Mnemonics and the Need to Remember Stuff
Rick Rader, MD, FAAIDD, FAADM, DHL (hon), Director, Habilitation Center, Orange Grove Center
Editor-in-chief, HELEN, Journal of Human Exceptionality
Summary: Mnemonics help medical students remember complex information. The P.A.T.I.E.N.T. mnemonic applies that same strategy to disability-inclusive care: put the person first, ask rather than assume, communicate directly, individualize care, ensure accessibility, avoid presuming incapacity, and treat the whole person.
“Emotion is the best mnemonic device.”
This month’s question is “About how many things does a medical student have to memorize?”
There is no universally accepted number, but a medical student must learn and retain tens of thousands of individual facts, concepts, relationships, and clinical patterns over four years of medical school. If you include the detailed information needed for examinations and clinical practice, the number could be substantially higher.
One published estimate suggests medical students learn approximately 55,000 new medical words over four years.
Another useful measure is the number of flashcards students use to organize their learning. One medical-school study reported that many students used thousands of flashcards to prepare for examinations, although flashcard counts cannot tell us how much knowledge a student has mastered.
There is also a sobering finding about retention: a study of medical students found that, after an interval of 8–10 months, average retention of first-year knowledge was approximately 46%, with substantial variation by subject and question format.
I remember one of the first things I was required to remember was the t cranial nerves.
There are twelve of these critters; they are specialized bundles of axons that connect the brain directly to the head, neck, and trunk. Unlike most nerves, they bypass the spinal cord entirely, allowing for rapid transmission of sensory and motor data.
Trying to memorize the names of these nerves was like trying to remember the lines in a Shakespearean sonnet, they never actually became part of my repertoire. I struggled and my frustration mounted until I found the road to “inside trading.” The mnemonic was my salvation.
A mnemonic is a memory aid for something, often taking the form of a rhyme or an acronym. I before E except after C, is a mnemonic to help you remember how to spell words like “piece” and “receive.”
The mnemonic for the cranial nerves has multiple versions, some of which include explicit language for memorization. Probably the most well-known and recognized mnemonic for the twelve cranial nerves is the one that begins, “Oh, Oh Oh To Touch And Feel……” it’s randy, and I’ll stop right here. It’s been used for decades, and its humorous and shocking elements contribute to its memorability. (They reflect the Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial and the other five that I forgot).
A milder example of a mnemonic is the rhyme, “Stones, bones, thrones, abdominal groans and psychic moans.” (Causes of hypercalcemia)
Another well-known mnemonic in neurology reflects the features of migraine:
P.O.U.N.D.:
P-pulsating,
O-one to three days duration (4 – 72 hours),
U-unilateral,
N-nausea and/or vomiting,
D-disabling
Of course, the problem with mnemonics, especially under pressure when being questioned on grand rounds, is that you remember what the mnemonic is but can’t remember what it represents. Bad look. “Yes, professor I think the patient has that POUND thing.”
Interestingly, there are surprisingly few widely accepted mnemonics specifically designated for clinicians caring for people with disabilities.
HELEN thinks that medical students might adopt the one disability specific mnemonic that is aimed specifically at the physician’s behavior.
P.A.T.I.E.N.T
P – Person first, disability second
A – Ask, don’t assume
T – Talk directly to the patient
I – Individualize care
E – Ensure accessibility
N – Never presume incapacity
T – Treat the whole person
And of course, when all else fails there’s always the wisdom of Edgar Allan Poe,
“IF you wish to forget anything on the spot, make a note that this thing is to be remembered.”
