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Australian Aboriginal Techniques for Memorization: Translation into a Medical and Allied Health Education Setting Notes

Background

  • In the modern era, writing and digital storage have reduced the emphasis on memorization in Western education.
  • In health professional training, memorization remains crucial for:
    • Ensuring trainees have readily available information.
    • Establishing a knowledge foundation for building complex information layers during advanced training.
  • The progression in medical training from broad concepts to specialized knowledge mirrors the training of Australian Aboriginal youths progressing to Tribal Elders.

Methods

  • Australian Aboriginal memorization techniques were tested for novel word list acquisition and recall by first-year medical students (N = 76).
  • Undergraduate student evaluations (N = 49) assessed the use of the Australian Aboriginal memory technique for studying foundational biomedical knowledge (the tricarboxylic acid cycle).
  • Qualitative and quantitative analytic methods based on Bloom’s taxonomy were used.
  • Word list acquisition and recall were assessed without memory training, after training in the memory palace technique, or after training in the Australian Aboriginal narrative technique.

Results

  • Both memory training types improved item recall and reduced specific error types compared to untrained performance.
  • The Australian Aboriginal method showed an approximately 3-fold greater probability of improvement to accurate recall of the entire word list (odds ratio = 2.82; 95% c.i. = 1.15–6.90) compared to the memory palace technique (odds ratio = 2.03; 95% c.i. = 0.81–5.06) or no training (odds ratio = 1.5; 95% c.i. = 0.54–4.59) among students who did not correctly recall all list items at baseline.
  • Student responses to learning the Australian Aboriginal memory technique were overwhelmingly favorable; students found the training and technique enjoyable, interesting, and more useful than rote memorization.
  • The method has genuine utility and efficacy for studying biomedical sciences and in the foundation years of medical training.

Introduction

  • Cultures developed systems for encoding, transmitting, and protecting essential knowledge long before alphabetic writing.
  • Evidence of memorization techniques exists in cultural artifacts and sacred places, often accompanied by narrative- or song-based vocal rehearsal and performance.
  • Australian Aboriginal societies are among the oldest continuous human cultures, surviving for over 50,000 years without written information transmission.
  • Critical information for survival is relayed in stories, artistic expression, and artisanal crafts in a multi-layered system.
  • These constructs convey information at variable levels of depth and complexity based on the observer's education, experience, and status within the group.
  • Each clan and nation has its own established stories containing vital cultural knowledge, including Aboriginal Law, personal rights, land use, and astronomical and navigation information.
  • These ancient “Songline” stories exhibit little variation over time and are carefully learned and guarded by the Elders.
  • Songlines can be expressed orally, by dance, through paintings and petroglyphs, or a combination of these.
  • Core cultural information is maintained and recalled without written alphabets, allowing individuals to acquire vast, adaptable knowledge.
  • Tribal Elders are highly respected, with their knowledge essential for group growth and survival.
  • Critical information, such as seasonal food sources, political relationships, tool use, and ’secret business,’ is incorporated into songlines and artworks.
  • Symbolic and geometric patterns in artworks often contain detailed tribal information, unapparent to casual observers.
  • When learning new information outside the Songline tradition, Australian Aboriginal people construct stories incorporating local flora, fauna, and geography.
  • Detailed information is built into the narrative, rehearsed frequently for rapid and accurate recall.
  • These stories are personal, adaptable, and easily modified to accommodate new information.
  • Location-based methods resemble classical memory techniques used in Western societies for reciting epic poems, religious liturgies, and literary works.
  • Kelly notes that Australian Aboriginal societies entirely stored their culture in memory.
  • Even with alphabetic writing, paper and books were rare until recently, making a vast memory beneficial.
  • The best-known classical method is the memory palace, an imagined environment where learners attach information to specific features and locations.
  • The memory palace is a specific example of the method of loci, using spatial position as a cue for recall of information.
  • Learners attach information to features in a mental landscape and use spatial memory to facilitate detail recall.
  • The study aimed to assess the suitability of this approach for medicine and biomedical science education by comparing the Australian Aboriginal approach with the memory palace technique and evaluating classroom applications of the Australian Aboriginal approach.
  • The primary aim was to provide early-year medical students with a powerful system for memorizing large amounts of information quickly and improve understanding and awareness of Indigenous Health and cultural safety.

Methods Pt. 2

  • All procedures were approved by the Monash University Ethics Committee (MUHREC; application ID 9568).
  • Incoming graduate-entry medical students (Year A) from Monash University were invited to participate during the 3-day orientation program at the start of their first semester.
  • Students were given information sheets, and informed consent was obtained from 76/106 students.
  • Students were randomly assigned to one of three study groups.
  • Block randomization was performed using playing cards where hearts = Group 1, diamonds = Group 2, spades = Group 3.
  • When participants returned their signed informed consent, they were assigned the next study ID in the series by a staff member who was not present during the card draw.
  • Demographic data for participants in this study are presented in Table 1.
  • Group 1 received instruction in Western memory techniques; Group 2 received instruction in the Australian Aboriginal technique; Group 3 received no memory training (‘untrained recall’ group).
  • The recall testing procedure and item list were identical across groups and timepoints, though testing of the three groups took place in separate rooms.
  • All participants were given an identical list of 20 words (common butterfly names) on a single page to study for 10 minutes.
  • Butterfly names were used to avoid associating the information with the medical curriculum and prevent any disadvantage to students who chose not to participate.
  • Students were instructed to memorize the list without marking it or using electronic devices.
  • After 10 minutes, the word lists were collected, and students wrote down as many list items as they could recall within five minutes.
  • After the first recall test, students in Groups 1 and 2 were given 30 minutes of instruction in either Western or Australian Aboriginal memory techniques.
  • After the training period, students returned to the test areas, and the same memory procedure (10 minutes memorization, five minutes to record list items) was repeated.
  • Students then had a further 20 minutes of unscheduled time during which they could chat with their peers, but could not discuss the item list or anything related to the recall tests; nor could they use their mobile phones or electronic devices.
  • A final recall test was performed without the opportunity for students to review the list prior to recall testing.
  • Participants were asked to follow a hypertext link or scan a QR code to an electronic survey consisting of feedback questions related to the training session and their subjective opinions about the utility of the respective techniques.
  • The subjective ratings of task difficulty conflict with the observed group performances prior to training, as described in the previous section, where all groups started with a recall performance of 85–90% correct.

Group 1: Memory Palace Technique

  • Participants received a brief, whiteboard-assisted seminar on the history and use of the memory palace and collaboratively illustrated a schematic diagram of a simple memory palace, using a brief story containing student-suggested items.
  • Students could ask questions and were encouraged to create their internal ’memory palace’ using their childhood home's remembered floor plan.
  • Participants were instructed to visualize a familiar setting and recall the location and physical appearance of items in the imagined space.
  • Participants were instructed to associate items to be remembered with specific objects and locations in the imagined space, with as much detail as possible.
  • To recall items, participants were instructed to imagine themselves walking into the room, approaching each object and location which had a list item associated with it, and to attempt to recall the list item in conjunction with the imagined object.

Group 2: Australian Aboriginal Memorization Technique

  • Participants were given an overview of the technique by an experienced Australian Aboriginal educator, including a short description of how Elders instruct young people, and the elements of place-based narrative, image, and metaphor.
  • To construct a narrative around the butterfly word list, the instructor walked students around a rock garden on campus with rocks, plants, and concrete slabs arranged in a footprint shape.
  • Each list item was incorporated into a narrative related to elements in the rock garden.
  • The narrative was practiced as students physically walked through the garden with the instructor, and participants were encouraged to visualize walking through the garden during recall.
  • As the participants mentally "walked" the path in the narrative, they were encouraged to approach each feature in the garden and identify the place and its associated butterfly name.

Group 3: Untrained Recall

  • Participants received no instruction in memory techniques; instead, they watched a documentary called ’a Kind of Medicine’.

Data Analysis

  • Results from each recall test were collated, scanned, and manually scored.
  • The number of correct items was scored, and recall errors were counted in four categories:
    • NULL: No entry was made.
    • NEAR MISS: Incorrect due to a small error.
    • INS: Insertion of a completely different word.
    • REM: Removal of a previously entered correct answer.
  • Simple spelling errors that did not produce a semantically meaningful answer were not counted as near misses.
  • Each response sheet was assessed for the sequence of items, counting items out of sequence and assigning values to the number of places out of sequence.
  • The Sequence Index was introduced to correct for the fact that an item recalled out of order introduces a second error; it was calculated using the following formula:
    SeqI = (#position\ errors - 2) / (#correct\ responses)
  • Data were manually entered into Microsoft Excel and double-checked for accuracy.
  • Statistical analysis was performed using the Real Statistics Resource Pack for Macintosh.
  • Violin plots were used to represent the magnitude and distribution of data for each experimental group.
  • One subject from Group 2 was randomly selected and excluded from the calculation to facilitate repeated measures analysis across unequal group sizes.
  • Non-parametric methods were used for statistical comparisons, as the numbers of correctly recalled items were not normally distributed due to a ceiling effect.
  • Repeated measures comparisons were performed using the Friedman test, with post-hoc pairwise comparisons made using the Friedman-Nemenyi test.
  • An indirect measure of effect size was obtained using the Kendall’s W-statistic (KW), computed from the Friedman Q value.
  • A second analysis computed the likelihood of a student improving from less-than-perfect recall to perfect recall as an odds ratio (OR).
  • A follow-up trial was conducted six weeks after the initial sessions to assess differences in long-term retention of memorized information.

Student Responses to the Comparison of Memory Techniques

  • Feedback was sought via an online questionnaire consisting of six 5-point Likert Scale statements and a free-text question.
  • Likert scale responses were converted to percentages, and free-text responses were subjected to thematic analysis.

Study 2: Utility of the Australian Aboriginal Memory Technique in the Classroom

  • Student responses were obtained from classes taught in 2017 (N = 25) and 2018 (N = 24), totaling 49 course evaluations.
  • Students received one hour of instruction from an experienced Indigenous educator (TY) regarding the underpinning theory and history of the technique, followed by a mnemonic story to aid recollection of the tricarboxylic acid cycle
  • Students then attended the location at the Monash University campus where the story took place, a garden with eight native Australian Corymbia citriodora (lemon-scented gum) trees, and were walked through the landscape-based narrative.
  • Students were asked to add their own details to their stories to help with memorization of the detailed complexities of the reactions.
    Specific questions about the students’ engagement with, and opinions about, the Australian Aboriginal memory technique were incorporated into the normal class evaluation survey at the end of the academic semester.

Thematic Analysis

  • Thematic analysis explored qualitative data from the online survey, identifying patterns or categories that emerged from the data.
  • The method moved the raw data from simple description to more substantive concepts, using the ‘Constant Comparison’ method.
  • Researchers analyzed student responses in a series of white-board workshops, reaching consensus on final themes through collective input, debate, and conversation while undertaking constant comparison of data.
  • The themes were further explored utilizing Bloom’s taxonomy of learning.

Results Study 1

  • Both methods of loci improved recall relative to those who received no memory training.
  • Improvement in both memory training groups was greater (memory palace: Friedman Q = 18.5, df = 2, p = 0.00009, Kendall’s W = 0.37; Australian Aboriginal method: Q = 21.3, df = 2, p = 0.00002, KW = 0.43) than that observed in the untrained recall group (Q = 8.4, df = 2, p = 0.014, KW = 0.17).
  • This suggests that the observed improvements could not be attributed simply to repeated exposure to the item list.
  • Although the mean number of items recalled after training was similar between the memory-trained groups, (mean ± SD = 18.8 ± 2.1; 19.3 ± 1.8 memory palace and Australian Aboriginal method, respectively), several differences were apparent between the two methods of loci.
  • Students trained on the Australian Aboriginal technique exhibited significantly fewer errors of sequence recall than those without training or those taught the memory palace technique.
  • Students employing the memory palace technique made fewer near miss errors after training (Q = 14.6, df2, p = 0.0007, KW = 0.29), while the near miss rates for the Australian Aboriginal method and untrained recall groups showed no significant change.
  • All groups showed improvement with respect to NULL errors, but the effect was largest in the Australian Aboriginal method group (memory palace: Q = 11.5, df = 2, p = 0.003, KW = 0.23; Australian Aboriginal method: Q = 26.0, df = 2, p = 0.000002, KW = 0.52; untrained recall: Q = 11.7, df = 2, p = 0.002, KW = 0.23).
  • Students trained on the Australian Aboriginal memory technique were markedly more likely to progress from a less than perfect score at baseline to complete recall of the item list (12/19 participants, 63%, OR = 2.82; 95% c.i. = 1.15–6.09) than students trained on the memory palace technique (10/22 participants, 45%, OR = 2.03; 95% c.i. = 0.81–5.06) or those without specific memory training (6/17 participants, 35%, OR = 1.51; 95% c.i. = 0.54–4.59).
  • The memory palace group exhibited the best long-term performance, with the results from the three participants trained on the memory palace technique achieving 8, 8, and 5 items correctly recalled out of the list of 20.
  • Student rated the importance of memory skills highly (97%).
  • Students rated training on specific memory techniques would be helpful, with 93% indicating ‘strongly agree’ or ‘somewhat agree’ in response to the question: “Specific memory training as a component of medical education would be worth my while”.

Results Study 2

  • Five overarching themes were identified in the qualitative data relating to the use of the Australian Aboriginal memory technique and memorization of the Citric Acid Cycle: consolidation and learning (lower order thinking); movement and culture (middle order thinking); and engagement which corresponds to even more complex ‘meta’ thinking skills.
  • The ability of the learner to remember subject matter in novel ways helps to concretise the material in the early stages of learning.
  • Applying a particular technique to a specific task, and then being able to apply it more widely, involves higher order thinking that also draws from Bloom’s taxonomy.
  • Stories help to make memorable connections in a way that a disparate list cannot.
  • Indigenous cultures use geography and landscape to create “memory spaces” and even “narrative landscapes”.
  • Connecting Indigenous culture with science learning is appreciated.
  • It is important not to examine Australian Aboriginal knowledge systems, but to explore the external systems “from an Indigenous knowledge perspective”.
  • The Technique was different, alternative, new, creative, engaging and fun
  • Most (95%) students indicated that they found the technique effective, and over half (56%) indicated that they would definitely employ the method in their future studies.

Discussion

  • Narrative-based memory techniques employing variations of the method of loci:
    • Can improve short-term retention of complex, ordered sets of information with a single training session.
    • The utility of either the Western "memory palace" technique or the Australian Aboriginal narrative method likely requires sustained practice and repeated exposure to the target material for long-term retention (i.e. weeks to months).
  • The Australian Aboriginal method seems better suited to teaching in a single, relatively short instruction period.
  • However, it is likely that the narrative structure and consistent order of recall that the Australian Aboriginal method incorporates confers an advantage where the specific sequence of information is a relevant parameter.
  • Sequence-dependence is a common feature of the types of information health professions students are required to learn, as evidenced by long and complex metabolic processes such as the tricarboxylic acid cycle and oxidative phosphorylation components of cellular respiration.
  • The use of physical location, even in an imagined environment, as a memory aid likely arose as a result of the fact that so much of the essential information stored in memory can be linked to foraging-type behaviours.
  • Consistent with the notion that exploitation of spatial memory is among the most effective memorization techniques, an early MRI study of competitors in the World Memory Championships showed that 90% of the memory athletes employed some variation of the method of loci for rapid learning and accurate recall of information
  • Students who received the method of loci training outperformed a control group of students taught using only didactic lectures and self-directed learning.
  • Our data suggest that the techniques developed over 60,000 years or more of Australian Aboriginal culture can inform and enhance the education of students in the most technically advanced disciplines, if time and attention could be devoted to teaching the techniques.
  • The qualitative data collected in this project clearly indicate that this learning approach is pleasurable and productive in itself, and may well have a role in decreasing the ‘drudgery’ often associated with modern higher education.
  • In an analogous manner, the depth of understanding and level of necessary detail changes over the course of a medical education program in a very structured way, with a student first exposed to the foundation knowledge underpinning medical diagnoses and therapies, then with increasing emphasis on the pathophysiological, social, and professional/political factors associated with professional practice in the healthcare system.

Limitations

  • The foremost consideration with respect to teaching of the Australian Aboriginal memory technique is the cultural safety aspect and respect for the peoples who developed this approach.
  • This system has allowed the process to continue when TY is unavailable for teaching.
  • First, resolution between the memory techniques with respect to efficacy is impossible, given the ceiling effect of our study population.
  • Subjective reports from the investigators monitoring each study group indicated that during recall testing, most students were finished within approximately 2–3 minutes for the 20 item list, and had disengaged from the task and were idly staring around the room or otherwise exhibiting signs of boredom for the remainder of the task.
  • A second limitation extends to the long-term recall of information, and the need for rehearsal/revision prior to application of the recalled information for, e.g., a written or practical examination.
  • The limitations associated with the analysis of class-evaluation surveys in Study 2 largely result from the difficulty of extracting precise information from large groups of subjective ratings.

Conclusion

  • Students in the medical and allied health professions expect that memorization will play a substantial role in their training, and that they are receptive to learning techniques that can improve recall performance on memory tasks.
  • In addition, the students sampled in this work viewed training on the Australian Aboriginal method as meaningful, interesting, and fun.
  • The attractiveness of this approach, combined with the clear quantitative improvement in recall after a single, short training session, suggests that memory techniques based on Indigenous knowledge can be beneficially incorporated into health professions education.