The Memory Curve
The memory curve is an imaginary line illustrating the process of
remembering and forgetting. It climbs with study exposure, drops with neglect,
and moves up again with relearning. Depending on the timing and frequency of
specific memory reinforcers, this line can form a constant upward curve, or it can
be as erratic and risky as a roller coaster ride.
Because the up-and-down roller coaster is an inefficient mode of
maximizing memory, your goal is to create an upward optimal memory curve, a
steadily rising slant achieved through well-timed, planned, and disciplined
reinforcement of mastered material. Optimal memory curve techniques demand
that you pay attention to the timing of reinforcers and to the specific methods you
use to secure short-term and long-term memory.
Achieving the optimal memory curve takes practice. Not only does
practice make perfect, but time of practice is key. To illustrate the creation of an
optimal memory curve, let’s look at two common examples:
1. Learning to play a musical instrument
2. Learning to speak a foreign language
Music
You play a passage of music on your instrument. At your lesson, the
teacher corrects your fingers or phrasing. In order to remember the revision, you
must immediately reinforce your new learning by replaying the passage correctly
at least three times. It will also help your memory if you tap your foot or sing
along as you reinforce the learning.
Foreign Language
You say a sentence and your grammar is incorrect. Someone corrects
you. In order to recall the correct usage, you must immediately repeat the
sentence properly, saying it at least three times. Use the sentence in a different
paragraph.
In both examples, the immediacy, frequency, and variety of learning-stylespecific reinforcers – hearing, doing, saying, seeing, and moving – can make the
difference between short-term learning or forgetting. Reinforce and expand your
learning-style dimensions immediately after your learn something new.
To achieve long-term memory, you will need to break large tasks down
into smaller, manageable ones. Reinforce facts and details over a long period of
time. Set deadlines and priorities. While going about your everyday routines,
like shopping or banking, use waiting time efficiently. Avoid interruptions and
guard against procrastination. Increase efficiency by combining tasks and –
most important – adhere to a routine of daily memory reinforcement.
The daily routine includes specific tasks you need to do before class,
during class, and after class each day. By following a routine, you will use less
time to remember large amounts of material and you will retain that memory over
the long haul.
You want to create an optimal memory curve. To establish it, you will
need to know and apply the proper order of activities during the learning process.
Students who do not follow this order of activities have difficulty maintaining
academic competence.
Most students that have trouble in medical school do not have a lack of
intelligence or proper background to get through medical school. Instead, most
have no conscious system of study or allow themselves to get distracted or overinvolved with outside interests.
Undisciplined time use compromises your learning ability. Irregular spurts
of study make you feel out of step, inadequate, guilty and unduly anxious, which
results in forgetting. Dysfunctional memory/forgetting curves are usually caused
by procrastination, externally generated motivation, losing sight of the goals, lack
of learner control, and failure to apply immediately any newly learned information.
If you don’t immediately reinforce newly acquired data, you will need to spend
extra time relearning it. This is time that you simply do not have to spare!
Optimal Memory Curve
Steps 1-6: Exposure and Analysis – within the first 24 hours
Steps 7-13: Memorization and Synthesis – within the first week
Steps 14-17: Consolidation – within the first month and throughout career
Improving Memory
Success in medical education demands self-discipline, steady
commitment, and a sense of humor. Create a schedule and adhere to it
faithfully. You can construct your schedule so that you intersperse serious times
with fun. Your schedule is your tool to enhance your ability to learn. The
organization of your time must not feel like a prison sentence or a drag. A
schedule is your steady encouragement.
Specific Study Strategies
In learning new material, you will need to proceed with the following study
steps within the first 24 hours of your initial exposure.
1. Skim read
Prepare for class and anticipate findings through rapid reading. Before
going to class, quickly skim read the chapter or material. When swiftly flipping
each page, attend to the special type, such as boldface or italicized print. Slow
down to read charts, diagrams, and graphs. Read the introduction, table of
contents, and summary statements. Notice if there are relationships in the
material. Pay attention to compare/contrast data. Depending on the complexity,
you can skim read 60-100 pages in about 20 minutes.
In order to prevent note-taking slow down, develop a glossary of unfamiliar
terms. Scan the pages and the table of contents for words or concepts that are
unfamiliar, and say them aloud. Use a medical dictionary if you feel particularly
uneasy about the terms.
2. Attend lecture
With skim reading as your map, navigate the lecture territory by going to
class prepared to listen and to take notes as fast as you can. In the lecture, by
paying attention to the lecturer’s verbal, visual, and tonal emphasis, you will
discover those areas that are important to memorize and other areas that can be
whizzed through quickly at your second reading.
Sit in a well-lighted place free of the distraction of active doorways or
colleagues’ conversation. Position yourself in the front of the room so you will
not be able to drift off and fall asleep.
3. Take notes
One of the main goals of note taking is to create your own text. Because
the most advantageous time to study is within 24 hours of exposure to new
material, a personal up-to-the-minute textbook is one of the best ways to
reinforce immediately what you must learn. NOTHING can replace a good set of
notes.
Use a fast-moving writing instrument and capture as much of the lecture
as possible.
Use only one side of the page, so that you have space to fill in additional
information on the opposite, facing page. Leave two-inch margins. Margins
invite you to apply labels when you are organizing your notes at home.
4. Consult colleagues
Immediately after class, talk with your classmates. Go over the concepts
you understand, and ask your classmates if they can clarify points that were
unclear to you. Discussions go well with lunch or walking to and from class,
while exercising or while socializing.
On the page facing your own lecture notes, write the ideas you have
acquired from colleagues in a different-colored ink. By distinguishing others’
notes from your own, you will be able to see those areas that were unclear to you
when you first heard the material. These areas will need extra attention.
Remember that the best way to learn is to teach. Teach your colleagues
what you know. Teaching forces you to clarify what you know and to
acknowledge what you don’t know. As a resident, you will be teaching as you
learn. As a physician, you will spend most of your time educating yourself and
your patients.
5. Label notes
Labels written along the margin in contrasting colors and with a different
style of writing will act as a visual memory pegs. Organize details by using such
identifying words as: Structure, Function, Mechanism of Action, Mechanism,
Steps of a Process, Requirements, Results, Cause-Effect, and
Compare/Contrast.
Use different colors for your labels. Color-keyed organization gives you
the opportunity to visualize as you memorize efficiently.
6. Fill in from text or handouts
Amplify your classroom notes. Use the space you have provided on the
blank page facing your notes to deepen your understanding and widen your
knowledge base. Add notes from textbooks, from handouts, and from the
information you go through discussions with colleagues. Again – to improve your
memory – use contrasting colors when adding new information to your original
notes.
7. Look for patterns
In physical objects courses, such as anatomy, notice relationships of
structures to one another. Notice how structures with similar shapes perform
similar functions. Observe how structure, function, and mechanism of action
interact. Observe the sizes, shapes, textures, and physical and chemical
linkages of structures. Where do they anastomose? Where do they bifurcate?
Arrange structures in order from outside in and inside out.
In process courses, such as biochemistry, develop a five-point information
matrix containing the following information:
 Steps of the process (how many and what are they?)
 Requirements for the process to move forward
 Results in terms of cause-effect
 Reactions to too much or too little of any required components in the
process
 Points at which the process changes direction – where it splits or where it
joins with another process
8. Analyze
What does all the information mean? Make it make sense by asking
yourself about the relationship of the subjects to one another. How do anatomy,
physiology, and biochemistry fit together? How might these phenomena relate to
clinical implications?
9. Memorize
Keep the memory methods of the music and foreign language examples in
mind. Hearing, saying, seeing, and applying items at least three times is the
bare minimum you will need to commit material to short-term memory.
Successful memorization requires more than simple intent to remember. In order
to memorize successfully, you must understand the material and engage in
activities that use all of your creative capacities.
Break the vast number of components to be remembered in groups of
three or four items that are related to one another. Take note that “performance
declines as the number of events to be learned increases.”
Condensing techniques are useful tools to facilitate memorization. Carry
charts and cards you can use while you wait in line at the supermarket, while
you’re stuck in traffic, or whenever anxiety clutches at your gut.
A word of caution: do not spend so much time making your memory apparatus
that you do not leave enough time for drilling yourself and memorizing the
material you have organized on the charts or cards. Funny mnemonics are hard
to forget. But again, beware: don’t get so enamored of the mnemonics that you
forget what you were attempting to memorize.
To increase memory, try the following:
 Use all of your senses
 Reread
 Rewrite grouping small related clusters of information
 Make compare/contrast cell charts and flow charts
 Compile flash cards
 Create mnemonics – especially funny ones
10. Discuss with colleagues
Ask your friends and colleagues to review material with you. Ask them the
exam questions you constructed and ask them to quiz you.
11. Memorize some more
Use corrected charts and amplified understanding to reinforce your
memorization.
12. Formulate possible examination questions
All questions are derived from labels. Because simple recall questions are
rarely used, create complex questions in which two labels are used together. In
physical objects courses, put together the relationships of structure, function,
mechanism of action. Ask yourself: if structure changes, what happens to
function?
In process courses, such as biochemistry or physiology, ask yourself what
would happen if there was an increase or decrease in the amount of flow or a
change in any aspect of the requirements necessary for the process to move
forward. Ask: what will impede this process? What will hasten it? What other
processes does this process depend on? For example, how does the Krebs
cycle relate to glycolysis? How does the cardiac system depend on the proper
workings of the renal system?
13. Challenge colleagues
Review your notes and charts with opposite-type colleagues. Are you on
the right track? Was your understanding the same as your colleagues’
understanding? If not, why not? Pose sample exam questions to opposite-type
colleagues to see if you omitted anything. Engage in scientific discourse. If
colleagues’ ideas differ from yours, ask them to prove their points. Be certain
that you have not omitted anything.
14. Reanalyze
Instead of merely memorizing, you want to be able to form reasoned
judgments. To be certain that you have considered all the information and the
relationships of one system to another, and to integrate new with known material,
reanalyze the data. How will you apply the new data? Use your new insights to
understand how the new material fits together with the old. What does the new
material explain? What might be left unexplained?
What do you understand about the significance of the basic science
material vis-à-vis clinical implications? For example, “It is one thing to know that
the blood urea nitrogen rises in renal failure, but it is another to understand that
this phenomenon may occur whenever there is a reduction in glomerular filtration
rate, which can result from a variety of hemodynamic factors as well as
destruction of glomerular tufts.” Increase understanding by noting the causeeffect relationships.
15. Memorize again
Remember that memorizing each time you have added depth to your
understanding sets the data in long-term memory.
16. Fit new material into old concepts
To be sure that new material fits into those facts and concepts that you
already know, consider various relationships and the causes and effects of
changes in each system. To achieve the full picture of the knowledge you have
gained, synthesize your learning. How does biochemistry impact the physiologic
aspects of the material you are studying? Anatomy and physiology? Create
questions that combine sever subjects.
17. Memorize for long-term memory
Reinforce the material each day. Vary the methods by which you see, do,
say, analyze, and synthesize the material. Be active! If you practice the material
every day during the first week of exposure, and if you use all your senses and a
variety of modes of reinforcement, you will be able to cut down on study time
later in the study process. Remember that more time spent early in the learning
process equals less time for memory brushups and integration of material before
exams.
You can immunize yourself against forgetting if you reinforce early in the
learning process and keep intermittent reinforcing going throughout your twoyear course of basic science study. At the end of each week, review the material
you have learned that week, and if you have time, look at your notes from the
week before. Educational psychology research shows that people retain
information for decades as opposed to mere months when they learn and
reinforce the material over a longer period of time, building on and reviewing the
material as they go along.
Schedule Construction
To make the most efficient use of time, follow the steps outlined in the
Optimal Memory Curve. Create your personal optimal memory curve, developing
a schedule based on what you know about yourself. When, and under what
conditions, are you most energetic and efficient? In preparation for schedule
construction, answer the following questions:
1.
2.
3.
4.
At what time of the day or night are you most alert?
How much sleep do you need?
Do you need large blocks of uninterrupted time when you work?
Do you find that after one and a half hours of study, you must take a
break?
5. How long must the break be, and what do you like to do with the break
time?
6. When do you need to study alone? When with others?
By taking advantage of the natural ebb and flow of your energy, you will
be able to use time efficiently. Try not to fight your circadian rhythms, or you
will waste time. Tackle your most difficult study tasks when your energy is
highest. Work on your favorite subjects when your energy is waning.
Selecting Study Tasks
Narrow Your Focus
You will do well to tackle a manageable amount of material. Try to avoid
global statements like: “I need to study anatomy.” The use of the word “anatomy”
creates a mind-set that is too broad. Instead, select for study a defined section
of the body. For example, the brachial plexus. Tell yourself that you will devote
a specific block of time to mastering your study of only the nerve supply and
blood supply of that region. Or resolve to study x number of pages in a subject.
Don’t jump around or confuse yourself with too many resources. Stay with
one topic for at least an hour or an hour and a half. Set realistic goals, monitor
your progress, and record your accomplishments in your daily log book. Enjoy
noting your progress!
Work with Related Material
Once you have completed the manageable subject segment, or the
realistic number of pages you have designated, shift from this topic to a related
one. If you can see connections, make the connections. If you can’t, and you hit
a study barrier, use your medical dictionary to spur your understanding before
leaving the study section.
When you feel bogged down and want to escape immobilization,
intersperse subjects you find difficult with others that are comfortable, familiar,
and somehow related. So, if you become snagged in studying a section in a
process course (biochemistry), take a break and tackle a physical object course
(anatomy). Be sure your selection will amplify your understanding of the
troublesome area. Once you have completed this, take a break and change to a
completely unrelated subject.