Ive come across many analogies that try to convey the amount of memorization required in medical school. The most popular is drinking from a firehose. One physician writer put it like this: It was like being asked to enter a grocery store and memorize the names of every product in the store, their number and location, every ingredient in every product in the order in which they appear on the food label, and then to do the same thing in every grocery store in the city.

In medical school, we talk in terms of high yield and low yield information. Basically, everyone accepts that it is impossible to know everything or even close to it, so medical school becomes an exercise in figuring out what is most important. For every conversation about memorizing, there are also a couple of self-deprecating quips about forgetting. Ive had times where I studied something, took a short break, and then forgot what I was just reading. Is it sad? Yes. Demoralizing? Can be. But unique? Talking to other medical students, Ive found the answer is a resounding no. The consensus on memorization among my peers is comically Lake Wobegon in reverse: here, everyone is convinced (s)he is below average.

Are we inherently bad at memorizing? Are we just not programmed to be effective at learning everything the modern medical landscape demands from us? I wondered about that. But more so, I wondered about solutions. If we ask for help, most of us rely on casual tips from those who have gone through the process before us, and we try to assemble diverse anecdotes into a feasible personal plan. But research into the human mind and its ability to remember is vast. And that knowledge says that memorization is a skill that can be improved upon with strategy and practice.

What of that knowledge can apply to medical training, specifically? Which techniques can help information stick in ways that are meaningful, relevant, and ultimately useful for patient care?

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Chunking. Our short-term memory can store and retrieve a limited number of facts and researchers have honed in that number. In 1956, cognitive psychologist George Miller published a paper providing evidence for seven being the magic number, plus or minus two. It was one of the most widely cited psychology papers ever, and Millers figures are ones that many in modern psychology circles still go by. What does that mean if you want to remember more than seven items? The solution involves breaking down or chunking larger sequences into smaller ones. For example, if you want to remember the ten digit sequence 6256493174, you could instead think of it as 6, 256, 493, 174. Or 62, 56, 49, 31, 74. Or some other combination, as long as its in a retainable number of chunks.

We remember chunks better than long sequences. In medicine, chunking is really a way of saying simplify and organize.

Does it work? In medicine, we constantly need to remember facts that relate to a particular umbrella subject. Chunking is useful as a guide in keeping relevant concepts together, within a range that is ideal for memorization. I know, for example, that if I am trying to remember bacteria, it helps to classify them into groups with each group containing facts of nine or fewer items. In that sense, perhaps chunking is little more than a fancy way of saying organizing with the additional recommendation of what size you should organize subjects into to increase your chances of retaining.

One issue is that chunking refers to a technique for short-term memory. In medical training, I care about knowing things for the long term. Can chunking still help? Psychologist opinion seems to say yes: chunking improves the transfer of short-term memory to long-term memory. Some have used the example of language to make this point, in that we regularly use single words or phrases to capture complex meaning and remember it in the long-term. Medicine uses similar principles. That is, whenever we have a medical term for a constellation of symptoms, a disease progression, or a type of treatment, we are actually chunking multiple concepts into a single phrase. Taken in reverse a single medical term connotes multiple ideas. Medical language enables us to memorize better by having us memorize in chunks.

The bottom-line on the usefulness of chunking in medicine is that its a way of thinking consciously about something we tend to do naturally organizing complex ideas into simpler ones. Having that conscious awareness of why condensing works can make the number of facts we are expected to learn in medicine less intimidating.

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