Strong foundations.

The list of forgotten facts often feels longer than those retained. Retention is hard, the curse of the forgetting curve is against us. Undoubtedly the forgetting curve aids our ability to shed unwanted information. Unfortunately there is great difficulty asking your brain to shed the majority in favour of maintaining the minority that are the important things – the needles in the hay stack of everyday working memory.

I won’t write too much more on the forgetting curve or the means of overcoming it’s deleterious effects. For that, try the Learning Solutions magazine article ‘Brain Science Overcoming the Forgetting Curve’ (http://www.learningsolutionsmag.com/articles/1400/brain-science-overcoming-the-forgetting-curve). Also refer back to ‘How to Study.’ (https://wildermedicine.wordpress.com/2015/01/12/how-to-study-effectively/) for study tips.

For today, I write about what retention of knowledge means.

The other morning I got grilled on the mechanism of alteplase as a thrombolytic. The required details had unfortunately fallen victim to the forgetting curve. The conversation slowed, coughed a few times and stalled like a clapped out 2-stroke. The forgetting curve, the failure to retain, meant that the next step forward was halted. I sit now with a to-learn list based around things I’ve already done. Things I now need to re-learn and try to retain.

Don’t get me wrong, as student we are supposed to make use of our forgetting curve. I recognise that this predicament is inevitable and arguably important. What I am asking for is very straight forward and well known. As students, as junior doctors, as future senior in a variety of fields – we need to review and revise in order to retain.

Why retain?

Because our goal is to build knowledge.

Building knowledge, as with building anything, needs a stable foundation. I needn’t explain what happens to a building with poorly built or crumbling foundations. If the foundations of our knowledge aren’t established or are lost to the forgetting curve the height of our knowledge is inherently capped. Without a strong foundation we cannot go up, without a wide base we cannot go out. We need to retain a base of knowledge to elevate ourselves, we need to establish a breadth of knowledge to be able to think broadly. As future doctors we need to be able to do both of these things.

This sequence of thoughts is by no means novel. However, this morning it was indeed relevant. It caught me unaware and I stumbled. I now recall that the need for alteplase within the early stages of clot formation is because it’s mechanism is ineffective after the irreversible action of factor XIII in stabilising fibrin cross-bridging and strengthening clot formation. The foundation bricks of that gem are firmly back in place now and I am grateful.

The unashamed goal of all medical students is to build a tower of knowledge. A tower with a base that is strong enough and a reach that is wide enough that we might perform as competent doctors. What we need to recognise is that the forgetting curve continually erodes our base. It chips away at the hidden corners, the quiet unvisited depths of anatomy and pharmacology. Sure we can let some bricks go without harm or limitation (looking your way kreb’s cycle). But others, the true foundation bricks, the ones with the weight of towers upon them, must be maintained. Until the point where they are firmly locked in our memory we must re-visit them regularly, carefully patching new gaps, to prevent collapse and ensure continued growth.

Re-visit your foundations. Patch them, care for them, build upon them. Good luck.

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