Alex and I are doing independent study for the month of March. We decided to take Review of Anatomy, which is particularly relevant for us now.* We went to the gross anatomy lab a few days ago to dissect and review the muscles of the anterior forearm:
Flexor carpi ulnaris
Flexor carpi radialis
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
I’ll admit, before this review month, I could have recognized these names as those of the anterior forearm, but I couldn’t have named all of them in any coherent order. Even though I learned this material as a first-year medical student, I’ve forgotten it. I have some recognition but poor recall. Now that I’m learning it for a second time, I’m pausing to reflect on what I could do better.
The first time I studied this, my instinct was to avoid memorization as much as possible. This philosophy is still a good one to live by (see #1 of our Top Tips), but my threshold has changed. I remember looking at this list and thinking, well...if I know what the words mean and know the Latin roots (shoutout to Magistra Steele of Oxford Middle School), then I won’t have to memorize anything! Because my exams were mostly multiple choice, I was confident that by understanding the names, I could get by without memorizing. In fact, I thought I was being a savvy learner. Clearly, this strategy did not result in durable knowledge.
A two-step strategy
This time, I’m doing it a little differently. I’ve decided to memorize these anatomical parts in a logical, geographically-ordered list that goes superficial to deep and lateral to medial. After looking at an atlas to determine the muscles’ order and write out the above list, I put away the pictures and focus on the list itself. Finally, when I’ve memorized the list—independent of any image cue—I will use retrieval practice (eg, using Anki’s popular image occlusion addon, reviewing on a cadaver, looking at an MR image) to combine name with muscle. Note that even if I have Anki flashcards devoted to recalling muscle names based on an image cue (ie, image occlusion), I have my separate cards which I used to initially memorize the list without an image cue. For example: “Name the superficial muscles of the anterior forearm (lateral to medial).”
This two-step strategy is my current method for learning muscles of the body: independently memorizing the terms in a logical, geographically-ordered list sans atlas, then learning the three-dimensional distribution with an atlas. Memorizing these words in a linear string gives me verbal fluency and a familiarity with these muscles’ interrelationships without having to simultaneously learn terminology and spatial orientation. Having an internalized roadmap then gives me stability when I’m overlaying these new vocabulary words on an unfamiliar anatomical space. It will also help me if I’m stumped by an unfamiliar view, because I can systematically work through my list—superficial to deep, lateral to medial—to identify what’s in front of me.
I like that the act of ordering my list forces a deeper initial read of the atlas. In creating memory palace images, we argue it’s best to be highly selective in choosing which information to create images for. Just as that practice encourages critical thinking, so does this two-step approach to anatomy. The strategy forces me to learn more actively. It also encourages chunking—the act of grouping information into smaller, more memorable groups.
Develop a gestalt by avoiding the crutch of image cues
Essentially, I want to be able to recall this list in a geographically-ordered way without having to rely on an atlas image. Imprinting this order should help me more quickly develop a gestalt for these anatomical relationships. The image occlusion addon is powerful, but it contains external cues—the image’s spatial layout, its arrows, its particular cross-sectional view. If I start learning the muscle names by quizzing myself solely from an image, I might quickly develop fluency, but the image becomes a crutch. To develop adaptive expertise—knowledge I can transfer to new scenarios such as unfamiliar cross-sections—I can’t rely on such a cue. Instead, by learning the names implicitly, I’ll be sure to have all the muscles and their geographic arrangements stored in memory. In that way, the information becomes more transferrable. (The research on cued vs free recall is thornier than you might imagine,1 but for our purposes, this principle from cognitive psychology should suffice: the more active the retrieval practice, the greater the retention and transfer benefits.) When I eventually test myself on a cadaver, look on a radiology image, or use image occlusion (eg, to prepare using images I know will be replicated on my exam), I can adapt.
My plan to memorize the list and identify those muscles in a consistent order is also similar to the core strategy radiologists use to diagnose disease on imaging. They use search patterns, which are consistent, predetermined ways that they read images. For example, when reading a chest x-ray, a radiologist might always start with the trachea, then move to the lungs, then heart, etc. We often hear about the importance of internalizing a good search pattern. It not only holds the radiologist to a systematic practice but also allows him or her to develop a gestalt over time.
An argument against memory palaces (in this case)
You might think, “Shouldn’t you just use the body itself as a memory palace for these names? You could convert the names into images and encode them on the muscles themselves.”
I think this would be unnecessarily difficult. A palace works best with spaces with which you are already familiar. If I were to do that for the entire body, it would be extremely difficult to memorize the spatial organization and the terminology simultaneously. There are too many unfamiliar loci and too little differences between them for this memory palace to provide a worthwhile learning benefit.
What about using a familiar, non-body palace to encode this list? Again, I find this approach suboptimal. In some cases—for example, the non-anatomically correct facial nerve schematic that Alex discusses here)—these palace types may be appropriate. Here, however, I eventually want the spatial relationships of the muscles to become intimately familiar. I want to develop a gestalt. Having a separate palace with its own spatial layout may distract from that gestalt.
One thesis of this website is that palaces, to be effective learning tools, must be created sparingly and with care (again, see #1 from Top Tips); they are useful in the right circumstances and counterproductive in others. I think this anatomical example falls into the latter category. Here, rote but systematic memorization (eg, via chunked Anki cards without image cues) is the way to go.
1. Adesope, O. O., Trevisan, D. A. & Sundararajan, N. Rethinking the Use of Tests: A Meta-Analysis of Practice Testing. Review of Educational Research 87, 659–701 (2017).
*Alex and I have both matched into diagnostic radiology residency positions at the University of Alabama at Birmingham (@uabRadResidents), starting in July 2020. We are beyond thrilled and cannot wait to train and continue our research at our new home.