My version of the google-hippocampus connection is the sentence, “I’m not sure, but the internets know.” This is my response to a wide variety of questions on everything from pop-culture to history to science, and everything in between. (Recent examples include: How many times has Gene Simmons been married? Do seagulls hunt other animals or are they just scavengers? What was the name of that blond guy in the first Final Destination movie? How old was our “founding father” John Quincy Adams at the time of the Declaration of Independence?”) To be fair, if he is present, I am more likely to ask my husband these questions before I result to internet searching. For reasons I do not understand, he is often at least as annoyed by my truly random inquiries as he is flattered by my assumption that he knows, quite literally, everything.
Now some of the things that I google I really should know already, but as those examples suggest, a lot of my googling is the result of random curiosity about things that should not necessarily be taking up space in my brain. I think that illustrates a real difference in approach between people in my generation and folks in the generations before: I expect that the information I need will always be rapidly accessible. This does not apply only to the randomness, but also to the important stuff. Uptodate will tell me in seconds what the first-line antibiotic for a specific infection is, PubMed will happily guide me to efficient little summaries of a wealth of literature about any area of medical science that strikes my fancy, and I can download the full text with a click. If I don’t know already, I know I can find out, as long as I can come up with the right search terms. And I admit that when I can’t find something almost instantaneously, I become very annoyed.
Before I go on, allow me to say that in general, I think rote memorization is the lowliest, basest, and most pointless form of learning. I do not say this just because I am not particularly good at it, although I admit that I find it hopelessly boring. And I do not base this on the fact that google will tell me things that I don’t have stored up. I honestly think that 90% of memorization is a waste of time that would be better spent analyzing and manipulating the information to be memorized with access to a reference book. For example, I don’t feel like I necessarily “learned” anything by spending an afternoon first year cultivating the ability to recite the urea cycle. However, I absolutely learned something when I sat down with a diagram of it in front of me and rationalized my way through which enzyme deficits would lead to which lab results. On this point, I am decidedly with Einstein, “Never memorize what you can look up.”
That being said, I don’t think that the easy access to whatever information I desire has changed my medical education as much as that post suggests, in part because medical education has changed tragically little since days gone by. My philosophy of trying to understand things without bothering to memorize them does not serve one well in the first year of medical school. Sure, with a true understanding of a concept, you can often rationalize your way to the correct answer on a multiple choice question, but not with 70 seconds/question. And tragically, no matter how I wished for it, there was no google window on my biochemistry exams. Make no mistake about it, even in the information age, preclinical medical students are still forced into hours of hours of rote memorization of volumes of facts (many of which have little or no application to practical human health.)
Therefore, I think that the question we should be asking here is not, “Are medical students somehow learning less now that they don’t have to memorize things?” but rather, “Could medical students be learning MORE if we stopped making them memorize things?” I know that I would understand more of what I learned in biochemistry and anatomy if I had been forced to memorize less of it.
The thought broadcast post makes a case that overall memorization and the selective forgetting of the things that you don’t need yields a more comprehensive understanding of medicine. Here I think that he’s flat out wrong. In fact, I would advocate for the opposite. Time spent memorizing is time that could better be spent actually working with the information, and I think that the latter is more likely to lead to the kind of knowledge and understanding that we want our physicians to have. The bits of information that you actually need usually will be memorized as you use them: no flashcards, drilling, or other torture necessary. For example, there once was a time that I needed to check a periodic table to know the charge on a sodium or calcium ion. I don’t need to do that anymore. This is not because I spent time with flashcards memorizing the charges of ions (or even nerdier, memorizing the periodic table), but because I have used that information enough that it stuck, and now I will never forget it. In contrast, off the top of my head, I don’t know the charge on a manganese ion, but my day to day life has never suffered for that lack.
The sad (and awesome) reality is that medicine has become far too large to be contained in a single human mind. It is impossible to memorize everything that you might need to know to be successful in a single specialty, let alone the little bit of everything that they toss at you in the first two years of medical school. I honestly don’t think it serves us well that medical students spend so much of their time in the first two years blindly memorizing facts and honing their skills at single-best-answer multiple-choice questions. Frankly, that’s not how we’re going to need to use that information in the real world. Patients do not turn up to the ER with little cards attached to their chests offering five possible diagnoses to choose from.
I think that to rely on memorization is to imagine that the information memorized is static and unchanging, a frankly dangerous assumption in the world of modern medicine.
So yes, occasionally I do worry that I didn’t learn enough in the first two years when someone asks me how a medication works, and I have to turn around and ask google for the answer.(The worst question so far, “I have pain here. I think its tendonitis. Which tendon is that and what should I do about it?” Limb anatomy is not my friend.) But overall, I think that having an internet based hippocampus is preferable by far to having a lot of information memorized, but no idea at all how to use it when faced with an actual person.
*For those not up on functional neuroanatomy jokes, the hippocampus is a region of your brain that is essential for long term memory.
