The memory palace for medical exams: a step-by-step guide to the method of loci

What the method is

The method of loci is old: Greek and Roman speakers used it to memorise long speeches. You choose a place you know well, such as your flat or the ward you work on. You pick a fixed route with distinct stops. Then you place a vivid image for each fact at each stop. To recall, you walk the route in your head and read the images off.

Our brains are good at places and pictures and poor at arbitrary lists. The method borrows that strength.

What the research shows

In a 2017 study published in Neuron, Dresler and colleagues scanned memory athletes and also trained volunteers in the method of loci for six weeks, 30 minutes a day on 40 days. The trained group remembered more words than control groups, and changes in brain network connectivity were related to the improvement. The study was small and the authors’ results are about word lists, not clinical reasoning. It supports the idea that the technique can be learned and can improve list recall, not that it will raise your exam score by a given amount.

There is also research using the method with students, with mixed designs and modest samples. Treat it as a useful tool for ordered lists rather than a general learning strategy.

Build a palace in five steps

Start with a small palace, around ten stops.

1. Pick a place you can picture without effort: your home, your commute, your hospital unit.
2. Fix a route and stick to it, always in the same direction. Door, hallway, sofa, kitchen table, balcony and so on.
3. List the stops by name, and walk the route aloud once.
4. Turn each fact into a vivid image. Make it odd, active and a little silly: odd things are easier to remember.
5. Place the images at the stops, walk the route twice, then test yourself by walking it without the list.

A worked example: the twelve cranial nerves

Imagine a route through your home with a stop for each nerve. At the front door, a giant nose sniffs the handle for the olfactory nerve (I). In the hallway, a pair of spectacles hangs on the wall for the optic nerve (II). The next three stops cover the nerves that move the eye: III, IV and VI, each shown as a small figure moving a ball in a different direction. Further along, a trumpet player with a drooping cheek stands for the facial nerve (VII), a swallowing throat for IX and X, and a tongue poking out of the last doorway for XII.

The order is what you gain: you can read the nerves off in sequence. Then add the function and the clinical test as small details in each image. If you want the deeper facts, make flashcards for them. The route gives you the order, the cards give you the details.

Where it fits and where it does not

Good fits: cranial nerves, the layers of the scalp, a drug class list with its key members, the order of a procedure, a classification with many items. It is less useful for facts that are isolated and independent, such as one dose or one normal range, where a flashcard is faster.

It is not a way to learn understanding. You cannot palace your way through why a patient with sepsis needs fluids. Use questions and explanations for that, then use loci for the lists that remain. The next post shows the method on drug classes.

Common mistakes

Several errors slow people down.

• Using a place you have not visited recently or cannot picture in detail.
• Putting too many facts at each stop. One image per stop is cleaner.
• Making images that are dull. If it is not strange, it fades.
• Reusing the same palace without clearing it. Use different palaces for different topics, or practise “walking through” and swapping the contents before adding new ones.
• Skipping review. Palaces still fade, so revisit them with spaced repetition.

Choosing and preparing your place

The best palace is a place that you can walk through in your mind without effort. Your own home is the usual choice. A familiar hospital ward also works, although it may be too busy with real memories. A route you walk every day, with distinct landmarks, is another option.

Prepare by walking through it, physically or mentally, in a fixed order, and listing the stops. Each stop should be a distinct object or spot, not a general area: the doormat, the shoe rack, the mirror, the lamp, the sofa arm. Stops that look alike cause confusion. Make sure the number of stops matches the list you want to store, with a spare or two.

Write the route on paper once. Then close your eyes and walk it from memory. If you skip or swap stops, fix the route before adding facts, because a wobbly route spoils everything placed on it.

A first twenty-minute session

Pick a list you know is awkward for you, such as the layers of the scalp, the branches of a nerve or the steps of a procedure. Keep it to eight to ten items. Spend five minutes making images, five minutes placing them along the route, five minutes walking the route and five minutes testing yourself on paper, in order and out of order.

Test out of order too: ask yourself what is at stop six. A good palace lets you jump in at any point. Repeat the walk the next morning and again two days later. If one image will not stay, change it. It is normal for a couple of images to fail the first time.

Using several palaces

One palace per topic keeps things from tangling. A home palace for neuroanatomy, a ward palace for emergency drugs, a commute palace for the steps of a procedure. When a palace is full, retire it by reviewing it a few times and then leave it alone, and build a new one for the next topic. Label them in your notes with a one-line description so you can find each one again. A candidate who builds five or six palaces over ten weeks will have more storage than the exam is likely to ask for.

Reading the evidence sensibly

The studies of the method of loci show that people can learn it and that it improves recall of ordered lists, including in long-term follow-up in the training study by Dresler and colleagues. They do not show that it improves performance in clinical exams. Most of the research uses word lists, not medical content, and the participants were volunteers who had the time to practise daily. Treat the method as one tool and judge it on your own results: build one palace, test yourself a week later and compare with the recall you get from a list of the same length that you learned by plain repetition.

How much time to spend

A first palace for twelve items takes about 20 to 30 minutes to build, then a few minutes a day to review. Do it for one list that you struggle with before you decide whether the method suits you. If you do not enjoy it after a fair try, drop it. Flashcards and questions carry most of the weight for most candidates, so see how flashcards fit with the DHA exam guide before you invest a lot of time in palaces.

Frequently asked questions