April 8, 2006

Remind me again why we rely on memory?

It has been traditional in nursing education to emphasize memorization. Students must memorize anatomical parts, drugs and their uses and effects, pathophysiologic changes with disease, lab values, diagnostic testing procedures, et cetera, et cetera. Often what is required to be committed to memory will change over time as research reveals new information. So why do we continue to require so much memorization? The standard answer is that nurses must have that information to make decisions quickly. But what happens when memory fades, or only parts of what was memorized is recalled? I believe it is better for nurses to learn how to find information as they need it. Information that is frequently needed will soon be committed to memory, but they would also realize the limits of memory.

In the past we looked up information in texts. Texts are efficient for storage but not so fast for retrieval (or easy to carry). Electronic texts such as a drug guide for a handheld computer are easy to carry and very easy to access. Nursing educators must teach students to use such resources, then evaluate students on the quality of their application (rather than recall) of knowledge.


Anonymous said...

I couldn't agree with you more on this topic. I am a former student of yours and a RN for 6 years. I am Charge nurse of a very busy Emergency room and get asked questions all the time by my staff. I often use Davis Drug guide on my palm pilot for answers I am not positive on or dont know. As a charge nurse I use my hospitals policy manual online with keyword searches to answer questions that arrise that i dont know the anwser to. I find using the online policies is twice as fast as the actual policy binder.

However I do know there are many times I recall information from memory that I have no idea where it came from. I also have gut feelings on patients that i would bet come from all the hours of memorization you made me do :) So I would have to say the memorization is a vital part of my education but it is very important to be able to use resourses to get anwsers
Jeffrey Anderson BSN RN

Brent Thompson, DNSc, RN said...

You are very right in that some memorization is needed in every specialty. I would argue that is impossible for nurse educators to know what is important to memorize in every possible nursing situation now and in the future. We memorize things we need to know. We know we need to know those things through repeated use.

I also believe "gut feelings" come from the combination of your many experiences with patients, plus the things you learned were important in practice. As a teacher I can tell you "this is important" but until you actually see the need for the information clinically I don't think my admonition gets to the "gut".

Thanks for the great comment.

Bear said...

Brent and Jeffrey

As someone who put off starting the trek for nursing school for decades because i didn't think i had a sufficiently good memory - i'd disagree.

Memory is step 1 on the path to grasping complexity. Yes, we do need to know how to access information - but memorizing frequently used information saves us time in addition to giving us the ability to recognize patterns that the person with a smaller and shorter term memory would never recognize.

While it is a given that we, qua educators, can only guess what will be useful 10 years from now - there is little to be lost by requiring memorization, so we also cannot be certain that it won't help.

Now, I actually made it a challenge not to remember key ranges when I was a student - and I lost a lot of gimme questions on MC patho and med-surg tests - but I can't for the life of me see a gain that I achieved by not memorizing...

Bear said...

PS - Assuming I grant your point that we rely too greatly on memory when we should be teaching nurses how to retrieve information - and also ignoring the issue of all those McDonalds and Walmart clerks that cannot compute the sum of a three item order, calculate the appropriate tax, and calculate the correct change from a $20 bill - would you expect students to memorize the shortcuts needed to retrieve information - or should they just know how to retrieve the information about how to retrieve information?

Brent Thompson, DNSc, RN said...

Bear, you are right that there is a place for memorization. What I am fighting is an overreliance by faculty on expecting memorization rather than learning application. For example, when teaching research I could ask a student to memorize the definition of concurrent validity, or I can ask to explain why a particular study used concurrent validity (and allow the student to use the textbook). I would argue that the latter approach teaches a skill (and demonstrates the learning) that will persist longer than the memorized fact.

Memorized facts are great if they're needed in your practice; but as educators of generalists we shouldn't be devoting too much energy to memorizing facts that will soon be forgotton.

The other problem of over-reliance on memory is the number of things to memorize only grows each year, while our capacity to memorize does not. Jeff's example of the drug guide points out that we remember many things we need, but still need tools to fill in the gaps. We may be able to remember a few side effects of a given drug, but not many of us could remember the 20 that may be listed in the drug guide.

There will always be a need for some memorization. All learning involves some memorization, or else you would never recall anything you learned.

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