Memory Mastery: Spaced Repetition (Nursing)

00:01 Now, chunking is good. It helps you strengthen neuronal connections.

00:04 It helps you secure a place in long-term memory.

00:07 It helps you with increasing in encoding and retrieval.

00:10 You're into all that. Hopefully you buy that by now.

00:13 But here is another strategy. It's called spaced repetition.

00:17 Yes, you're really not going to like this one.

00:19 But just hear me out before you make a decision.

00:22 Spaced repetition means that you can study something 20 times in one night or you can study it 20 times over 20 days.

00:32 Do you know which one has better encoding and retrieval? Yes, I know. You don't want to admit it.

00:37 But we try to tell ourselves that just cramming is going to do it.

00:40 It doesn't do it for a long-term. Do you know how I know this? Because I always give cumulative final exams.

00:46 Our program, that's a requirement.

00:49 So I see students that have done really well in individual exams but when they get to the final, they tank.

00:55 That's because they crammed and knew it for just that test.

00:59 But they couldn't make the connection over time.

01:01 So here are some more bit of news you're going to be real excited about.

01:05 You want to get the biggest bang for your buck? The best time to review your class notes is the same day as class.

01:11 You're going to get a lot more for your money if you'll spend 15-20 minutes looking at your notes from class the same day.

01:20 Now, you should keep reviewing that information on a regular basis, maybe every day.

01:24 As you gain more mastery of it, you can increase the time in between reviews.

01:29 Because you gained content mastery, you don't have to review it as often.

01:33 Cumulative finals would not be as scary if you kept reviewing the information as you went along this semester.

01:40 We all start with those good intentions but very few of us really follow through.

01:44 I started a new strategy with students that when I give exam one on exam two, there's exam two content and exam one.

01:52 When I give exam three content, there's exam two and exam one, same thing with exam four.

01:57 That will give the students a challenge and encourage them and a reward for reminding themselves to use spaced repetition throughout the semester.

02:06 Now, we talked about ways to chunk information.

02:09 I use the head to toe method and we show you an example of that there.

02:12 When I'm learning about a disease, or a drug, or a problem, then I think about it in head to toe.

02:19 So I just use a simple stickman figure.

02:21 That's for the neuro system, the cardiac system, the respiratory system, the GI, GU, skin immobility.

02:28 I just take corticosteroids and I rewrote them symptom by symptom.

02:32 Now, I did the whole movement thing with it.

02:35 You don't have to do that, or you can. It can be kind of fun.

02:38 But when I group them like that, the list looks much less intimidating.

02:43 My brain can see it in that systematic format.

02:46 It makes it easier to remember with spaced repetition.

02:49 Now, I've got other examples of student notes here because I want you to see that different things work with different people.

02:54 As you can see, some people are really into colors and they're artistic.

02:58 Frankly, I am not that talented. I just have really basic generic notes.

03:03 But some people, this works for their brain to use lots of color, and drawing, and pictures. I wish I could but I cannot.

03:11 I want you to make sure that you see the note, that note card.

03:15 You see there's just screened letters written on it.

03:17 Well, this was a student that I had in class.

03:19 He's incredibly fun to have as a student because he loved learning.

03:23 The only notes he took in class were flashcards because I want to talk to you about flashcards.

03:28 I've never seen anyone use flashcards like this.

03:31 Here is how I normally see students use flashcards and I always advise against it.

03:36 They spend hours and hours and hours.

03:39 They have tubs and tubs and tubs full of flashcards.

03:42 The problem is they invest all their energy in making flashcards and they run out of time to actually study them and make the connections between the information.

03:52 This guy, he sat in class with a stack of note cards and that's the only way he took notes.

03:57 He'd write brief notes that made sense to him on the note cards.

04:00 That's the way he took notes and then it worked for him.

04:03 Now, that's a very unusual system but here's what he didn't do.

04:07 He didn't spend the majority of his time making the note cards.

04:10 He spent more time studying the note cards than he did making the flashcards.

04:15 That's the takeaway point for you.

04:17 Now, look at these notes. This student was really precise.

04:22 They liked to have everything all spelled out like this.

04:25 This is what they came up with with drugs for angina.

04:28 I think they eventually got to sell these to their peers because everybody wanted to buy copies of their notes.

04:33 See, they don't really get the benefit.

04:35 Who got the benefit was the person who made this chart and decided what information needed to go there.

04:41 But I want to talk to you about how you can chunk information that will help you raise your exam scores and know what to do as a nurse when you walk into a room.

04:51 We've got some columns here.

04:54 The first one you have diagnosis or procedure.

04:56 Then you have the letters WCS. That stands for worst case scenario.

05:02 The next column says, “How would I recognize it?” And then it says, “What would I do about it?” So you've got your columns.

05:09 This is how you'll know if you're ready to take a test or if you're ready to take care of a patient that has one of these.

05:15 So every time you see a diagnosis or a procedure, I want you to think through can I answer this.

05:21 Writing this out when you're first learning the diagnosis procedure is really what you need to do.

05:25 So let's take CHF. We've talked about it a little bit but it's a pretty common one and most of you know that one.

05:31 CHF is congestive heart failure. Now, let's answer the question.

05:37 What's the worst case scenario for congestive heart failure? Well, congestive heart failure is edema.

05:42 The worst kind of edema is pulmonary edema.

05:45 Yes, it's a bad deal to have edema in your legs and other places.

05:50 But the worst case scenario is pulmonary edema.

05:53 Now, you'd make a list of the things of how you would recognize it.

05:56 Well, I could listen to their lungs and see if that crackles or not.

06:00 I could look at their chest X-ray report.

06:03 I could look at ABGs which are arterial blood gasses.

06:06 I could see if the patient might be complaining of shortness of breath.

06:09 Now, what would I do about it? Well, I'd want to give him oxygen.

06:14 We'd consider giving diuretics. I would elevate the head of the bed.

06:18 I would listen to their breath sounds.

06:19 I would weigh the patient. I would educate them about their disease.

06:22 Okay. Now, let me tell you what the secret is.

06:25 You should be able to do this with every diagnosis or procedure because this is how we write test questions.

06:32 That’s right. I just let you in on a big nursing school secret.

06:37 This is how we write a test question.

06:39 What we're looking for is do you recognize when a patient is getting into trouble.

06:44 That's the recognized column, right? Then we look for do you know what to do.

06:50 That's the "What would I do about it" column.

06:52 I'm going to give you an example of a question so you can kind of walk through it.

06:55 Now, when you see in the what would I do about it column, we might ask you to prioritize that.

07:00 If I ask you what's the first thing you would do, likely it would be elevate the head of the bed if the patient is really in distress.

07:07 What's most important is getting that patient oxygen.

07:10 So, prioritization can be learned as you start putting the information while you're studying in this format.

07:17 So, let's take a look at a question and I'll tell you how it works on how we write test questions.

07:22 See, we're trying to test you on those last two columns when we write nursing school tests.

07:27 Mr. Gutsman is a 79-year old client who has been diagnosed with congestive heart failure.

07:33 Which of the following questions would be most important for the nurse to ask? I'm looking at a test question. So I see the word CHF.

07:41 I know that's a diagnosis.

07:43 Underline that in your notes. All right, so it's CHF.

07:47 You start thinking worst case scenario, pulmonary edema.

07:50 How would I recognize it? You already got that.

07:52 Split it out in your brain.

07:54 What would I do about it? All right, we've got it.

07:56 So the question that would be most important for me to ask is for this particular patient, Mr. Gutsman, a 79-year old who has CHF, in this particular setting, well, we're not sure where they are, what keeps him the safest? All I know about him is he's elderly and he has CHF.

08:17 But I do know the worst case scenario.

08:19 So now I have four questions.

08:21 This is a very common nursing school format.

08:25 So, when I look at each one of those four questions, I want to pause for a minute and let you read through them.

08:35 Okay, let's look at these questions.

08:38 Remember, my goal is to keep the patient the safest.

08:41 So, I'm looking for the question, the assessment that will give me the best information, the most global information about the worst case scenario for Mr. Gutsman's diagnosis of CHF.

08:53 Number one, do you have swelling in your feet and legs? Well, does that have to do with CHF? Yes.

08:59 Number two, do you weigh yourself every day? Well, that applies to CHF and volume overload.

09:05 Number three, huh, I'm not really sure.

09:09 Then number four, take your pulse every day.

09:13 Okay well, I'm going to use my scratch paper.

09:18 I'm going to have one, two, three, four because I know when I take the NCLEX, I have a write-on/wipe-off board.

09:23 I can use this strategy, writing one, two, three, four.

09:27 So what you do is you write that down and I look at these four answers.

09:31 I know CHF worst case scenario is pulmonary edema.

09:37 Number four doesn't really have anything to do with pulmonary edema.

09:41 So I'm going to cross through number four.

09:43 Now, one, two, and I'm not really sure on three, probably have something to do with CHF but I have to start eliminating them.

09:53 Well, does number one tell me anything about pulmonary edema? No, I can cross through that.

10:00 Do you weigh yourself every day? Well, it's about fluid volume but I don't think it leads to pulmonary edema.

10:07 I'm going to get through it. Whoa! Now, I have number three.

10:12 So I've crossed off number one, number two, number four.

10:15 What does number three tell me about pulmonary edema? I'll tell you what it tells you about pulmonary edema.

10:22 Where you sleep at night, the patient will tell you, “In my bed or in my recliner.” Because the patients with CHF, we asked them where they sleep because if they have pulmonary edema, they can't lay flat in their beds.

10:36 They need to sit upright in a chair to sleep.

10:39 That's why number three is the most important question.

10:43 See how we did that? We knew the worst case scenario was pulmonary edema.

10:47 Number three was the best information to give us about pulmonary edema.

10:52 So, that's how you start using this format of taking notes for any diagnosis or procedure that when you see a test question, you're thinking through. Worst case scenario, how would I recognize it? What would I do about it? In this case, they were testing you to see if you knew the worst case scenario for CHF.

11:09 So we've talked about how people learn.

11:13 Remember, you have to have attention, encoding, storage, and the ability to retrieve it.

11:19 So you're not looking at a test going, “Ah, I know we studied that but I can't remember it.” Because remember, encoding, storage, and retrieval, you have an ability to improve the effectiveness of all of those strategies by using the strategies we've discussed today.

11:33 Because the best way to improve your memory for specific information is to practice retrieving it.

11:39 So ask yourself questions. Have your friends ask you questions.

11:43 Man, get your family involved with simple questions.

11:46 But keep asking yourself question because that's the best way to improve your memory and to practice retrieving it.