300 prescribed medications. I did this more as an experiment in memory rather than to prepare for school, but it’s paid off in spades. I haven’t tried recalling the entire thing since the Summer, but I still remember almost every single one whenever one presents itself in class. And the other thing is that it’s impossible for me to think of a medication and not think about the location where I last left it. They’ve now become one in the same. My memory palace has helped me with quite a few exam questions and has helped me learn the context of these medications quite a bit. The other amazing thing is that I can add to it… now that I’ve learned more about Lisinopril (Zestril, Prinivil) which is the desk in the front room of my parents’ house. This desk is now in my apartment, but I think about the location that it used to be, rather than where the desk is now when I recall Lisinopril. I was able to mentally put a stack of bananas on the desk and think about a person swelling up as well to remember that the medication causes hyperkalemia and angioedema.
I’ve only created a couple of fully baked Memory Palaces in PA school, but they’re still handy when I need them. The most infamous for me is for the entirety of what we needed to know for vaccines. I used the layout of our PA studies building. The best part about it was that it was fun. It was active. I looked at the slides of what we needed to know and was filled with existential dread. There’s a lot of power in pulling out the Uno reverse card and saying “You know what, I’m going to make you the most fun thing to learn ever.”
I have the layout of my apartment in my back pocket in case a particularly nasty concept presents itself. You can encode in insane amount of information in the place where you live.
Numbers
The greatest challenge and barrier to memory so far in PA School is arbitrary numbers. Luckily, my program doesn’t make us memorize medication dosing (since they can be looked up) but there are a bunch of numbers we still need to know:
Years (vaccinations, houses for asbestos, etc.)
Volume, like the amount of CSF in the brain, in mL
Length, like the size of the aorta
Scales such as BMI and hypertension
Age ranges like for screenings, childhood development, etc.
Time, like the amount of time that has to elapse for hospital acquired pneumonia, post-op ileus, DVT risks, etc.
Frequency, like how often to get a mammogram, colonoscopy, etc.
Amounts like salt, alcohol, calories, fat, etc.
It’s… a lot and really tough to remember.
I’ve heard some people create an image for every number from 1-100. So if 35 was a camera lens, and 70 was my grandfather, I’d associate my grandfather and a camera lens for the ages of a diabetes screening. But you need 100 images, and have to memorize all of them before you can start applying it.
There’s another system called the Major System that converts numbers into sounds. The general idea is:
1 = t,d (both letters have 1 downstroke)
2 = n (has two downstrokes)
3 = m (three downstrokes)
4 = r (R kind of looks like 4 backwards, is the last letter of fouR)
5 = l (roman numeral for 50)
6 = soft g/j (looks like an upside down 6), sh, ch
7 = k/c (looks like two sevens stuck together), q, hard G
8 = f (cursive f looks like 8) or v
9 = p/b (mirror image of 9)
This one sounds insane, but requires much less up-front effort. Let’s see if we can apply it. So let’s say I need to remember 18-79 for the ages for Hepatitis C screenings. I would create the sentence Taffy Cup, maybe you get Hep C from licking a bunch of taffies in a cup. The first two consonants of Taffy are T and F, which is 18 and the first two of Cup are C and P which is 79. That’s… actually very cool. This is absolutely the kind of insane stuff I’d be into.
HIV screening ages are 15-65. Tall Jill. So I’d just remember Tall Jill or think of a tall person named Jill with HIV. I really, really like this. The cool thing too is 15 can just now become “Tall” every time. I can come up with a library of words so I don’t have to think of new ones. I mean, unless that becomes too unwieldy. Like anything with 15 would be Tall Jill, Tall Mike, Tall Golf, Tall Chip, etc.
I think this is a fascinating technique and one worth trying.
Memorizing the 9 sounds would be absolutely cake. I could even test myself with creating words and asking what number they would be. I definitely want to research this some more.
There are actually quite a few resources that generate words for you:
In looking over the slides for class tomorrow, I gave the major system a try. To remember the values for hemoglobin for men and women, I came up with: Men: Tear Tequila and Women: Denim Dilemma. Tear is 14 and tequila is 17.5. Denim is 12.3 and dilemma is 15.3. Oh man. It’s so stupid but it’s already working. Do you know how long it would take to memorize those numbers alone? Probably days, especially because they have decimals.
Can You Have Too Many Mnemonics?
You might be skeptical of all of the ridiculousness of these memory techniques. Is this even learning at this point? Can you have too many mnemonics that you don’t even remember the actual information anymore? The answer to this question is a resounding no. If I don’t have some sort of harebrained, humorous way to remember something, I have a much lower chance to remember it.
If at least one exam question doesn’t make me laugh out loud because of some absurd conversation I had about a topic, I’m not trying hard enough. Actually, I’m probably trying too hard and taking things a little bit too seriously.
I see mnemonics like shortcuts on your desktop. Sure they take up more memory, but they are kilobytes to the megabytes and gigabytes they lead to. Efficiency has an upfront cost but saves time and reduces errors in the long run.
Anyway, that’s it for now. Happy 2024! Catch you in the next one.