Overcoming the limits of biological memory:

I have thought for a long time that the amount of time we force our students to memorize material (2 years) is probably 80% wasted. Until a few years ago, I had little to offer as a substitute except strategies that were based on my opinion. With the advent of the Internet, with Google as my navigator, I have found that I can readily locate something that I forgot. Therefore I want to raise again the question, why do we force our students to learn things we know they are not going to use frequently enough to remember.

This brings me to once again, to the forgetting curve. Just as learning is dependent on repetition, forgetting is dependent on the absence of repetition. Both are activity-dependent processes, as our neuroscientists are telling us. The less we use something, the greater our recall error until I am unable to recall it at all, and I must guess. The problem for the practicing doctor is that as the recall error moves from 0 to 100%, the opportunity to provide misleading or simply wrong information increases. Not knowing what I don't know is troublesome. This is a sort of memory atrophy caused by disuse.

The learning curve is well understood by everyone. Repetition is the law. But, in my experience, few have looked at the mirror image of the problem and explored the implications. A simple example makes the forgetting curve obvious. I know that the first time I look at something and decide to remember it, then I must repeat the episode, either explicitly, by looking again, or implicitly, by closing my eyes and visualizing what I want to remember. I have observed that when I make the repetitions frequently, remembering is virtually 100% reliable. However if I wait 1 month before repeating the learning episode, my recall accuracy is near zero. I call this loss of accurate recall, forgetting.

It should now be obvious that if we require our medical students to memorize things that they will rarely use, then they will forget them. In my opinion, why should a student pay money to learn something they will surely forget? The argument by professional educators was that we must prepare the students for every possible eventuality. But such a strategy ignores the forgetting curve. If sufficient time lapses between the learning and the episode where remembering is essential then forgetting has the day. Before the Internet and Google, I had no alternative. With the Internet and Google, suddenly any student can locate with great accuracy something he or she was taught and later forgot, a result of memory disuse atrophy. Google and the Internet free us from the belief that we must fill a student's head with everything required to address every possible future senario. Instead, we will teach the student core concepts over a period of months, we will teach Google with an emphasis on thinking critically during the same time and during the clinical years, we will reinforce Google and critical thinking by addressing the unknowns of each patient's problem.

The benefit of avoiding memory disuse atrophy by not memorizing things we never use, is that I can retarget the energy expended on unnecessary memorizing and recalling to thinking. Retargeting mental energy is of great benefit to everyone, but few have recognized that the Internet and Google offer the key to this freedom. Who will take this key and break loose of today's memorization-bound medical education system?