Why memorize what can be looked up?

For a long time nursing education has been heavily based on memorization – read, regurgitate and repeat. Memorize the skills and steps of a full cardiovascular exam, learn by heart the symptoms of multiple sclerosis, remember the signs of Parkinson disease.

It turns out, this approach is a problem for a few reasons.

Much of what we need to know is infinite and constantly changing. Science continuously gives us new information, which means that what we knew yesterday isn’t always the same information we should know for today. It doesn’t matter how long we’re in school for, or how much time we dedicate to continuing education, there’s simply not enough time or mental capacity for us to singlehandedly manage the amount of knowledge and expectations in our work. Especially when it comes to information that never stays the same.

And although some information never changes (like history taking and physical exams), there’s just too much for one person to remember. Every nurse knows how to use a stethoscope, but how many of us always remember every step in a respiratory or cardiovascular assessment?

We’re overloaded with information and what we do is too complex to rely on the ‘learn by heart’ strategy. When we can’t apply what we used to know (or supposed to know) consistently, we screw up and people get hurt.

Maybe, instead of asking us to memorize and regurgitate, school helped us learn to create, develop and implement templates, algorithms and checklists. Things that will help us apply information that’s hard to consistently remember. Can’t recall the steps involved in a complete neurological exam, why not write them down and look them up?

Is it better to try remembering the steps in a cardiovascular exam and forget certain parts, or is it better to perform this exam correctly, 100% of the time, using a checklist?

What would happen if we referred to templates that help us ask the right questions based on someone’s symptoms?

Doesn’t it make more sense to know how to access the latest and best information from research than to try memorizing it, or worse – using information that’s now obsolete?

If we started with the end in mind, with evidence-based, consistent, reliable, accurate, best-possible health care, my guess is that memorization wouldn’t be the solution.