Picmonic: the Secret to USMLE Success?

Human memory is a fickle thing. How is it that we can remember a line from our favorite movies years later (“ARE YOU NOT ENTERTAINED?”) yet forget somebody’s name before they are even finished talking?

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For medical students, memory is an especially frustrating topic. The ultimate memory tests are the USMLE and COMLEX Step 1 board exams, 8-hour long marathon tests taken at the end of the second-year of medical school that cover all the material presented during the first two-years. At 649 pages long, First Aid for the USMLE Step 1 is considered to be a “condensed” version of the high-yield material tested on the exam. Adding to the stress of the exam, Step 1 scores are considered to be one of the most important factors in selecting candidates for residency interviews.

Capitalizing upon, and perhaps worsening, this frustration has been a vast array of board preparation services offered: online courses, review books, and question banks to name a few. And while a 2003 study found no improvement in USMLE scores for those who took a commercial course versus self-study, there are no shortage of options available to students for board prep.

One of the newest and fastest growing board prep companies is Picmonic, an Arizona-based start-up founded by two third-year medical students, Adeel Yang and Ron Robertson. Spreading through medical campuses with an impressive word-of-mouth campaign, Picmonic takes traditional medical education methods and throws them out the window.   

Traditional medical education content can be rigid, dry and text-heavy, which is challenging for students who have little time to master an insane amount of information. Picmonic is the opposite; although the content is the same, it’s delivered in a fun, imaginative, audio-visual environment which allows users to remember so much more and for much longer”- Adeel Yang, co-founder of Picmonic

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How does Picmonic work?

In the simplest terms, Picmonic takes age-old memory techniques, employs empirically driven cognitive science, and creates “simply unforgettable” audio-visual mnemonics (“mnemonics on steroids” as some students have called it). Penicillin, the beta-lactam antibiotic, becomes Pencil Villian, a Zoro-masked pencil. Rheumatic fever, an inflammatory disease following Strep pyogenes infection, becomes the Roman Fever Beaver, a beaver on fire wearing a laurel wreath.

The idea of ridiculous imagery sounds pretty silly at first, but the data and results behind Picmonic speak for themselves. A pilot study by the company showed an improvement in memory retention by 162%. This memory technique isn’t just limited to medical students either, USA Memory Champions routinely use absurd imagery to memorize decks of cards, hundreds of random digits or shapes, or unpublished lines of poetry.

When I pressed Adeel for more evidence to support the Picmonic program, he responded with a laundry list of studies showing the efficacy of audio-visual mnemonics.  A 2008 study found “long term memory is capable of storing a massive number of objects with details from the image.” A 2010 article that showed “research over the past three decades has supported the efficacy of mnemonic instruction.” And most importantly, an IRB approved research study, currently pending publication, conducted at Midwestern University shows a definitive improvement in memory retention for medical students who used the Picmonic program over traditional text-based information.

The Proof In The Pudding: My Picmonic Review

Even with all this data, I was skeptical of how effective the Picmonic program would be for me. I had been researching various board prep services as a second-year medical student and Picmonic was one of the most talked about services offered.  The Picmonic team was gracious enough to give me a free subscription for review, and I gave the program a trial during my Cardiology course.

My game plan for Picmonic was to learn the Picmonic “cards” after getting a thorough review of my classes and other resources (Kaplan Videos, Pathoma).

For example, while learning about cardiomyopathies, I would go over my class PowerPoint slides, the associated Kaplan and Pathoma videos, then finish with related Picmonic cards. One of the topics I learned about was dilated cardiomyopathy, a condition in which the heart becomes weakened and enlarged and is caused by a variety of things such as alcohol abuse, wet beriberi, pregnancy, and Doxorubicin toxicity. Through a sound understanding of the pathophysiology, I learned that the weakened heart walls lead to increased filling, presenting as a S3 heart sound. While none of this sounds particularly complex or difficult to memorize, the difficulty came from remembering this information within the context of the entire cardiology system. Hypertrophic cardiomyopathy presents with a S4 heart sound, right-sided heart failure presents with hepatomegaly, the list goes on and on. And this is where Picmonic came in handy, to help sort out the details in the chaos. Below is the Picmonic card for dilated cardiomyopathy:

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Dilated cardiomyopathy became a dilated partying heart in a mayo jar with a S3 stethoscope. The causes became a pregnant lady, beriberi potion, and a toxic daschund playing with a Rubik’s cube. The video explanation took no longer than 2 minutes, but I could already start seeing the audio cues in my head whenever I reviewed dilated cardiomyopathy. I continued this routine with the rest of the Cardiology topics, essentially “topping-off” my studying with Picmonic cards.

Surprisingly, on exam day, when difficult questions came up regarding specific details, the first memories to jump into my mind were the Picmonic cards. Instead of thinking “this topic is on the upper-right corner of my third page of notes” I pictured the S3 stethoscope around the partying dilated heart in the mayo jar.

Not only that, when I started going through practice questions in Qbanks, I began visualizing Picmonic cards whenever I got stuck. Just a few days ago, a question that presented with dilated cardiomyopathy asked for a possible cause and seeing Doxorubicin in the answer choices instantly triggered the image of the toxic Daschund playing with a Rubik’s cube.

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After trying out the Picmonic program, I highly recommend it as an excellent supplemental source for board preparation. At the end of the day, the majority of test and Qbank questions I’m answering are still based off understanding the concepts and pathophysiology behind each of the system. However, Picmonic excels in cementing traditionally difficult to memorize details that show up on exams. And when every question counts, I’ll take my (evidence-based) chances with Picmonic.

Featured image from video above.

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Ryan Nguyen, "Almost" DO

Ryan Nguyen is a DO student at the Western University College of Osteopathic Medicine of the Pacific and blogs about medical school at WhiteCoatDO.com. In addition to school, he is a Foundation Scholar for the California Academy of Family Practice and Student Ambassador for Doximity. He tweets @RNguyenMed.

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