Audio-Visual Picture Mnemonics and Spaced Repetition Can Improve Student Learning AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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 | 2 AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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 | 3 AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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. | 4 AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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 | 5 AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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/ | 6 AUDIO-VISUAL PICTURE MNEMONICS AND SPACED REPETITION CAN IMPROVE STUDENT LEARNING 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.