Musical mnemonics in health science: A first look

Abstract

Song, with its memory enhancement potential and ability to engage, has been employed as a learning tool in some academic settings. Of the countless learning environments, health science may seem the most atypical setting for the musical mnemonic, and yet it may be the most suitable for its application. With medicine's robust history of student-made mnemonics, it only seems natural that learners and instructors alike have begun to experiment with song meant to educate and entertain, primarily imparting them through popular media-sharing sites. This initial assessment of song in health science is meant to highlight notions of efficacy, audience, and use through an informal survey of 10 user-made YouTube musical mnemonics. Two of these mnemonics were co-created by the author, while the remaining eight were identified via select search terms and significant viewer numbers. Resulting YouTube data infers that instructors play a major role in the use of musical mnemonics in health science education. User comments indicate that some students have found value in mnemonic songs, helping them recall information during assessments. More robust research methods, like Q-method, meta-analysis, and opinion mining, can further confirm the value and role of musical mnemonics as they pertain to medicine and healthcare.

Introduction

Setting the tone

Music is and always was a form of communication. It is omnipresent in nearly every culture, so much so that anthropologists claim it is “…an essential part of human nature” (Merkur 1999). From the most ancient times, song was used as a vehicle for passing stories from one generation to another (Dunlap & Lowenthal 2010). Since then, its role has expanded. Now, music can be heard accompanying significant events in nearly every society, including weddings, celebrations, funerals, and religious ceremonies (Blacking 1995). At work, music keeps time, cadence, and rhythm (Dunlap & Lowenthal 2010) while at play it mirrors our innermost thoughts and feelings (Bennett 2005). It has been used as a peripheral persuader, a manipulative tool, and a powerful societal unifier (Mackinnon 2008). Lemieux (2008) describes it as influential, thanks to its “highly engaging, highly repeatable, and participatory nature.” Brown (2006) claims it has the potential to “increase the meaning and memorability of linguistic messages.” Overall, music looks to have found a place in every facet of life, and given its unique qualities, is certainly ripe for use in education.

Called by Brown (2006) an “associative enhancer of communication,” music is a near-perfect learning tool. In terms of cognition, MacKinnon (2008) notes that the linguistic message of a song is processed centrally, while being supported peripherally by non-linguistic musical elements. Explained further, Dissanayake (2006) writes that this central message is interpreted through the audience's association with emotional stimulation, a phenomenon linked closely to the temporal and tonal variances of a song. This, says Snyder (2000), “provide[s] the context that gives [music] meaning, by relating the moment to a larger framework of ongoing experience and previous knowledge.” When read with the work of Weinberger (1998) in mind, these observations can explain why “music offers [such] great opportunities for communication and…can enhance learning and intellectual development.” It is no surprise, then, that studies in music and education link song to a variety of human traits, including memory (Snyder 2000; Hickok et al. 2003), speech and language acquisition (Hickok et al. 2003), emotion (Sloboda & Juslin 2001; Krumhansl 2002; Craig 2007), intelligence (Schellenberg 2005), and identity (Hargeaves et al. 2002). By the same token, music has been found to be a useful tool to teach the subjects of humanities, social science (Stovall 2006), mathematics (Foster 2004), history (Cooper 1994), English as a second language (ESL) (Griffee 1990; Murphey 1992), humanism (Newell & Hanes 2003), foreign language (Salcedo 2002), and, of course, the fundamental learning concepts we often see in children's programming (Calvert 2001).

Of all the academic environments, none other has more use for a powerful learning tool like music than medicine, a field notorious for brutal tests in memorization. Anatomy, biochemical pathways, surgery, clinical procedure, diagnostics, medication, and treatment are all part of a health professional's fundamental knowledge. Unfortunately for students, each one of these subjects contains within them fine, often vital, details that must be recalled correctly in order to succeed. For this reason, many medical students have created their own mnemonics to help them recall information. The word “NAVEL,” for example, is an acronym used to identify the contents of the femoral triangle from the lateral hip towards the medial navel (i.e. Nerve, Artery, Vein, Empty space, Lymphatics). Similarly, the words ‘SOAP BRAIN’ help clinicians remember the eight most common signs and symptoms of lupus. These aide-mémoires, and many more, have been invented to help not only students, but doctors and nurses, recall the information they need in a healthcare setting. Many mnemonics have been documented in online databases, such as http://www.medicalmnemonics.com, though few, if any, are musical in nature. Fortunately, some creative pioneers have begun to explore this untapped resource and disseminate their own medical music mnemonics online. In this paper, the breadth and potential of musical mnemonics in health science education will be explored. Following the review, the YouTube data of 10 medical music mnemonics will be informally analyzed, laying the foundation for further study in this uncharted arena.

Fundamentals of entertainment-education

For all intents and purposes, educational music falls under the genre of entertainment-education. Occasionally called edutainment, the practice of combining lecture with amusement is timeworn. In fact, its roots can be traced back to the philosophers of Ancient Greece, who taught moral lessons through the dramatic arts and theatre (Piotrow 1994). Modern entertainment-education however is, according to Singhal and Rogers (1999), a “relatively new concept,” first pioneered by Miguel Sabido, who used Mexico's television network to teach sexual health, AIDS prevention, and family planning (Piotrow 1994). Under the Singhal and Rogers (1999) definition, entertainment-education is “the process of purposely designing and implementing a media message to both entertain and educate, in order to increase audience knowledge about an educational issue, create favorable attitudes, and change overt behavior.” Another take, by Johns Hopkins University, defines entertainment-education as the use of “drama, music, or other communication formats that engage the emotions to inform audiences and change attitudes, behavior, and social norms” (de Fossard & Lande 2008). MacKinnon (2008) compares and contrasts these two definitions indicating that, although they both agree on the goals of entertainment-education, they differ on their delivery methods. Because JHU's definition of entertainment-education has an affinity for audience participation, it is this definition that fulfills the participatory nature of musical mnemonics.

Educational media embracing participatory communication “involve[s] [the] human subject[s] of social change in the process of communicating” (Dagron 2001). It allows the target audience to partake, to interact, and to be a part of the message conveyed. MacKinnon (2008) frames dialogue as central to the process, quoting Paulo Freire who proclaims that through dialogue, we are “better able to comprehend and analyze [our] situation, find [our] voice, and effect necessary, contextually appropriate and sustainable social change” (Howson & Witte 2008). In a number of forms, entertainment-education is participatory communication. Educational video games allow players to participate by yielding control. The dramatic arts and song let performers become the vehicle for conveying the message. For some, participation has proven itself to be “the critical element for effecting change” (Sood 2002). After all, as MacKinnon (2008) points out, health communication theory implies that entertainment-education is essentially participatory in nature, and as its ‘motto’ suggests: “sing and the world sings with you. Lecture, and you lecture alone” (Piotrow et al. 1997).

Outside of music, participatory entertainment-education has seen significant success in the study of medicine. Interactive applications (Sward et al. 2008), card games (Odenweller et al. 1998), video games (Duque et al. 2008), and performance art, such as improvisational theater (Newcomb & Riddlesperger 2007), have all been methodically researched as potential learning tools in healthcare. Music and song, however, seem to be missing from the bulk of the literature. Given that the “recall of verbal material … in conjunction with songs [is] greater than recall of spoken words alone,” it is hard to believe that little is known about music's efficacy, audience, and use in medical education (Bartlett 1996). Until more research is done on musical mnemonics in health science, it will always stand as a fertile ground for comprehensive investigation.

Learning with music in the health sciences

Knowledge acquisition is the first step in the pursuit of any career in healthcare. In order to absorb as much information as possible, many medical students arm themselves with mnemonics; ─ witty acronyms, risqué wordplay, and memorable poems ─ that can help them recall vital, often complicated, concepts. At first, it may seem as though medical music might have evolved from these simple word-based reminders, but surprisingly, the limited history of medical music points to a wholly different origin.

In the fourth quarter of the twentieth century, music inspired by medicine was seemingly reserved for novelty song and comedy. Acts like Monty Python, The Arrogant Worms, Weird Al Yankovic, They Might Be Giants, and The Laryngospasms have all at one time mined clinical or anatomical themes as their main source of humor. In these examples, parody, farce, and satire are the presiding end goals. Little can be said for their aim to educate. By the mid to late nineties, this balance began to shift, and educational programming, like Bill Nye the Science Guy, began to incorporate music into their televised lessons. Unlike earlier songs inspired by anatomy and physiology, this breed's aim was to instruct, though comedic appeal was still very much an acting catalyst.

With the dawn of the twenty-first century, came a wealth of digital opportunities. Consumer software, social networking sites, and accessible online venues, such as YouTube and Vimeo, granted aspiring musicians the ability to write, record, publish, and share their own user-generated music. Students, whose musical mnemonics might have gone undocumented before, now had a means to create and distribute their own niche science-inspired songs. Some of these songs, like Gus Halwani's Cranial Nerve Mnemonic (Halwani 2009) and Ryan Tatar's Making ATP (2008) are parodies on popular songs, while others, like Shake That Lower Limb by John Paro (2009), are entirely original both in word and melody. As John Paro himself explains in a 2009 NBC news report, medical mnemonics make the perfect lyrics for original songs, helping him recall information while preparing for a future in the medical practice (Johnson & Bryant 2009).

Interestingly, at about the same time, health science instructors began to explore the benefits of musical mnemonics. McFadden (2009), an instructor of human biology at Stanford University, wrote and recorded the parody rap song Regulatin’ Genes for use in his courses (Tierney 2009). Similarly, Bonnycastle (2010), a professor of the College of Medicine at the University of Saskatchewan, developed an online playlist to aid in course building. Music, it seems, had finally been embraced by the instructors themselves for use in the health science classroom. Though there are songs written to inform the public of environmental dangers, disease, and lifestyle choices, these nonprofit initiatives are not aimed for use in the classroom (MacKinnon 2008). Generally, user-made examples found online are the only songs written specifically to assist students in study at this time.

Whether these songs are effective learning resources for students in healthcare is still unconfirmed, though some sparse sources may point in the direction of an answer. One study on the use of popular music in online learning revealed that participating students consistently found musical activities highly immersive, leveraging their interest in music to learn new subjects in the classroom (Dunlap 2010). This was especially true when students were allowed to compile or create their own educational tunes. A similar experience is shared by Cooper (1994), who states that popular song lyrics are intellectually stimulating, allowing students to “assemble a more reasoned perspective on professional health care reality.” In the context of online sharing, Agazio and Buckley (2009) argue that YouTube videos (which aren’t always musical in nature) can be used as innovative teaching tools, involving students, illustrating theoretical content, and stimulating discussion in digital learning communities. Music tied to video comes with a warning tag, however, as substantial past research suggests that visual prompts inhibit associations between written word and spoken response (Wu & Solman 2011). Additionally, factual inaccuracies within user-generated media are common and concerning. Misinformation in any medical or healthcare environment could have adverse consequences for practitioners, and as such, it is recommended that all musical mnemonics be checked for accuracy before being used as trusted resources.

Exploration

YouTube, statistics, and limitations

Student and instructor-made musical mnemonics are plentiful on the web, and their accessibility is as simple as searching the right terms. Thanks to a handful of standard YouTube statistical tools, researchers can paint a spotty picture of a given video's audience and its potential applications. The number of times a video has been viewed, identified as a favorite, liked, disliked, and commented on is displayed publicly below each video. In addition, a music video's age group appeal is also defined. YouTube Analytics, a recent addition to the site's statistical toolbox, features even more information on performance, engagement, audience retention, and demographics, but unfortunately, these data are only available to a video's creator (Hamilton 2011). Because of this, only the standard set of YouTube statistical tools were available for this reviewer's use. It is important to note, though, that YouTube has several limitations as a statistical tool. The information it provides is primarily qualitative in nature. Its data, for the most part, is descriptive. The user is not given any insight as to the approach used for collecting data, making it difficult to assess its statistical validity. One might view it as a sort of “black box,” withholding the opinion of informed, transparent predictions and inference. Internal statistical analysis could no doubt be further enhanced by using a multi-method triangulation approach, and yet with YouTube there are limited opportunities for cross-referencing. As researchers in social media are aware, extracting useful information from social media is not an easy task (Cambria et al. 2012) and “…there is still a need for better tools and technologies to search large collections of multimedia data [in order to] find and deliver the right content to a user according to her current needs and preferences” (Venkatesh et al. 2008). With that said, the following numbers and analyses can best represent a prelude to further research on musical mnemonics in medicine.

Methods, observations, and discussion

The author surveyed the statistical data of 10 health science musical mnemonics during a search of the YouTube video database (Table 1). Two of these, The Pathway (Cirigliano and Klotz 2007) and The Heart (Cirigliano and Klotz 2008), were of the author's own creation, while the remaining eight were identified through search terms like “science,’ ‘health,’ ‘anatomy,’ ‘mnemonic,’ and ‘song.’ In addition to the publically available statistics, notable words, namely words referring to learning, were tallied from each comments section and included in Table 1.

Table 1  Observed Statistics on 10 YouTube health science music videos

Slate Magazine reports that only 10% of all YouTube videos break the 1000-view ceiling (Wilson 2009). Gassko (2010), a writer on statistical odds in pop culture, estimates that there is a 1 in 613.2 chance that a given video will attract 10,000 views. With these numbers in mind, the author narrowed selections by choosing mnemonics vastly exceeding 10,000 views. The video with the lowest number of views was Nurses Medication Study Song (Waldron 2011) with 31,213 views.

It is unknown whether the majority of viewers were actively seeking out songs for their health science studies, though user comments inferred that the videos were watched for educational purposes. Learning-related terms, like ‘exam,’ ‘study,’ and ‘lab,’ were all words frequently used in commentary. The word ‘study’ in particular was used most often to indicate how helpful a given song was during a student's studies. For example, the term was used twice in this context to explain the usefulness of the Muscles of the Leg Song (Williams 2009). The most commonly used notable terms were ‘class’ and ‘teacher,’ totaling in at 300 and 321 times respectively over the breadth of all 10 videos listed in the table. This, along with candid comments about instructors playing the songs during lecture, supports the notion that teachers are playing an active role in promoting and disseminating musical mnemonics in the classroom. Of particular note are Tom McFadden's Regulatin’ Genes (2009) and Hsu's Cellular Respiration Song (2010), both of which were created by instructors and have well over 200,000 views apiece. The words ‘exam,’ ‘test,’ and ‘quiz’ were frequently used in comments indicating how the songs have or will help recall information during coursework assessments. This is reflected in The Pathway and Cellular Respiration Song, where these terms were used in relatively high frequency. Whether or not the majority of students found the songs to be effective learning tools, however, is unidentifiable, although one would expect that a more robust experimental design and study, using a more targeted research approach, could shed light on this question.

The age group for which each music video was most popular proposes some interesting scenarios about the audience of each video. Some songs, like Making ATP, Muscles of the Leg Song, and Cellular Respiration Song attracted a young audience, while others, like The Pathway, The Heart, and Regulatin’ Genes, garnered a much older following. The content of each song may explain some of this, given that certain subjects are taught at different levels in health science and human biology education, but for videos drawing a majority of viewers over the age of 40, like The Pathway and Regulatin’ Genes for example, another dynamic appears to be at work. Although the ages between 40 and 55 don’t correlate with the average ages of first year medical students or nursing students, which are 24 (Moulton & Amundson 2005) and 30 (Shepherd 2009) respectively, they do draw a closer parallel to the ages of average nursing (Alexander & Liu 2009) and medical school faculty members (Rosseter 2011). This, coupled with comments about instructors sharing the videos in class, could imply that teachers and professors may be the group most interested in accessing and using those healthcare-related YouTube musical mnemonics. Could it be that instructors get more use out of these musical mnemonics as course builders than students do as a study aids? Are mnemonics used more often as a catalyst for introductory topics rather than study? A controlled assessment on age, application, and appeal could tell us more about who finds musical mnemonics most attractive and for what reasons.

The lean of the binary ‘like’ and ‘dislike’ system was overwhelmingly positive across all 10 videos. The most significant difference was seen in the Cranial Nerve Mnemonic, where there were approximately 208 times more ‘likes’ than ‘dislikes’ tallied. On the low end was The Pathway, with only seven times more ‘likes’ than ‘dislikes’ observed. Unfortunately, little else is known about the reasoning behind this positive slant. A controlled qualitative-quantitative study could pinpoint what factors made each musical mnemonic appealing, or unappealing for that matter. As one paper on social media points out, “…existing tools and research efforts [pertaining to social media venues] are limited to a polarity evaluation or a mood classification according to a very limited set of emotions…and hence they are unable to capture opinions and sentiments that are expressed implicitly” (Cambria et al. 2012). The same can be said for the number of ‘favorites’ tallied for each of the musical mnemonic videos. In examples like The Heart, The Pathway, and The PCR Song (Compare Networks, Inc. 2008), there were more ‘favorites’ observed than there were ‘likes.’ Although ‘likes’ and ‘favorites’ are both clear indicators of a positive experience with these musical mnemonics, we cannot assess why a user felt a video was more worthy of favoritism than a simple ‘like.’

Conclusions and future research

Although YouTube is not completely suited for genuine research regarding musical mnemonics in medicine, it does raise some enticing questions about the utility, value, and appeal of such media. What we can surmise from this review is that students and instructors do use musical mnemonics in conjunction with health science education, and readily so given their popularity. User comments make it clear that teachers play a major role in sharing mnemonics with their students, some of which indicate that the songs had value in preparing for exams. Additional assessments on listener preference, genre, quality, and teaching efficacy can only bolster the case for music in health science education, given that proven methods of data collection replace less thorough YouTube tools. Hybrid qualitative-quantitative studies, like Q-Methodology (Valenta 1997) would be appropriate for gathering data on listener attitudes and opinions, while Meta-analysis techniques, like those used by Means et al. (2009) in their study of the efficacy on online teaching, could be used to combine the findings of independent studies and search for the presence of heterogeneity in results on effectiveness. If social media platforms are found to have value and utility in such a study, the limitations indicated in this article could be overcome with techniques like opinion mining, sentiment analysis, or the Semantic Web methods described by Cambria et al. (2012). One concern I have when using the collective opinions of individuals as data, is the question of whether the analysts know what is best for the individual, especially when faced with the appeal of performance art like musical mnemonics. Schechner (1974) suggests that, “…mutually exclusive, hierarchical, independent classifications give way to ideas of “clustering” interrelations between data and their evaluations…But this is not the way things were, are or will be. The world is relativistic, pluralist, contradictory, and intra-subjective.” Everyone will have different temperaments and experiences that are reflected in their varied opinions on song in healthcare. Generalizations on those opinions can only paint an incomplete picture. In order to expand our understanding of the potential behind musical mnemonics in healthcare education, debate, discussion, and continued study will be needed. As for my personal experiences with musical mnemonics, I can firmly say that creating health science songs has helped me recall information during my own studies in anatomy and physiology. Whether or not others feel the same is a question worth answering.

Practice points

• Entertainment-education song has proven to be effective as a memory enhancer and learning tool across a number of disciplines.

• YouTube data infers that instructors share user-made health science songs in lecture and some students use them in preparation for exams.

• Proper research methods, like Q-Method, meta-analysis, and opinion mining, can confirm song's efficacy and role in health science education.

Acknowledgements

Author thanks Dr Michael G. Dieter and Dr Michael C. Cirigliano for playing integral roles in directing the course of this research note. He is very much indebted to their sage guidance. Special thanks to Dr Eric Klotz for co-creating and co-performing two of the original songs used in this study. Dr Kristin J. Stuempfle should also be thanked for allowing to perform these songs in human anatomy class. Additional thanks to Dr Judy Zelikoff and Dr J. S. Jacobsen for helping brainstorm an approach to this unusual topic.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.