It is fashionable in higher education circles to bemoan memorization as a style of learning. It is better to learn critical thinking and creativity over being able to regurgitate some facts.
Medical school does not escape this trend. New curriculum redesigns focus on making learning more intuitive and less painful than memorizing drugs and pharmaceutical side-effects through brute force.
The underlying thought is that memorization is dumb. Any old monkey can be conditioned to hear a prompt and spit out a fact. The truly educated among us can see between the facts, understand the inherent truth, and whip up a novel insight.
I spent roughly the first two decades of my educational career agreeing with this idea. So much so, that I would pass this bit of sophomoric wisdom to others.
“Don’t memorize facts,” I would council students younger than me. “You should focus on really understanding the concepts behind the material”.
When I entered medical school, this view of memorization was reinforced in me. I spent two years in a medical school that preached truly understanding concepts over the brute memorization of facts.
“You don’t have to memorize individual drugs or microbes,” my sage professors lectured. “Just understand the trends and concepts, and you can derive the details later.”
I ate that reinforcement up. The best of the best were telling me that I should not memorize physiological steps — instead, I should seek to intuitively understand mechanisms that drive life.
This form of learning served me well for 20+ years. It served me well through elementary school, college, and laboratory research.
It all came crashing down when I started studying for Step 1 of the United States Medical Licensing Exam. It is an excruciating 8 hour multiple choice exam that tests aspiring doctors on the minutia of the medical corpus. The exam is set up so that a test-taker has approximately one minute per question — one minute to read a case, identify a disease, and then spit out a related piece of trivia.
Yet, while one might criticize the exam's design (and many do), it does force a medical student who prizes learning and not memorizing to learn many new tricks.
I have struggled with format of the exam, perhaps because of an ingrained resistance to the idea of brute memorization. Why should I memorize all of the many symptoms of a disease if I can derive them all by understanding the singular mechanism of how that disease works?
In the Step 1 exam, you do not have time to derive the symptoms of a disease. Instead you must just be able to hear “Metachromatic leukodystrophy” and be able to immediately respond with, “It is a lysosomal storage disease due to an Arylsulfatase A deficiency that presents with ataxia and dementia due to central and peripheral demyelination.”
I fought this initially, due to my ingrained bias against memorization. Only dumb medical students rote memorize without learning. But soon, I came to a surprising realization. I have to memorize. Without rote memorizing some basic facts, I cannot tap into the creativity I pride myself on.
An article in The Economist on education illustrates this point well:
“Educationalists go further, arguing that facts get in the way of skills such as creativity and critical thinking. The opposite is true. A memory crammed with knowledge enables these talents. William Shakespeare was drilled in Latin phrases and grammatical rules and yet he penned a few decent plays.”
Similarly if I do not memorize the basic phrases of medicine, I will not be able to practice the art of medicine. I need to drill in the basic grammar of disease so that I can efficiently synthesize and communicate my thoughts with patients and others doctors.
I realize in hindsight, that I have been memorizing things all my life. I never could have done algebra without first memorizing multiplication tables. I could never have written code for a mobile app without memorizing the vocabulary of a programming language. Just because memorizing came easy to me then, does not mean that I did not do it.
Thus, I have a simple request for people designing educational curriculums. It is good to preach understanding and creativity as the goals of leaning. Don’t, however, forget to emphasize the necessity of learning the basics—even if it requires brute, dumb, rote memorization.