Mnemonics Aren’t Enough to Pass USMLE Step 1

Mnemonics are undoubtedly a fantastic way to remember information. Most generally, mnemonics use retrieval clues or imagery as specific tools to encode any given information in a way that allows students to efficiently store and retrieve the information. They tend to be very effective because the human mind remembers spatial, personal, surprising, sexual, humorous, or otherwise “relatable” information more effectively than otherwise abstract or impersonal forms of information (such as which HLA-DR is associated with which medical condition).

Encoding otherwise tedious or abstract information in the form of a fun and easy-to-remember mnemonic is a great way for students studying for the USMLE exams to memorize and recall this type of information. Obviously, remembering key facts is critical to passing the USMLE exams. However, given the nature of the USMLE exams as well as the importance of the information you are trying to memorize in the practice of medicine, it is critical to translate this key knowledge into a clinical context, rather than encode it via simple (often incomplete) mnemonics.

Despite their many advantages, mnemonics alone are insufficient for passing USMLE Step 1 or indeed doing well in medicine more generally. Perhaps this is an obvious point, but caring for patients effectively, as well as passing the USMLE exams, requires the ability to put together multiple, often disparate-appearing puzzle pieces to arrive at the big picture diagnosis. No matter how many fantastic mnemonics students can commit to memory, there is absolutely no way there will be a mnemonic for every single patient presentation seen on the exam, or in real life. Understanding that mnemonics are not an ultimate solution for learning medicine or passing the USMLE exams is simply the first step in utilizing them effectively.

What are mnemonics good for in medical school?

Extensive research has shown that the true power of mnemonics is enhancing short-term memory. Short term memory has three key aspects: 1) limited capacity for new information; 2) limited duration; 3) limited mechanisms for encoding information. This is where mnemonics truly shine. Mnemonics can increase the brain’s capacity for new information, increase the duration of information storage, as well as provide unique ways for the brain to encode and associate new information for easier and faster recall. Why would students studying for the USMLE exams and looking to practice medicine for the rest of their careers, then, rely solely on their short term memory? Short-term memory is a necessary step toward the next-stage of retention, long-term memory. Treating short-term memory as the “bottleneck” of acquiring information necessary to pass the USMLE exams highlights the importance of mnemonics. Often, medical students “drink from the firehose” when learning and acquiring new information. Mnemonics used to expand and build short-term memory capacity for keeping up with the complex and in-depth material presented can be an extremely important strategy for keeping up with medical school content and ultimately doing well on the USMLE exams and ultimately converting all that information to long-term memory.

What else do I need to do well on the USMLE exams?

While mnemonics are wonderful at enhancing short-term memory, they do little to help students build critical thinking skills and deeper understanding of medical material. USMLE exams, and the practice of medicine in general, require students to put together and analyze multiple pieces of information to arrive at the big picture. This is where understanding that mnemonics do nothing more than enhance your short-term memory is key. The next step to do well on the USMLE exams and the practice of medicine is to apply the information to clinical scenarios. Usually, this involves doing lots of practice UWorld questions prior to taking the USMLE Step 1 exam, or taking responsibility in patient care to understand the steps used in the diagnosis and management prior to the USMLE Step 2 and 3 exams. Applying the information acquired through the use of mnemonics to actual clinical scenarios cements the information and converts it to long-term memory. Perhaps the most important aspect of this process is that the information, previously encoded in a humorous or otherwise relatable mnemonic, is placed in a certain clinical context, and the implication of each individual factoid is associated with certain clinical conditions or information. This process converts the information from the short-term memory “recall” domain to the long-term memory “storage” domain. Ideally, students preparing for the USMLE step 1 exam should use their time during their 1^st and/or 2^nd year basic science coursework to enforce and build their short-term memory, and subsequently use practice questions to place that information in a clinical context and convert that information to long-term memory. The more effectively and faster students convert information from short-term memory to long-term memory, the easier addressing difficult NBME questions becomes.

In summary, mnemonics are an extremely important tool for aiding short-term memory and the acquisition of key USMLE-relevant information. Mnemonics, however, are merely a first-step in the process of learning for the USMLE exams and the practice of medicine. Applying and converting that information to clinical contexts is the most important next step!