Audio-Visual Picture Mnemonics and Spaced Repetition ......The Science of Memory. Since early Roman times, people have been fascinated by the science of memory, developing techniques

Audio-Visual Picture Mnemonics and Spaced Repetition Can Improve

Student Learning

AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING

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Introduction Attrition in higher education has been a focus of educators for decades. For professional programs, the problem is particularly acute. The dropout rate has been increasing for medical students in recent years, from 5 to 20%1, and can be as high as 45%2 of nursing students at some institutions. High attrition can impact an institution’s reputation and staff and student morale, and is being actively addressed by learning specialists and academic success departments at many professional healthcare schools.

Since the root causes of attrition can be varied and complex3, educators turn to a broad range of solutions. Online learning resources have grown in popularity as learning intervention tools used by academic success coordinators, and by classroom faculty to engage millennial students and keep them coming to class prepared and ready to learn.

The rise in popularity of picture mnemonics and AI-algorithm-driven software has led to the development of study resources that help higher education students learn and educators to engage them. This white paper addresses the science underlying the effectiveness of using picture mnemonics for learning in higher education, along with a research study to demonstrate the effectiveness of this approach for healthcare students.

The stakes are higher than ever. The competition for post-graduate placement has risen dramatically, putting pressure on institutions to increase resources and support for students in order to maintain exit statistics. With medical student application growth outpacing the growth of schools and residency programs, institutions provide resources and intervention support to prepare their students to achieve highest possible exam scores, ensuring that their students will get matched to a limited number of residency program spots. A similar situation exists for nursing programs – over 50% of MSN programs turned away qualified applicants since 2014.

1 https://www.aamc.org/system/files/reports/1/graduationratesandattritionratesofu.s.medicalstudents.pdf

2 https://www.rn.ca.gov/education/attrition.shtml

3https://www.aacrao.org/research-publications/quarterly-journals/college-university-journal/article/c-u-vol.-94-no.-2-spring/student-retention-models-in-higher-education-a-literature-review


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What are Picture Mnemonics? The popular saying, “A picture is worth a thousand words,” is based on science. Simply put, a complex idea can be expressed better with a single image than a block of text, and a fact associated with a wacky image will be remembered longer, too. These “symbols” can in turn help trigger memories of facts and hard-to-remember information, improving learning and performance.

The Science of Memory Since early Roman times, people have been fascinated by the science of memory, developing techniques to improve memory function (encoding), enhance retrieval and reduce forgetting. The Greek orators actively used the Method of Loci, using mnemonics to memorize a list. In recent centuries, philosophers, biologists, and psychologists have researched and documented memory phenomenon such as Picture Superiority effect, Dual-coding theory and Von Restorff effect. Hermann Ebbinghaus charted the rate at which information is forgotten over time (known as the forgetting curve), which led to the discovery of “the spacing effect”4.

All of this research has led to the development of techniques that improve one’s ability to learn and retain knowledge. In turn, better knowledge retention can lead to improved conceptual understanding and increase the likelihood that what is learned can be effectively applied to solving real-life problems and scenarios.

4 https://www.britannica.com/science/memory-psychology/Long-term-memory#ref985315


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How Memories are Formed Memory formation is a three-part process. Memories are encoded, stored, and then retrieved.

Step 1: Encoding It all starts with the senses, where external stimuli (visual, acoustic, tactile and semantic) are converted into electrical signals that are sent to the brain for processing. Based on how information is presented has a major impact on where and how well it is encoded in the brain. A few memory phenomena come into play that can be leveraged to encode more durable memories.

Dual Coding Theory Verbal and nonverbal information is processed through different channels in our brain, and provide separate representations for information. For example, seeing a picture of a circle is processed in a different neural pathway than hearing the word “circle.” To form a strong memory Dual Coding Theory says that both channels should be used concurrently when encoding information (look at a circle and hear the word “circle” at the same time)5.

Picture Superiority Effect Picture superiority effect basically states that images are remembered better than text alone. Therefore visual cues can facilitate recall of facts and information6.

Von Restorff Effect The isolation effect explains that weird, odd or unique things tend to stand out and are remembered better. The more something stands out, even if it’s unfamiliar or nonsensical, the easier it will be to remember it7.

Humor Effect When emotions run high experiences are more likely to be remembered. Facts are remembered better when they are funny, rather than mundane, because laughter evokes emotion that improves memory8.

5 Clark, J. M. & Paivio, A. (1991). Dual coding theory and education. Educational Psychology Review, 3(3), 149-170.

6 Levin & Levin https://journals.sagepub.com/doi/abs/10.3102/00028312027002301

7 Hunt, R. Reed (1995). “The subtlety of distinctiveness: What von Restorff really did” https://www.ncbi.nlm.nih.gov/pubmed/24203592

8 Badli, Tunku & Dzulkifli, Mariam. (2013). The Effect of Humour and Mood on Memory Recall. Procedia - Social and Behavioral Sciences. 97. 252-257. 10.1016/j.sbspro.2013.10.230.


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Baker-Baker Paradox If one is introduced to John “the Baker,” the brain can weave associations between what is already known (a “baker”, perhaps in a white baker’s hat baking bread) and what is unknown (his name is “John”). This enables one to remember a name better because of the visual representation9.

Step 2 Once new information is encoded, storage is the next step in the memory formation process. Picture mnemonics are tools to help encode, store and recall information more easily.

A very basic form of a mnemonic, and usually the most common, is an acronym which takes the first letter of every word in a list and creates a new word. A few examples are ROYGBIV for the colors of the rainbow or FACE and EGBDF for notes on the treble clef in music.

However, with some acronyms, it’s hard to remember what each letter stands for. Using the Baker-Baker Paradox, a phonetic representation and a visual character can be developed to accompany the acronym, because the more associations that are attached to something, the higher likelihood a fact will be remembered and recalled.

Adding an interaction with another visual character forms more associations that lead to stronger memories. This is also known as the “linking” or “story” method10.

EXAMPLE: “Cabbage” represents CABG (Coronary Artery Bypass Grafting)

9 James, L. E. (2004). Meeting Mr. Farmer Versus Meeting a Farmer: Specific Effects of Aging on Learning Proper Names. Psychology and Aging, 19(3), 515–522. https://doi.org/10.1037/0882-7974.19.3.515

10 https://artofmemory.com/wiki/How_to_Link_Mnemonic_Images


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Step 3 Retrieval is the final step that will ensure one can always recall memories when we need them, even in a stressful situation such as taking an exam.

A huge misconception is that rereading a textbook, reviewing study guides and notes over and over will get information to stick. Just memorizing the visual text creates an illusion of mastery; repetition is an ineffective tool in mastering a complex subject at an advanced level, information is only being re-encoded over and over again, not learned for the long term11.

Instead, practicing “active recall” of recently learned information will stimulate the memory process and strengthen memories, making it easier to recall information in the future. Flashcards, simple quizzes or having a friend ask questions out loud are easy ways to practice active recall.

How to Strengthen Long Term Memories Material that cannot easily be recalled must be studied again. But there is a core learning strategy for long term retention that is scientifically proven to lead to more effective retention: Spaced Repetition.

Combatting the Forgetting Curve In 1885 Hermann Ebbinghaus coined the term “forgetting curve”, and it basically states; a memory, no matter what it is- a fond childhood memory of a trip to the beach, or a lab value learned in class - will be forgotten over time. However, subsequent scientific research into the “spacing effect” demonstrates that the forgetting curve can be lessened with “spaced repetition” methodology12.

Hermann Ebbinghaus’s “Forgetting Curve”.

11 Peter Brown, “Make It Stick”, Belknap Press. https://www.hup.harvard.edu/catalog.php?isbn=9780674729018

12 B Price Kerfoot https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517927/


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Spaced repetition involves reviewing information spaced out over increasing intervals of time. With each review, the slope of the curve becomes less and less, until it’s eventually stored as a long-term memory.

The most efficient approach is to review information right before it is forgotten. Unfortunately, that is nearly impossible for a student to predict. Recently software-based study tools have been developed to incorporate automated spaced repetition algorithms so that student reviews are personalized to their performance with active recall quizzes13.

13 https://elearningindustry.com/online-flashcards-for-active-recall-and-spaced-repetition


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Validation for Picture Mnemonics Medical students Ron Robertson and Adeel Yang leveraged the scientific research behind image mnemonics and created a tool for medical, nursing and other students in the healthcare professions to memorize hard-to-remember facts required to pass class and board exams and excel in school. They took thousands of topics and created wacky characters tied together with humorous stories and audio – and put it online to create the ultimate interactive studying system for retention and recall.

In a single-center, randomized, subject-blinded, controlled study14 the Picmonic Learning System was compared to text-based material and found that students using Picmonic picture mnemonics improved student retention of facts by 331% over a one month period, using a paired matching method of recall. Using free recall, students showed 200% improvement.

With either method of retrieval, students using Picmonic’s picture mnemonics outperformed the control group. 14Picmonic Learning System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029202/


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Another way of looking at the data is by observing how much Picmonic lessened the forgetting curve. Using paired matching method of recall, even if students in the control and test group had recalled the same number of facts during session 1, students who used Picmonic remembered greater than double the number of facts than the control group at the end of the 1 month period.

Using free recall, students who used Picmonic recalled nearly double the number of facts than the control group.

Adv. Med. Educ. Pract. 2014 May 8; 5: 125-32 doi: 10.2147/AMEP.S61875. eCollection 2014


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How Picmonic “Picture Mnemonics” Work To create a Picmonic, a concept/topic of interest is selected and the most important attributes are identified and encoded into memorable characters. Characters are created using a phonetic keyword mnemonic strategy, following the process of encoding information described by Levin and Levin in their 1990 study. Converting a word into its sound-alike, picturable equivalent creates a memory anchor that enables recall.

Picmonic “picture-mnemonics” are then linked to each other with an original story that helps increase memorability. The Picmonic research study describes this process as follows15:

A linear narrative is created to connect the characters together, and this story is illustrated as a picture and recorded as an audio file. These files, along with text-based definitions for each of the attributes and a topic summary, are then inputted into the Picmonic Learning System (PLS). Students can access the PLS and their library of Picmonics via a Web site portal, where they can perform self-assessment by ranking their mastery of concepts/topics and identifying areas of weakness.

15 Picmonic Learning System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029202/

“I started using Picmonic for help in my pharmacology class. I used many resources to study for Step, but on the day of the exam, the easiest facts to recall were the ones I studied with Picmonic.”

– Elizabeth Lucich (2017 Grad)


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Each Picmonic includes a 10 question multiple choice quiz that is delivered to the student right after the Picmonic characters and story are viewed. By including built-in quizzes for each Picmonic, students are given an opportunity to practice low stakes recall, a technique which has been proven to improve retention16.

Because personalization can create a more engaging experience that leads to greater learning effectiveness, Picmonic incorporates learning algorithms that adapt to a students’ learning patterns, ensuring efficient and effective knowledge mastery and retention.

Artificial Intelligence in Action: Individualized Spaced Repetition

Retention of newly learned information decays exponentially over time in a predictable pattern. Due to this known phenomenon, software algorithms can predict when a student will start forgetting information and schedules reviews of the information at the optimal time.

Picmonic has incorporated machine learning-based algorithms into their learning system to automatically determine a student’s weakness with a particular topic. These results are fed into a spaced repetition-based quizzing system that creates personalized daily quizzes to focus on what each individual student needs to review when they need to review it.

16 Roediger & Kopicke https://journals.sagepub.com/doi/abs/10.1111/j.1467-9280.2006.01693.x

“Picmonic is the most powerful memory aid I’ve ever used. It’s impossible to forget stories like those of Taco-lioness and the Astronaut-police (for tacrolimus and azathioprine), both on test day and during clinicals. Plus Picmonic has an auto-generated spaced-repetition schedule that would have taken me hours of work every week to create myself.”

– Charles (Med student)


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Picmonic intelligently and automatically adjusts to tee up subjects that require review each day to minimize the forgetting curve (dark blue line).

Picmonic’s Daily “Smart Quiz” was designed to apply retention algorithms in order to identify when students might begin to forget facts, and deliver quiz questions in intervals designed to lessen the forgetting curve.

Individual learning objectives are broken down into key facts, and are pulled into the testing queue based on what students get right and wrong. If they get a fact wrong, it will be prioritized first in their queue because they still need to review it. If they get a fact right, it will show up again too, but spaced out over increasing time intervals to optimize retention. Many other data points are also factored into the algorithms, such as how long it takes a student to answer a question and if they use a hint (showing the character). The algorithms are complex, but they are proven to help students overcome the forgetting curve and ensure that they review what they need review when they need to review it.

“My tutoring students rave about Picmonic, saying, ‘Everything on the exam I reviewed with Picmonic I got right.’ They express less stress while studying, more confidence in knowledge, and longer recall of information studied. I would absolutely recommend Picmonic to students, especially visual learners.”

– Julia Young, Delaware Technical Community College


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How Educators use Picture-Mnemonics to Engage Students Picture mnemonics improve memorability and appeal to a generation that was weaned on video games and Cartoon Network. Although seemingly less than appropriate for a professional learning program, learning with cartoons is natural for this generation and the edginess enhances product effectiveness.

Picmonic is free for educators to use, to add material to lecture slides or assign material to students for review. Picmonic is also used as an intervention tool for struggling students. Since Picmonic has a free signup option, any student with an internet connected computer or a mobile phone can access the Picmonics shown in class or assigned by a teacher, up to 1 Picmonic and quiz per day (at the free level). Picmonics can also be played on mobile devices without ongoing connected access, providing flexibility for both educators and students to use Picmonic in a variety of settings.

“Picmonic takes challenging content and not only makes it understandable and memorable, for a wide variety of students (especially those who are visual, or whose first language is not English), but it also helps students build the connections that will lead to better analysis and critical thinking which is essential to becoming a successful healthcare professional. Picmonic not only reinforces critical thinking, but conveys valuable content using a fun, interactive format that today’s gamer-culture-immersed students just get.”

– Tonya Taylor, RN, MSN, MBA, COS-C Director of Nursing & Associate Professor at Northeast Texas Community College


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Beyond the Classroom Picmonic picture-mnemonics have helped over 700,000 students become more successful healthcare professionals. Students have also claimed that Picmonic helped them with clinical rotations and post-graduation refreshers.

Picmonic has also been used as a study tool for recertification exams, and has supported doctors’ and nurses’ performance on the job by ensuring they can recall the information they need to know.

For more information about Picmonic, to receive free educator access or to book a free memory seminar and demo for students or faculty, contact [email protected].

“Picmonic is the GREATEST! I’ve been using Picmonic ever since my second week of medical school. Now as a fourth year, I continue to reap the benefits of this memory learning tool! The numerous facts that Picmonic has embedded into my memory make me into a better clinician.”

– Lucasso (Med Student)

“It’s been 5 years since I graduated school. I never took the NCLEX back then because I became a stay at home mom and my career wasn’t my focus anymore. Now, 5 years later I’m prepping to take boards and stumbled upon Picmonic. My only regret is not finding it sooner and wasting valuable study time in a book trying desperately to remember words. Picmonic has helped me retain more and understand more now, 5 years later, than I felt like I ever did when I was actually in school. I wish I had this tool when I was in school!

– Chelsea (Nursing Student) “We had an elderly woman with a history of bipolar disorder on the med-surg floor lapse into an ataxic, semi-obtunded state. During this period she had a pronounced resting tremor in her upper extremities; I proposed lithium toxicity to the resident as a potential cause of her decompensation (because I remembered the Picmonic), and we ordered confirmatory testing at the bedside. She has recovered beautifully.”

– Dr Matt Mason, a Picmonic alum, recalls an ER incident where a patient benefited from Picmonic.


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About Picmonic Over 700,000 students have used the Picmonic Learning System since the company was founded in 2013. Picmonic study tools make it easier for students to remember “hard to recall” facts, and help healthcare students improve grades and increase board/licensing exam scores. The product line includes material to supplement curriculum for medical school courses (MD, DO), nursing school courses (RN,LPN, NP), courses for physician assistant, pharmacy, paramedic, occupational therapy, physical therapy, pre-health students, as well as an introductory medical terminology course. Widely recognized as a leading study resource and mobile app to help study for the USMLE® Step 1 & Step 2 CK, COMLEX, NCLEX®, PANCE, PANRE, FNP, MCAT, and more.

Copyright © 2020 Picmonic.

“This is the best visual learning resource I’ve come across. Picmonic was a huge part of keeping me afloat for shelf exams and my favorite non-QBank resource for Step 1.”

– Clay (Med Student)

“There’s no way I would’ve scored above a 250 on Step 1 without Picmonic. Plus, it also helped me to score extremely well on my first two Shelf Exams during third year rotations.”

– Steven (Med Student)

“The first big test I used Picmonic for I was the first person to finish (which is not my norm) and I almost felt like I cheated by using Picmonic because it had made it so easy for me to remember the minute details that I saw others struggling to remember.”

– Dr. Callie Davies (2015 MD Graduate)

Documents

Audio-Visual Picture Mnemonics and Spaced Repetition ......The Science of Memory. Since early Roman times, people have been fascinated by the science of memory, developing techniques