Using Mnemonics and Spatial Visualization to Retain Critical Knowledge

by Robbie Ross, PharmD, PGY1 Pharmacy Practice Resident, G.V. (Sonny) Montgomery VA Medical Center

A student ruffles through his notes, textbook, and lectures for several hours trying to cram every last bit of information before the upcoming pharmacology exam. He arrives on test day, reads the first question, and his heart sinks; he knows he read about it, but just can’t remember the answer. Memory is an important part of teaching/learning and involves more than just recollection. Memory involves the learning, understanding, and the ability to link information together whether it was taught or experienced/researched on one’s own. When a teacher evaluates a student’s memory through tests, they are assessing more than just recall, but rather a deeper understanding of the information.

Students today live in an age of technology where information is always available at their fingertips and many students come to believe that recalling information really isn’t as important as it used to be. For example, how many of us can recall a friend’s phone number any more? Moreover, we are more likely to remember things we find interesting, which can pose a challenge in some classes. Students are more likely to achieve higher marks in courses related to their major or in electives, and more likely to struggle in general education classes.¹

The responsibility for remembering and retaining information is mutual — both the student and the teacher need to do their part. Educators need to pay attention to the “learning” aspect of “teaching/learning” and help students develop strategies to retain and understand the information. When a student is presented with new information, it is first held in short-term (aka working) memory while it is processed. Short-term memory is limited in capacity and duration — only five to nine items can be held in short-term memory for about ten to twenty seconds.²

This is where memory aids can come in handy. Several strategies have proven effective to facilitate memorization and long-term retention including mnemonics and spatial visualization.

• Mnemonics are strategies for associating words or phrases with a list of facts or principles.
• Spatial visualization involves assigning pieces of information with everyday actions and objects. Then when it is time to recall the information, imagining those actions and objects associated with the information.

Another technique this is often used to memorize information is repeating.  Repeating is simply that, repeating the information to keep it in short-term memory. Unfortunately, repeating doesn’t move the information into long-term memory. Moreover, short-term memory has a limited capacity, so it’s difficult to retain large amounts of information when we rely on repeating. Cramming for an exam is a common example where students often use the repeating method to pass a test but fail to recall the information days or week later.²

Many of us first learned about mnemonics in childhood. For example, “Every Good Boy Does Fine” was a useful way to remember the major musical notes and “Please Excuse My Dear Aunt Sally” was a mnemonic I learned to remember the order of operations in middle school math class. Other methods used in our early schooling included rhymes to remember what year “Columbus sailed the ocean blue” and the months that have 30 days. While mnemonics were useful for retaining these “elementary school” concepts, can these principles be applied to college-level courses where the content is much more detailed and sophisticated? In short, yes! One study tested the use of mnemonics in college students who were required to match a portrait to the name of its artist. Students who used mnemonics to recall the information significantly outperformed those who did not.³ The technique has been used to teach engineering students.  Eighty percent of the students reporting they benefited from the use of mnemonics and believe it help improved their exam scores.³

Mnemonics are rarely used in pharmacy school and vast amounts of information are presented to students from PowerPoint slides. From my experience, cramming for tests is common and most student use the repeating method, reading and re-reading handouts and notes as many times as possible shortly before an exam. This works well for some types of information and for a short period of time (long enough to remember it for the exam), but it is soon forgotten. A few instructors (but not many) still include memory aids in their presentations.  I still remember “Please Let Grandma Brown Bring Peaches To Your Wedding” as a way of remembering the colors of warfarin tablets (pink/ lavender/ green/ brown/ blue/ peach/ teal/ yellow/ white). However, mnemonics are used far less often in college than in elementary school.

Another memory aid that health professional students could use is SketchyPharm and SketchyMedical.com which uses spatial visualization to help learners understand complex topics. This is a subscription-based service first developed for medical students but has one section specifically related to pharmacy topics. A picture is presented and each item in the picture is associated with a more complex piece of information, and essentially helps the student visualize what they are learning through storytelling. This gives the phrase “a picture is worth a thousand words” a whole new meaning.⁴ While there are no peer reviewed research articles (yet) to support its effectiveness, medical students from the University of North Carolina rated the use SketchyPharm higher than many other common exam prep techniques (like flash cards) and 83% of students claimed they used it to study for their Step 1 medical licensure exam.⁵

The use of memory aids diminishes as a student progress from elementary school, to high school, to college, and beyond. Why?  Memory aids work and instructors should be using mnemonics and encouraging students to use spatial visualization to not only recall information but move important facts out of short-term memory. There are lots of websites to help create mnemonics; so, there no excuse not to incorporate them into lectures in combination with active learning activities. Encouraging students to use SketchyPharm or spatial visualization strategies during and after a lecture can really solidify the information being taught.

References

1. Comtois T. Using Memory to Become a more Effective Advisor [Internet]. Manhattan (KS): NACADA Clearinghouse of Academic Advising Resources; 2006 Nov [cited 2020 Feb 22].
2. Banikowski AK, Mehring TA. Strategies to enhance memory based on brain-research. Focus on Exceptional Children [Internet]. 1999 Oct [cited 2020 Feb 22];32(2).
3. Dave H, Awasthi S. An Investigation of the Role of Mnemonics in Higher Education. Proceedings of International Conference on Digital Pedagogies (ICDP) 2019 [Internet]. 2019 Apr 21 [cited 2020 Feb 22].
4. SketchyMedical [Internet]. Sketchy Group, LLC; 2018 [cited 2020 Feb 22]
5. Keepers B, Oh L. Step 1 Preparation: 2020 Hindsight. University of North Carolina [Internet]. 2018 May [cited 2020 Feb 2022].

The Utility of Debates as an Alternative Instructional Method

by Amanda Bridges, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center 

The landscape of education is ever-changing with educators pioneering fresh ideas to disseminate knowledge and maintain student engagement. While traditional lectures remain a mainstay in many health professional degree programs, students often struggle to make meaningful connections with the subject matter. Healthcare topics are often complex and require motivation and engagement from students to apply content to future experiences. Studies have shown that active involvement in learning results in more favorable outcomes. The success of any teaching strategy is dependent on successful execution by the instructor. Enter debates – an instructional strategy that dates back to the 5th century. Debates provide an opportunity for students to thoroughly research and logically present a topic.  Moreover, debates foster critical thinking and help students build effective communication skills.¹ While not ideal in all didactic settings, debates are a great way to teach controversial topics that have literature to support different stances.

Icons made by Freepik from www.flaticon.com

Some of the most challenging skills to develop as students make the transition to independent practitioners are clinical decision-making and problem-solving.²  Students are often left to develop these skills after graduation in conjunction with learning the intricacies of a new career. Debates foster the development of both of these skills by encouraging critical thinking to formulate a well-reasoned argument. Successful preparation for the debate involves discovery and assessment of literature – a skill that students will continue to use throughout their careers. Additionally, the exercise helps students to develop effective and persuasive communication techniques that will prove useful during both professional and personal interactions. Traditional lectures, I believe, fall short at fostering the development of these skills.³ 

The implementation of debates as a learning strategy occurs in two distinct steps – the pre-debate and the debate. Instructors should prepare for the debate by framing the chosen topic as a debate – that is to say, making a statement regarding an issue rather than asking students to answer a question. Students are then assigned to two opposing sides – a pro side in favor of the statement and a con side who is opposed to the statement. During the pre-debate stage, students are expected to thoroughly research and prepare a brief (typically 10-12-minute) presentation to support their side of the argument as well as collect ample information to support their stance in the event of a rebuttal from the opposing side. During the debate, the two sides present their argument and a rebuttal followed by a discussion by the entire class, facilitated by the instructor, about both sides of the argument. Some teachers had added another opportunity for learning by having the students prepare test questions tho assesses the key points presented during the debate.^1,2 In addition to being a means to assess student understanding, question writing can stimulate interest in academia as a career path.

In contrast to the assessment techniques used after traditional lectures, which focus on knowledge acquisition, debates can be used to evaluate students on concepts other than knowledge. Typically, the desired learning outcomes are assessed using a rubric that is given to the students before they begin their debate assignment. The assessment of individual students should focus on the persuasiveness of the presentation, use of data to support the argument, composure during the debate as well as eye contact and body language. An assessment of the debate team (or group) could include avoidance of redundancy during the formulation of the argument – an indirect way to assess team communication.¹ The evaluation rubric can be modified based on faculty resources and class size.² 

Studies have shown that students may benefit more from a debate when the approach is coupled with a patient case. Without this application, students struggle to make the connection with clinical practice.¹ Using debates repeatedly during a course can help students hone their skills.  When asked, students admitted that the initial debates took much longer to prepare than those occurring later in the semester.² 

While this instructional method has some clear advantages, debates as a teaching strategy also have limitations. As a student who struggled to speak up and express opinions in front of the class, I can see how this approach is intimidating. However, as healthcare professionals on an interdisciplinary team, it is essential we develop the confidence and poise to speak up and make appropriate recommendations. For students who struggle to speak up, a solution might involve grouping similar students on a team so that there isn’t a strong personality to drown them out. Additionally, debates inherently encourage competition which could lead to a trivialization of issues for the sake of winning.³ The goal is not to “win” the argument but rather to thoroughly research and present the argument with clarity using facts.  Once both sides of the argument are clearly understood, it’s important to emphasize consensus-building and compromise. Lastly, debates can be time-consuming and require a lot of faculty manpower. It may be necessary to split up students into subgroups in a large class to allow direct observation during multiple debate sessions.²

As a student I would have been terrified to take a course that required students to debate topics throughout the semester.  But in retrospect, the opportunity to enhance critical thinking and clinical decision-making using a debate format would have been immensely valuable. The greatest utility of debates, in my opinion, lies in the exploration of topics not easily explained in black and white terms during traditional lectures.

References

1. Charrois TL, Appleton M. Online debates to enhance critical thinking in pharmacotherapy. Am J Pharm Educ. 2013; 77 (8): Article 170.
2. Hawkins WA, Fulford M, Phan S V. Using debates as the primary pedagogy to teach critical care in a PharmD curriculum elective course. Curr Pharm Teach Learn. 2019; 11 (9): 943-948.
3. Darby M. Debate: a teaching-learning strategy for developing competence in communication and critical thinking. J Dent Hyg. 2007; 81 (4).