Weird, witty and worthwhile: Exploring the benefits of mnemonic- based medical education

Weird, witty and worthwhile: Exploring the benefits of mnemonic- based medical education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Weird, witty and worthwhile: Exploring the benefits of mnemonic- based medical education Shazia Sarela, Malvi Shah, Emma Kelley, Nidhi Rege, Harish Bava, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5595921/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Mnemonics, both self- created and well- established, are commonly used by medical students to boost their recall of knowledge in exams. Previous studies have evaluated mnemonics’ utility in medical education, but few have demonstrated positive effects on students’ knowledge and confidence. Mnemonics are also more commonly shared directly between peers, as opposed to being formally taught in medical schools. However, previous studies have not specifically evaluated mnemonics in near- peer based teaching. This study explores the impact of mnemonic-based, near- peer-led teaching on medical students' knowledge and confidence. It aims to determine whether mnemonics enhance students' ability to answer exam-style questions and boost self-perceived confidence and future mnemonic use. Methods: Over eight months, 23 peer-led teaching sessions on commonly- tested clinical medical topics were held for third-year medical students, with at least two mnemonics incorporated into all sessions. Pre- and post- session SBA questions and five- point Likert scales were used to assess change in students’ knowledge and confidence, respectively. Post- session, Likert scales were also used to assess students’ self- rated utility of the mnemonics taught and their likely future use of each mnemonic. Statistical analyses were performed using Python and SciPy packages. Results: Students demonstrated a significant improvement in SBA scores, particularly for mnemonic-linked questions (p < 0.05). Confidence levels also significantly increased post-teaching (p < 0.01). Students reported a higher likelihood of future mnemonic use, and a strong correlation was found between improved confidence and increased mnemonic use (p < 0.001). Out of five mnemonic types used, rhymes were the most useful mnemonics across all sessions, though absolute numbers of each mnemonic used were too small to draw any statistically significant conclusions. Discussion: Peer-led teaching with mnemonic integration significantly improved both knowledge and student confidence. Mnemonics proved to be a valuable tool in aiding recall, and students expressed a higher likelihood of using them in the future. This study highlights the potential of both mnemonic-based and peer-led learning strategies in medical education. Future work could assess the utility of different types of mnemonics and follow up learners to assess knowledge retention over time. medical education models memory aids mnemonics student confidence teaching strategies Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Undergraduate medical education requires effective learning strategies to cope with high- stakes written and practical exams ( 1 , 2 ). As medical students, we frequently find mnemonics, defined as ‘any device for aiding the memory’ ( 3 ), a valuable tool for managing the vast amount of information we need to retain. Mnemonics provide numerous benefits for both written and practical medical examinations, aiding the quick recall of differential diagnoses or management options, and offering structured frameworks for history-taking, examinations, or procedures, particularly in high-pressure situations ( 4 , 5 ). Different types of mnemonics include acronyms, where each letter corresponds to the first letter of a memorable word, imagery which uses visual recall, rhyme which employs memorable phrases, and connections and associations, where a phrase sounds similar to the target concept ( 3 , 6 ). Table 1 provides examples of each type of mnemonic. Students often use established mnemonics as well as self-created ones, which may relate to their own personal contexts and experiences ( 3 , 7 – 9 ). Research into the utility of mnemonics in medical education is limited, with two studies demonstrating their effectiveness in improving differential diagnosis generation ( 11 , 12 ). Students’ test scores in these studies improved following the mnemonic-based teaching, and students found the mnemonics taught to them useful. However, only imagery- based mnemonics yielded significant improvements in test scores. Mnemonics have also been evaluated as part of an interactive audiovisual mnemonic- based learning platform for teaching basic sciences, factual-recall type information. Students using the audiovisual platform had significantly better immediate and delayed recall of the facts and reported significantly greater satisfaction with the learning methods compared to students taught with traditional methods ( 13 , 14 ). Mnemonic frameworks have also been proposed for recalling communication techniques in serious illness conversations and conversations about disability and teaching students about brief motivational interviewing, with many reported to be memorable and useful for students ( 15 – 17 ). However, other studies have shown weaker evidence for the utility of mnemonics. A study comparing the utility of the ‘standard’ mnemonic (‘4 Hs and 4 Ts’, standing for hypotension, hypokalaemia, hypothermia, hypoglycaemia, tension pneumothorax, cardiac tamponade, thrombus and toxins) to an image-based memory aid for recalling the causes of electromechanical disassociation in cardiac arrest demonstrated that the image- based mnemonic was significantly more effective for immediate recall of the causes, but not for delayed recall ( 18 ). Another study using an imagery- based mnemonic to help undergraduate students learn the Krebs cycle was unsuccessful in improving knowledge acquisition compared to the control ( 19 ). Although mnemonics have been investigated in various contexts, few studies have shown significant impacts on both test scores and student confidence. Additionally, limited research has explored the wide-ranging applications of mnemonic-based teaching across a range of different medical specialities or examined their impact on long-term learning strategies. Furthermore, most studies have investigated mnemonics as part of formal, faculty-led teaching sessions, with limited exploration of their use in near-peer teaching. Near-peer teaching, defined as instruction provided by ‘a trainee one or more years senior to another’ ( 20 )has been shown to be highly effective. Senior students can offer recent insights into examinable topics, allowing them to provide teaching focused on high-yield concepts and topics commonly found challenging ( 21 , 22 ). Despite the recognised benefits of mnemonics and near-peer teaching as individual strategies, there is limited research on their combined effects. This study aims to address this gap by investigating the impact of mnemonic-based, near-peer-led teaching on medical students' knowledge and confidence. Near-peers, having used mnemonics in their own exams, are uniquely positioned to identify concepts that benefit from memory aids and share mnemonics they found particularly effective. We hypothesise that integrating mnemonics into near-peer teaching provides a powerful, dual approach that enhances recall, exam performance, and self-confidence. The primary aim of this study was to investigate whether mnemonic-based teaching significantly affects students’ performance on exam-style questions, their confidence in examinable topics, and their likelihood of using mnemonics in future learning. The secondary aim was to evaluate whether near-peer led, mnemonic-based teaching significantly improves students’ ability to correctly answer exam- style SBA questions and confidence in examinable topics. Table 1 Types of mnemonics commonly used in medical education Mnemonic category Example Explanation Acronym ABATE the bleed (ABCDE for acute resuscitation, blood transfusion, antibiotics, terlipressin, endoscopy within 24 hours) Acute management of upper GI bleeding Imagery Hypocalcaemia ECG changes: lengthened QT interval à Mum and baby are far apart if there's hypocalcaemia therefore lengthened interval Hypocalcaemia ECG changes Rhyme Stones, bones, thrones, abdominal groans, psychic moans Causes of hypercalcaemia Association Rich Old Men only Call people Richter’s transformation of CLL to an aggressive non- Hodgkin’s lymphoma commonly occurs in older men Connection In DKA treat the Ketosis, in HHS treat the Hyperglycaemia Management of diabetic emergencies Methods Table 2 Topics taught by Year 4 medical students in 23 online, voluntary teaching sessions across an 8-month period Session number Topics taught during 23 teaching sessions 1 Anaemia 2 Metabolic Abnormalities 3 Electrocardiograms and Chest X-rays 4 Arterial Blood Gases and Abdominal X-rays 5 ABCDE Structure and Pharmacology 6 Acute Kidney Injury Causes and Management 7 Perioperative Care and Prescribing 8 Acute Coronary Syndrome and Tachycardia 9 Type 1 & 2 Diabetes 10 Heart Failure and Hypertension 11 LFTs and Gallbladder, Pancreatic and Hepatic Conditions 12 Bowel Conditions and Abdominal ABCDE Situations 13 Statistics and Ethics and Law 14 Stomach, Oesophagus and Colorectal Conditions 15 Pneumonia and Tuberculosis 16 Fluid Balance Disorders 17 Thyroid & Parathyroid Disorders 18 Neurology Emergencies and Epilepsy 19 Lung Cancer and Pulmonary Function 20 Glomerular Problems and Renal Topics for Practical Exams 21 Visual Field Defects and Headaches 22 Rheumatology Antibodies and Presentations 23 Haematology Cancers and Blood Films Twenty-three weekly 90-minute sessions were delivered over eight months, targeted at third-year medical students at University College London (UCL). These sessions were designed and taught by a team of ten fourth-year UCL medical students, with content reviewed by qualified doctors. Sessions were held online, advertised as incorporating high-yield curriculum content, memory aids, and exam-style questions. Attendance and participation in the teaching sessions was voluntary. Table 2 lists the topic covered. Each session incorporated at least two mnemonics linked to the content taught, categorised as one of the following types: acronyms, rhymes, associations, connections or imagery. Figure 1 outlines the structure of the feedback form used for the first 15 sessions. A five- point Likert scale was used to assess students’ confidence in the topics being taught before and after the session, frequency of mnemonic use before teaching; perceived utility of mnemonics taught, and likelihood of future use. A score of 1 corresponded to ‘completely inutile’, ‘very poor’ or ‘never’, and 5 to ‘extremely utile’, ‘excellent’ or ‘all the time’. The SBA questions students were asked to complete included questions that could and could not be answered using the help of mnemonics taught in the lesson, with a minimum of two of each type of questions in each session. This was so that students’ performance in non-mnemonic linked questions would serve as a ‘control’ question to be compared against those that were linked to a mnemonic. Data was collected using Google Forms. This study received exemption from ethics approval by UCL as it collected completely anonymous, non-sensitive data from students. All students attending the teaching sessions were provided with a Participation Information Leaflet which detailed how their data would be used and their right to withdraw from the study at any time. All students who completed the feedback form consented to their anonymous data being used for research purposes. Based on mid-cycle feedback from tutors and students, the pre-session aspect of the feedback form was removed for the final eight sessions to expedite form completion and encourage higher response rates. (Fig. 1 ). Data was analysed using Python Pandas and SciPy packages. The Spearman Rank Correlation Test was used to evaluate correlations amongst Likert scale variables and SBA scores. The Wilcoxon Signed Rank Test assessed significant differences in paired pre- and post- session data, enabling comparisons between mnemonic-linked and non-mnemonic-linked SBA questions. Results A total of 147 students attended the teaching across the 23 sessions conducted, with a mean of 6.39 (range: 1–18) students attending each session. SBAs to assess utility of mnemonics and overall utility of peer-provided teaching sessions There was a significant improvement in the mean percentage of non-mnemonic related SBAs and mnemonic-related SBAs answered correctly after teaching (Mnemonic: Wilcoxon Signed Rank Test p value = 5.966x10 − 7 ; Non-mnemonic: Wilcoxon Signed Rank Test p value = 1.630x10 − 6 ). After teaching, the mean percentage of correctly answered mnemonic-based SBAs was significantly greater than that of non-mnemonic-based SBAs (Wilcoxon Signed Rank Test p value = 0.0055) (Fig. 2 ). Confidence in topics taught before and after delivery of teaching sessions Students’ mean self-perceived confidence in the topics taught after teaching (mean: 3.9558/5) was significantly greater than their confidence before teaching (mean: 2.3321/5) (Wilcoxon Signed Rank Test p value = 1.630x10 − 6 ). Utility of mnemonics provided during teaching sessions Over 65 mnemonics of a range of type and purpose were taught over the 23 sessions held. 47% of students rated the utility of the mnemonics in aiding their memory of the associated facts as 5/5, with 97% of all students rating the utility as greater or equal to 3/5. The mean rating of mnemonic utility across all sessions was 4.2/5. Acronyms were used the most frequently across all sessions (51 uses), followed by associations (6 uses). Rhymes, imagery and connections were used the least frequently (3 uses). Rhyme related questions were answered correctly 100% of the time after the teaching, followed by associations (95%). Acronyms and imagery linked questions were answered correctly 78% and 76% of the time after teaching, followed by imagery related questions answered correctly only 63% of the time. Rhymes also received the highest mean rating out of 5 for utility by the students (Fig. 3 ). Figure 4 represents the correlation between students’ scores for their confidence in the topics taught after teaching and their scores for the utility of mnemonics provided. A significant positive correlation was found (Spearman Rank Correlation p value = 0.00085). Frequency of use of mnemonics before and after delivery of teaching Students self-reported likely use of mnemonics after teaching (mean: 4.381/5) was significantly greater than their use of mnemonics before attending the teaching (mean: 3.496/5) (Wilcoxon Signed Rank Test p value = 1.85x10 − 13 ). Over 50% of students reported their likely future use of mnemonics after the teaching as 5/5, compared to 27% before the teaching (Fig. 5 ). Figure 6 illustrates the correlation between students' change in confidence in topics taught and their predicted change in frequency of use of mnemonics before and after delivery of teaching. A significant positive correlation was found (Spearman Rank Correlation p value = 1.157x10 − 9 ). Figure 7 illustrates the correlation between students’ scores for their likely future frequency of use of mnemonics after teaching and their scores for the usefulness of mnemonics taught. A significant positive correlation was found (Spearman Rank Correlation p value = 1.278x10 − 17 ) (Fig. 7 ). Discussion Our study provides evidence that the use of mnemonics significantly enhances students' performance in SBA questions. Students performed better in SBA questions which could be answered with the help of mnemonics compared to those that were not assisted by mnemonics. This suggests that the ability to recall facts about a medical topic using a range of mnemonics may improve students’ performance in assessment. This finding aligns with previous studies which demonstrated the positive impact of mnemonics on students’ knowledge, such as by improving students’ differential diagnosis generation and students’ multiple- choice test scores on medical sciences topics. ( 11 – 14 , 23 ). Importantly however, in one study looking at a mnemonic to assist the generation of cardiac differential diagnoses after being provided with a case vignette, there was a decrease in the number of potentially correct non- cardiac diagnoses. This highlights that mnemonics can potentially narrow students’ thinking or teach them to think mechanistically as opposed to considering the entire clinical context. Our study did not assess the potential negative impact of mnemonics, but this would be important to further explore in future work. Our sessions aimed to teach clinical concepts from first principles, and only then incorporate mnemonics once students had understood the concept, as a memory aid. Mnemonics were not taught in isolation, but in the context of an entire session on a particular topic. By contrast, studies investigating mnemonics on their own, that had not been incorporated into a wider teaching session, were not found to have a significant impact on students’ question- answering performance ( 18 , 19 ). This suggests that care must be taken to introduce mnemonics only when students have enough baseline knowledge to appreciate them. In our sessions, mnemonics were used to teach students discrete, hard to remember facts, that were judged by tutors to be of high importance in exams. Other studies which used mnemonics to teach complicated concepts, such as the Krebs’ cycle or the action of the extra- ocular muscles, showed less benefit to students’ assessment scores. ( 19 , 24 ) In situations like these, the mnemonic itself may be so complicated that it learning it becomes more cumbersome than simply rote- learning a topic. In addition to performance improvements, students' self- rated confidence levels increased significantly, which correlated with a greater projected increase in students’ frequency of use of mnemonics after teaching. This could be explained by the positive reinforcing effect of success: as students' confidence grows through improved understanding and recall of the material during peer-led sessions, they are more likely to adopt and trust the mnemonics that contributed to this and incorporate these mnemonics into their long-term learning strategy. Previous studies have also reported increases in student confidence and future mnemonic use, though the correlation between them was not assessed ( 11 , 23 ). Students also reported that they found the mnemonics taught in our sessions very useful. Learners have found a wide range of other mnemonics useful. ( 11 , 13 , 14 , 23 ) Interestingly in one study, students also suggested that they found the mnemonic- based teaching more enjoyable than standard teaching ( 23 ). This shows that mnemonics may be of particular benefit in topics that students normally find to be uninspiring or tedious to learn. The mnemonics taught during the teaching sessions were carefully selected by tutors, who considered the ease of remembering the mnemonic itself and its relevance in written and practical exams. Other studies which demonstrated significant improvement in students’ knowledge or confidence also utilised similarly judiciously- selected mnemonics. ( 11 , 12 , 23 ). By contrast, a study where students created mnemonics themselves and shared them with their peers did not show any improvement in performance or confidence compared to the control ( 25 ). This may suggest that ‘tried and tested’ mnemonics, chosen by senior students who have a recent understanding of their utility, are more likely to be helpful than those which have not been tested in the long term or in formal examinations. Additionally, the significant improvement in students’ confidence, as well as overall scores in SBAs, found in this study supports our secondary aim of demonstrating the benefits of peer-led teaching in conjunction with mnemonic-based learning and further emphasises the general impact and value of peer-led teaching in medical education. Senior students, having recently completed the same exams and curriculum, are ideally placed to assist junior students and make their learning process effective. The relatively relaxed, informal nature of near- peer teaching may allow for students to feel more comfortable asking questions, resulting in a greater improvement in their confidence and understanding ( 21 , 22 ). Of the five types of mnemonics provided to students, rhymes were rated the most useful. Furthermore, SBAs that could be answered with rhyme-type mnemonics were the most likely to be correctly answered. Rhymes may offer superior memorability due to their rhythmic and melodic nature, making them easier to recall during high-pressure exams compared to acronyms, which require additional cognitive effort to unpack. However, as creating ‘rhymes’ is challenging, resulting in their use only three times across the 23 teaching sessions conducted, leading to a limited sample size. In contrast, acronyms were utilized over 50 times. Acronyms are frequently used in medical education to recall common causes of diseases, frameworks for treatment, or lists of drug side effects. Their relative ease of creation compared to rhymes or associations contributes significantly to their utility. Our findings revealed minimal variation in confidence and utility of mnemonics across all the sessions, which demonstrates the generalisability of our findings across the wide range of topics we taught across the year. However, large variations in the number of attendees between sessions, ranging from 1 to 18, meant a topic and speciality specific analysis into the utility of mnemonics, as well as their impact on students’ ability to answer related SBA questions and their confidence in the topic, could not be conducted. A study with a larger, consistent group of participants at each session would allow for this limitation to be overcome. In addition, our sessions mainly focused on teaching students about the diagnosis, investigations and management of common conditions. Future sessions evaluating mnemonics on communication and skills decision making would be important, as many mnemonics have been proposed in these areas but have not been rigorously evaluated ( 26 – 28 ). A significant limitation of our study was the loss of pre-session data for the last eight sessions following amendments to the feedback form to maximise completion. For these sessions, students were required to retrospectively rate their confidence and frequency of use of mnemonics pre-session, which may introduce bias. Additionally, the lack of pre-session SBAs impaired the ability to assess the change in students' scores. Future studies where pre and post session feedback forms are part of a formal, mandatory evaluation would allow for full assessment of this aspect. Another limitation of this study was our inability to link the data of students who attended multiple sessions across the year as we did not collect identifying data. This prevented the evaluation of whether greater attendance improved SBA scores and usage of mnemonics. Students who attended more sessions may have reported a greater pre-session frequency of using mnemonics than other students as they had been positively influenced by previous sessions they had attended. As such, further studies that allow linkage of students’ data across different teaching sessions may allow for more in-depth analysis. This could be achieved by assigning each participant a unique, randomly generated number to input across feedback forms, allowing data linkage while maintaining anonymity. Additionally, mnemonic utility was assessed by asking students to complete mnemonic- linked and non- linked SBAs immediately after the teaching sessions, which evaluated how useful students found mnemonics for short term recall. Longer term follow-up of students would allow assessment of the long-term impact of mnemonics on recall, performance, confidence and understanding. Other studies which assessed longer- term knowledge retention did show that reduced over time, suggesting that one- off teaching may be less helpful than frequent knowledge refreshers, or students being given resources to take away to test themselves on mnemonic- based concepts ( 13 , 14 ) Finally, all variables assessed in this study were measured using SBA questions and 5-point Likert scales. Future studies involving more qualitative and thematic analysis through structured interviews and free-text questions would aid in greater understanding of students' perceptions of mnemonic-based peer-led teaching. Conclusion In conclusion, this is the first study to formally evaluate the impact of mnemonic-based, peer-led teaching on medical undergraduate students’ ability to correctly answer exam- style SBA questions, enhance confidence and promote long-term mnemonic use. The findings underscore the significant benefits of peer-led teaching and the use of mnemonics in medical education. The marked improvement in SBA scores and student confidence following the teaching sessions demonstrates the effectiveness of senior students in facilitating mnemonic- based teaching for their junior peers. Mnemonics, when carefully selected and integrated into teaching, proved to be highly valuable in improving both short- term recall and student engagement with examinable topics. Finally, the strong correlation between mnemonic use and confidence establishes the critical role for mnemonic-based, peer-led teaching in enhancing medical education, highlighting the need to incorporate these strategies into curricula to support deeper learning and sustained knowledge retention. Declarations Clinical trial: This study was not a clinical trial and therefore does not have a registration number. Ethics approval and consent: This study received exemption from ethics approval by UCL as it collected completely anonymous, non-sensitive data from students. Consent for publication: Not applicable Availability of data and materials: All data generated or analysed during this study are included in supplementary table 1. Competing interests: None to declare Funding: None to declare Authors’ contributions: MS and SS conceptualised and led the teaching series that collected the feedback from students. SS performed analysis of the data collected during the teaching series and wrote the results and methods sections of the manuscript. MS, RA, NR, HB, AP and EB conducted a review of existing literature on the topic and were involved in the writing of the introduction and discussion, with MS being the majority contributor. EK provided advice and was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements: We would like to thank all the tutors who taught as part of the teaching series and the students who attended across the year. We would also like to thank Professor Faye Gishen for her support and guidance throughout this project. Authors information: Corresponding Author: Shazia Sarela Shazia Sarela: [email protected] ORCID ID: 0000-0001-5605-8621 Shazia Sarela is a Final Year Medical Student at University College London. Malvi Shah: [email protected] ORCID ID: 0009-0001-8241-9272 Malvi Shah is a Final Year Medical Student at University College London. Emma Kelley: [email protected] ORCID ID: 0009-0001-7599-4105 Dr Emma Kelley is a Clinical Lecturer (Teaching) at University College London. Nidhi Rege: [email protected] Nidhi Rege is a fourth-year medical student at University College London. Harish Bava: [email protected] ORCID ID: 0001-0957-0494 Harish Bava is a fourth-year medical student at University College London. Rama Aubeeluck: [email protected] ORCID ID: 0000-0003-1336-7939 Rama Aubeeluck is a Final Year Medical Student at University College London. 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Wooden's pyramid: building a hierarchy of skills for successful communication. Med Teach. 2011;33(1):39-43. Eloge J, Napier TC, Dantz B. OPQRST(U): Integrating Substance use Disorders or “Use” into the Medical History. Substance Abuse. 2018;39(4):505-8. Additional Declarations No competing interests reported. Supplementary Files TableS1.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5595921","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":391912409,"identity":"2a689fd5-9023-48fe-bd82-c302a4ad2d8d","order_by":0,"name":"Shazia Sarela","email":"data:image/png;base64,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","orcid":"","institution":"University College London","correspondingAuthor":true,"prefix":"","firstName":"Shazia","middleName":"","lastName":"Sarela","suffix":""},{"id":391912410,"identity":"9b02115b-ea15-4dd5-a4d4-d6d7a94a53df","order_by":1,"name":"Malvi Shah","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Malvi","middleName":"","lastName":"Shah","suffix":""},{"id":391912411,"identity":"ffbdecb0-2085-494e-b8e9-8b94a12a9585","order_by":2,"name":"Emma Kelley","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Emma","middleName":"","lastName":"Kelley","suffix":""},{"id":391912412,"identity":"6dad7427-7529-4e17-ab0a-2da860b10628","order_by":3,"name":"Nidhi Rege","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Nidhi","middleName":"","lastName":"Rege","suffix":""},{"id":391912413,"identity":"bdbb917d-0fa2-4ec4-a083-59c639195933","order_by":4,"name":"Harish Bava","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Harish","middleName":"","lastName":"Bava","suffix":""},{"id":391912414,"identity":"a1019917-3e9d-4c4d-9e0d-18e62c1d45d2","order_by":5,"name":"Rama Aubeeluck","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Rama","middleName":"","lastName":"Aubeeluck","suffix":""},{"id":391912415,"identity":"5680e371-08e2-4d4a-b6b0-9e41bd19557a","order_by":6,"name":"Elena Boby","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Boby","suffix":""},{"id":391912416,"identity":"f10cc496-fc44-4def-87d2-2e4194ef37cb","order_by":7,"name":"Anusha Prabhu","email":"","orcid":"","institution":"King's College Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Anusha","middleName":"","lastName":"Prabhu","suffix":""}],"badges":[],"createdAt":"2024-12-06 20:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5595921/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5595921/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72021222,"identity":"e0284f39-e4d9-424a-85ce-bfd5bf5ecf9a","added_by":"auto","created_at":"2024-12-20 17:19:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":262812,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow Chart illustrating the structure using to collect data from students across delivery of 23 teaching sessions using feedback forms\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/cb9a0ed270e66840ea01f160.png"},{"id":72020011,"identity":"a4936e60-f084-4245-958a-11e055bf509a","added_by":"auto","created_at":"2024-12-20 17:04:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35842,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBox plot illustrating the percentage of mnemonic-based SBAs, non-mnemonic-based SBAs and overall SBAs correctly answered before and after the teaching session\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/da27be235cd5d869f2e422ef.png"},{"id":72020013,"identity":"bbd71387-5638-4a2d-b5a3-2fddf385f9cb","added_by":"auto","created_at":"2024-12-20 17:04:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":24457,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar charts illustrating mean students’ scores for the utility of the mnemonics taught out of 5 by mnemonic type\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/8abbcddf7fd3f4b211b91e73.png"},{"id":72020955,"identity":"90fad726-4293-4884-9762-8900271b7e43","added_by":"auto","created_at":"2024-12-20 17:12:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":45607,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRegression plot between\u003c/strong\u003e \u003cstrong\u003estudents’ scores for their confidence in the topics taught after teaching and their scores for the utility of mnemonics provided\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/02841a9e8db8d25eb9f79b7b.png"},{"id":72020003,"identity":"778951f2-903a-4153-97c0-f04c9276c8f0","added_by":"auto","created_at":"2024-12-20 17:04:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":28689,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar chart illustrating percentage of students rating their frequency of use of mnemonics before and after teaching out of 5\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/f4bc092edc9d01df7f19111a.png"},{"id":72020023,"identity":"7bf21556-6f43-40a1-b34f-7c90061cfe62","added_by":"auto","created_at":"2024-12-20 17:04:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":45424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRegression plot between students change in confidence in topics taught and their predicted change in frequency of use of mnemonics before and after delivery of teaching\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/2ea66354ae11921621336245.png"},{"id":72019989,"identity":"a77231c6-7b29-4d86-8da6-3783f429c8d0","added_by":"auto","created_at":"2024-12-20 17:03:59","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":50617,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRegression plot between students’ scores for likely future frequency of use of mnemonics after teaching and their scores for usefulness of mnemonics taught\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/38fe54d12641778a6411845a.png"},{"id":109614017,"identity":"521c4064-0620-4b0d-a70f-695c1e7c5647","added_by":"auto","created_at":"2026-05-20 08:11:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":675215,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/3f86e259-3db8-4641-8626-6d39756c83e0.pdf"},{"id":72020010,"identity":"59ba0f8b-d3b3-4613-a775-3144a1cf6886","added_by":"auto","created_at":"2024-12-20 17:04:00","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":39088,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5595921/v1/8cbc99dbf88585f386aea8a9.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Weird, witty and worthwhile: Exploring the benefits of mnemonic- based medical education","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUndergraduate medical education requires effective learning strategies to cope with high- stakes written and practical exams (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). As medical students, we frequently find mnemonics, defined as \u0026lsquo;any device for aiding the memory\u0026rsquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), a valuable tool for managing the vast amount of information we need to retain. Mnemonics provide numerous benefits for both written and practical medical examinations, aiding the quick recall of differential diagnoses or management options, and offering structured frameworks for history-taking, examinations, or procedures, particularly in high-pressure situations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Different types of mnemonics include acronyms, where each letter corresponds to the first letter of a memorable word, imagery which uses visual recall, rhyme which employs memorable phrases, and connections and associations, where a phrase sounds similar to the target concept (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides examples of each type of mnemonic. Students often use established mnemonics as well as self-created ones, which may relate to their own personal contexts and experiences (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch into the utility of mnemonics in medical education is limited, with two studies demonstrating their effectiveness in improving differential diagnosis generation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Students\u0026rsquo; test scores in these studies improved following the mnemonic-based teaching, and students found the mnemonics taught to them useful. However, only imagery- based mnemonics yielded significant improvements in test scores.\u003c/p\u003e \u003cp\u003eMnemonics have also been evaluated as part of an interactive audiovisual mnemonic- based learning platform for teaching basic sciences, factual-recall type information. Students using the audiovisual platform had significantly better immediate and delayed recall of the facts and reported significantly greater satisfaction with the learning methods compared to students taught with traditional methods (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Mnemonic frameworks have also been proposed for recalling communication techniques in serious illness conversations and conversations about disability and teaching students about brief motivational interviewing, with many reported to be memorable and useful for students (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, other studies have shown weaker evidence for the utility of mnemonics. A study comparing the utility of the \u0026lsquo;standard\u0026rsquo; mnemonic (\u0026lsquo;4 Hs and 4 Ts\u0026rsquo;, standing for hypotension, hypokalaemia, hypothermia, hypoglycaemia, tension pneumothorax, cardiac tamponade, thrombus and toxins) to an image-based memory aid for recalling the causes of electromechanical disassociation in cardiac arrest demonstrated that the image- based mnemonic was significantly more effective for immediate recall of the causes, but not for delayed recall (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Another study using an imagery- based mnemonic to help undergraduate students learn the Krebs cycle was unsuccessful in improving knowledge acquisition compared to the control (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough mnemonics have been investigated in various contexts, few studies have shown significant impacts on both test scores and student confidence. Additionally, limited research has explored the wide-ranging applications of mnemonic-based teaching across a range of different medical specialities or examined their impact on long-term learning strategies.\u003c/p\u003e \u003cp\u003eFurthermore, most studies have investigated mnemonics as part of formal, faculty-led teaching sessions, with limited exploration of their use in near-peer teaching. Near-peer teaching, defined as instruction provided by \u0026lsquo;a trainee one or more years senior to another\u0026rsquo; (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)has been shown to be highly effective. Senior students can offer recent insights into examinable topics, allowing them to provide teaching focused on high-yield concepts and topics commonly found challenging (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Despite the recognised benefits of mnemonics and near-peer teaching as individual strategies, there is limited research on their combined effects.\u003c/p\u003e \u003cp\u003eThis study aims to address this gap by investigating the impact of mnemonic-based, near-peer-led teaching on medical students' knowledge and confidence. Near-peers, having used mnemonics in their own exams, are uniquely positioned to identify concepts that benefit from memory aids and share mnemonics they found particularly effective. We hypothesise that integrating mnemonics into near-peer teaching provides a powerful, dual approach that enhances recall, exam performance, and self-confidence.\u003c/p\u003e \u003cp\u003eThe primary aim of this study was to investigate whether mnemonic-based teaching significantly affects students\u0026rsquo; performance on exam-style questions, their confidence in examinable topics, and their likelihood of using mnemonics in future learning. The secondary aim was to evaluate whether near-peer led, mnemonic-based teaching significantly improves students\u0026rsquo; ability to correctly answer exam- style SBA questions and confidence in examinable topics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTypes of mnemonics commonly used in medical education\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMnemonic category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExplanation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcronym\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eABATE the bleed (ABCDE for acute resuscitation, blood transfusion, antibiotics, terlipressin, endoscopy within 24 hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcute management of upper GI bleeding\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImagery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypocalcaemia ECG changes: lengthened QT interval \u0026agrave; Mum and baby are far apart if there's hypocalcaemia therefore lengthened interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypocalcaemia ECG changes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRhyme\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStones, bones, thrones, abdominal groans, psychic moans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCauses of hypercalcaemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssociation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRich Old Men only Call people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRichter\u0026rsquo;s transformation of CLL to an aggressive non- Hodgkin\u0026rsquo;s lymphoma commonly occurs in older men\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConnection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn DKA treat the Ketosis, in HHS treat the Hyperglycaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eManagement of diabetic emergencies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTopics taught by Year 4 medical students in 23 online, voluntary teaching sessions across an 8-month period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTopics taught during 23 teaching sessions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnaemia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetabolic Abnormalities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElectrocardiograms and Chest X-rays\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArterial Blood Gases and Abdominal X-rays\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eABCDE Structure and Pharmacology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Kidney Injury Causes and Management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerioperative Care and Prescribing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Coronary Syndrome and Tachycardia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType 1 \u0026amp; 2 Diabetes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeart Failure and Hypertension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLFTs and Gallbladder, Pancreatic and Hepatic Conditions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBowel Conditions and Abdominal ABCDE Situations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatistics and Ethics and Law\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStomach, Oesophagus and Colorectal Conditions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePneumonia and Tuberculosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluid Balance Disorders\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThyroid \u0026amp; Parathyroid Disorders\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurology Emergencies and Epilepsy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung Cancer and Pulmonary Function\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlomerular Problems and Renal Topics for Practical Exams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVisual Field Defects and Headaches\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRheumatology Antibodies and Presentations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaematology Cancers and Blood Films\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTwenty-three weekly 90-minute sessions were delivered over eight months, targeted at third-year medical students at University College London (UCL). These sessions were designed and taught by a team of ten fourth-year UCL medical students, with content reviewed by qualified doctors. Sessions were held online, advertised as incorporating high-yield curriculum content, memory aids, and exam-style questions. Attendance and participation in the teaching sessions was voluntary. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e lists the topic covered. Each session incorporated at least two mnemonics linked to the content taught, categorised as one of the following types: acronyms, rhymes, associations, connections or imagery.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the structure of the feedback form used for the first 15 sessions. A five- point Likert scale was used to assess students\u0026rsquo; confidence in the topics being taught before and after the session, frequency of mnemonic use before teaching; perceived utility of mnemonics taught, and likelihood of future use. A score of 1 corresponded to \u0026lsquo;completely inutile\u0026rsquo;, \u0026lsquo;very poor\u0026rsquo; or \u0026lsquo;never\u0026rsquo;, and 5 to \u0026lsquo;extremely utile\u0026rsquo;, \u0026lsquo;excellent\u0026rsquo; or \u0026lsquo;all the time\u0026rsquo;. The SBA questions students were asked to complete included questions that could and could not be answered using the help of mnemonics taught in the lesson, with a minimum of two of each type of questions in each session. This was so that students\u0026rsquo; performance in non-mnemonic linked questions would serve as a \u0026lsquo;control\u0026rsquo; question to be compared against those that were linked to a mnemonic. Data was collected using Google Forms. This study received exemption from ethics approval by UCL as it collected completely anonymous, non-sensitive data from students. All students attending the teaching sessions were provided with a Participation Information Leaflet which detailed how their data would be used and their right to withdraw from the study at any time. All students who completed the feedback form consented to their anonymous data being used for research purposes.\u003c/p\u003e \u003cp\u003eBased on mid-cycle feedback from tutors and students, the pre-session aspect of the feedback form was removed for the final eight sessions to expedite form completion and encourage higher response rates. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData was analysed using Python Pandas and SciPy packages. The Spearman Rank Correlation Test was used to evaluate correlations amongst Likert scale variables and SBA scores. The Wilcoxon Signed Rank Test assessed significant differences in paired pre- and post- session data, enabling comparisons between mnemonic-linked and non-mnemonic-linked SBA questions.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 147 students attended the teaching across the 23 sessions conducted, with a mean of 6.39 (range: 1\u0026ndash;18) students attending each session.\u003c/p\u003e\n\u003ch3\u003eSBAs to assess utility of mnemonics and overall utility of peer-provided teaching sessions\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cp\u003eThere was a significant improvement in the mean percentage of non-mnemonic related SBAs and mnemonic-related SBAs answered correctly after teaching (Mnemonic: Wilcoxon Signed Rank Test p value\u0026thinsp;=\u0026thinsp;5.966x10\u003csup\u003e\u0026minus;\u0026thinsp;7\u003c/sup\u003e; Non-mnemonic: Wilcoxon Signed Rank Test p value\u0026thinsp;=\u0026thinsp;1.630x10\u003csup\u003e\u0026minus;\u0026thinsp;6\u003c/sup\u003e). After teaching, the mean percentage of correctly answered mnemonic-based SBAs was significantly greater than that of non-mnemonic-based SBAs (Wilcoxon Signed Rank Test p value\u0026thinsp;=\u0026thinsp;0.0055) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eConfidence in topics taught before and after delivery of teaching sessions\u003c/h3\u003e\n\u003cp\u003eStudents\u0026rsquo; mean self-perceived confidence in the topics taught after teaching (mean: 3.9558/5) was significantly greater than their confidence before teaching (mean: 2.3321/5) (Wilcoxon Signed Rank Test p value\u0026thinsp;=\u0026thinsp;1.630x10\u003csup\u003e\u0026minus;\u0026thinsp;6\u003c/sup\u003e).\u003c/p\u003e\n\u003ch3\u003eUtility of mnemonics provided during teaching sessions\u003c/h3\u003e\n\u003cp\u003eOver 65 mnemonics of a range of type and purpose were taught over the 23 sessions held. 47% of students rated the utility of the mnemonics in aiding their memory of the associated facts as 5/5, with 97% of all students rating the utility as greater or equal to 3/5. The mean rating of mnemonic utility across all sessions was 4.2/5.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcronyms were used the most frequently across all sessions (51 uses), followed by associations (6 uses). Rhymes, imagery and connections were used the least frequently (3 uses). Rhyme related questions were answered correctly 100% of the time after the teaching, followed by associations (95%). Acronyms and imagery linked questions were answered correctly 78% and 76% of the time after teaching, followed by imagery related questions answered correctly only 63% of the time. Rhymes also received the highest mean rating out of 5 for utility by the students (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e represents the correlation between students\u0026rsquo; scores for their confidence in the topics taught after teaching and their scores for the utility of mnemonics provided. A significant positive correlation was found (Spearman Rank Correlation p value\u0026thinsp;=\u0026thinsp;0.00085).\u003c/p\u003e\n\u003ch3\u003eFrequency of use of mnemonics before and after delivery of teaching\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cp\u003eStudents self-reported likely use of mnemonics after teaching (mean: 4.381/5) was significantly greater than their use of mnemonics before attending the teaching (mean: 3.496/5) (Wilcoxon Signed Rank Test p value\u0026thinsp;=\u0026thinsp;1.85x10\u003csup\u003e\u0026minus;\u0026thinsp;13\u003c/sup\u003e). Over 50% of students reported their likely future use of mnemonics after the teaching as 5/5, compared to 27% before the teaching (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e illustrates the correlation between students' change in confidence in topics taught and their predicted change in frequency of use of mnemonics before and after delivery of teaching. A significant positive correlation was found (Spearman Rank Correlation p value\u0026thinsp;=\u0026thinsp;1.157x10\u003csup\u003e\u0026minus;\u0026thinsp;9\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e illustrates the correlation between students\u0026rsquo; scores for their likely future frequency of use of mnemonics after teaching and their scores for the usefulness of mnemonics taught. A significant positive correlation was found (Spearman Rank Correlation p value\u0026thinsp;=\u0026thinsp;1.278x10\u003csup\u003e\u0026minus;\u0026thinsp;17\u003c/sup\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study provides evidence that the use of mnemonics significantly enhances students' performance in SBA questions. Students performed better in SBA questions which could be answered with the help of mnemonics compared to those that were not assisted by mnemonics. This suggests that the ability to recall facts about a medical topic using a range of mnemonics may improve students\u0026rsquo; performance in assessment. This finding aligns with previous studies which demonstrated the positive impact of mnemonics on students\u0026rsquo; knowledge, such as by improving students\u0026rsquo; differential diagnosis generation and students\u0026rsquo; multiple- choice test scores on medical sciences topics. (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Importantly however, in one study looking at a mnemonic to assist the generation of cardiac differential diagnoses after being provided with a case vignette, there was a decrease in the number of potentially correct non- cardiac diagnoses. This highlights that mnemonics can potentially narrow students\u0026rsquo; thinking or teach them to think mechanistically as opposed to considering the entire clinical context. Our study did not assess the potential negative impact of mnemonics, but this would be important to further explore in future work.\u003c/p\u003e \u003cp\u003eOur sessions aimed to teach clinical concepts from first principles, and only then incorporate mnemonics once students had understood the concept, as a memory aid. Mnemonics were not taught in isolation, but in the context of an entire session on a particular topic. By contrast, studies investigating mnemonics on their own, that had not been incorporated into a wider teaching session, were not found to have a significant impact on students\u0026rsquo; question- answering performance (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This suggests that care must be taken to introduce mnemonics only when students have enough baseline knowledge to appreciate them.\u003c/p\u003e \u003cp\u003eIn our sessions, mnemonics were used to teach students discrete, hard to remember facts, that were judged by tutors to be of high importance in exams. Other studies which used mnemonics to teach complicated concepts, such as the Krebs\u0026rsquo; cycle or the action of the extra- ocular muscles, showed less benefit to students\u0026rsquo; assessment scores. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) In situations like these, the mnemonic itself may be so complicated that it learning it becomes more cumbersome than simply rote- learning a topic.\u003c/p\u003e \u003cp\u003eIn addition to performance improvements, students' self- rated confidence levels increased significantly, which correlated with a greater projected increase in students\u0026rsquo; frequency of use of mnemonics after teaching. This could be explained by the positive reinforcing effect of success: as students' confidence grows through improved understanding and recall of the material during peer-led sessions, they are more likely to adopt and trust the mnemonics that contributed to this and incorporate these mnemonics into their long-term learning strategy. Previous studies have also reported increases in student confidence and future mnemonic use, though the correlation between them was not assessed (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudents also reported that they found the mnemonics taught in our sessions very useful. Learners have found a wide range of other mnemonics useful. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) Interestingly in one study, students also suggested that they found the mnemonic- based teaching more enjoyable than standard teaching (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This shows that mnemonics may be of particular benefit in topics that students normally find to be uninspiring or tedious to learn.\u003c/p\u003e \u003cp\u003e The mnemonics taught during the teaching sessions were carefully selected by tutors, who considered the ease of remembering the mnemonic itself and its relevance in written and practical exams. Other studies which demonstrated significant improvement in students\u0026rsquo; knowledge or confidence also utilised similarly judiciously- selected mnemonics. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). By contrast, a study where students created mnemonics themselves and shared them with their peers did not show any improvement in performance or confidence compared to the control (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This may suggest that \u0026lsquo;tried and tested\u0026rsquo; mnemonics, chosen by senior students who have a recent understanding of their utility, are more likely to be helpful than those which have not been tested in the long term or in formal examinations.\u003c/p\u003e \u003cp\u003eAdditionally, the significant improvement in students\u0026rsquo; confidence, as well as overall scores in SBAs, found in this study supports our secondary aim of demonstrating the benefits of peer-led teaching in conjunction with mnemonic-based learning and further emphasises the general impact and value of peer-led teaching in medical education. Senior students, having recently completed the same exams and curriculum, are ideally placed to assist junior students and make their learning process effective. The relatively relaxed, informal nature of near- peer teaching may allow for students to feel more comfortable asking questions, resulting in a greater improvement in their confidence and understanding (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the five types of mnemonics provided to students, rhymes were rated the most useful. Furthermore, SBAs that could be answered with rhyme-type mnemonics were the most likely to be correctly answered. Rhymes may offer superior memorability due to their rhythmic and melodic nature, making them easier to recall during high-pressure exams compared to acronyms, which require additional cognitive effort to unpack. However, as creating \u0026lsquo;rhymes\u0026rsquo; is challenging, resulting in their use only three times across the 23 teaching sessions conducted, leading to a limited sample size. In contrast, acronyms were utilized over 50 times. Acronyms are frequently used in medical education to recall common causes of diseases, frameworks for treatment, or lists of drug side effects. Their relative ease of creation compared to rhymes or associations contributes significantly to their utility.\u003c/p\u003e \u003cp\u003eOur findings revealed minimal variation in confidence and utility of mnemonics across all the sessions, which demonstrates the generalisability of our findings across the wide range of topics we taught across the year. However, large variations in the number of attendees between sessions, ranging from 1 to 18, meant a topic and speciality specific analysis into the utility of mnemonics, as well as their impact on students\u0026rsquo; ability to answer related SBA questions and their confidence in the topic, could not be conducted. A study with a larger, consistent group of participants at each session would allow for this limitation to be overcome. In addition, our sessions mainly focused on teaching students about the diagnosis, investigations and management of common conditions. Future sessions evaluating mnemonics on communication and skills decision making would be important, as many mnemonics have been proposed in these areas but have not been rigorously evaluated (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA significant limitation of our study was the loss of pre-session data for the last eight sessions following amendments to the feedback form to maximise completion. For these sessions, students were required to retrospectively rate their confidence and frequency of use of mnemonics pre-session, which may introduce bias. Additionally, the lack of pre-session SBAs impaired the ability to assess the change in students' scores. Future studies where pre and post session feedback forms are part of a formal, mandatory evaluation would allow for full assessment of this aspect.\u003c/p\u003e \u003cp\u003eAnother limitation of this study was our inability to link the data of students who attended multiple sessions across the year as we did not collect identifying data. This prevented the evaluation of whether greater attendance improved SBA scores and usage of mnemonics. Students who attended more sessions may have reported a greater pre-session frequency of using mnemonics than other students as they had been positively influenced by previous sessions they had attended. As such, further studies that allow linkage of students\u0026rsquo; data across different teaching sessions may allow for more in-depth analysis. This could be achieved by assigning each participant a unique, randomly generated number to input across feedback forms, allowing data linkage while maintaining anonymity. Additionally, mnemonic utility was assessed by asking students to complete mnemonic- linked and non- linked SBAs immediately after the teaching sessions, which evaluated how useful students found mnemonics for short term recall. Longer term follow-up of students would allow assessment of the long-term impact of mnemonics on recall, performance, confidence and understanding. Other studies which assessed longer- term knowledge retention did show that reduced over time, suggesting that one- off teaching may be less helpful than frequent knowledge refreshers, or students being given resources to take away to test themselves on mnemonic- based concepts (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFinally, all variables assessed in this study were measured using SBA questions and 5-point Likert scales. Future studies involving more qualitative and thematic analysis through structured interviews and free-text questions would aid in greater understanding of students' perceptions of mnemonic-based peer-led teaching.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this is the first study to formally evaluate the impact of mnemonic-based, peer-led teaching on medical undergraduate students\u0026rsquo; ability to correctly answer exam- style SBA questions, enhance confidence and promote long-term mnemonic use. The findings underscore the significant benefits of peer-led teaching and the use of mnemonics in medical education. The marked improvement in SBA scores and student confidence following the teaching sessions demonstrates the effectiveness of senior students in facilitating mnemonic- based teaching for their junior peers. Mnemonics, when carefully selected and integrated into teaching, proved to be highly valuable in improving both short- term recall and student engagement with examinable topics. Finally, the strong correlation between mnemonic use and confidence establishes the critical role for mnemonic-based, peer-led teaching in enhancing medical education, highlighting the need to incorporate these strategies into curricula to support deeper learning and sustained knowledge retention.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial:\u0026nbsp;\u003c/strong\u003eThis study was not a clinical trial and therefore does not have a registration number.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent:\u0026nbsp;\u003c/strong\u003eThis study received exemption from ethics approval by UCL as it collected completely anonymous, non-sensitive data from students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data generated or analysed during this study are included in supplementary table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e None to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None to declare\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eMS and SS conceptualised and led the teaching series that collected the feedback from students. SS performed analysis of the data collected during the teaching series and wrote the results and methods sections of the manuscript. MS, RA, NR, HB, AP and EB conducted a review of existing literature on the topic and were involved in the writing of the introduction and discussion, with MS being the majority contributor. EK provided advice and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to thank all the tutors who taught as part of the teaching series and the students who attended across the year. We would also like to thank Professor Faye Gishen for her support and guidance throughout this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors information:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eCorresponding Author: Shazia Sarela\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eShazia Sarela: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID ID: 0000-0001-5605-8621\u003c/p\u003e\n\u003cp\u003eShazia Sarela is a Final Year Medical Student at University College London.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eMalvi Shah: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eORCID ID: 0009-0001-8241-9272\u003c/p\u003e\n\u003cp\u003eMalvi Shah is a Final Year Medical Student at University College London.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eEmma Kelley: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eORCID ID: 0009-0001-7599-4105\u003c/p\u003e\n\u003cp\u003eDr Emma Kelley is a Clinical Lecturer (Teaching) at University College London.\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eNidhi Rege: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNidhi Rege is a fourth-year medical student at University College London.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eHarish Bava: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eORCID ID: 0001-0957-0494\u003c/p\u003e\n\u003cp\u003eHarish Bava is a fourth-year medical student at University College London.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"6\"\u003e\n \u003cli\u003eRama Aubeeluck: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eORCID ID: 0000-0003-1336-7939\u003c/p\u003e\n\u003cp\u003eRama Aubeeluck is a Final Year Medical Student at University College London.\u003c/p\u003e\n\u003col start=\"7\"\u003e\n \u003cli\u003eElena Boby: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eElena Boby is a fourth-year medical student at University College London.\u003c/p\u003e\n\u003col start=\"8\"\u003e\n \u003cli\u003eAnusha Prabhu: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAnusha Prabhu is an Academic Foundation Doctor at King\u0026rsquo;s College Hospital NHS Foundation Trust.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnotes:\u003c/strong\u003e Not applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDabbagh R, Alwatban L, Alrubaiaan M, Alharbi S, Aldahkil S, AlMuteb M, et al. Depression, stress, anxiety and burnout among undergraduate and postgraduate medical trainees in Saudi Arabia over two decades: A systematic review. Medical Teacher. 2022;45(5):499-509.\u003c/li\u003e\n\u003cli\u003eAtherley A, Dolmans D, Hu W, Hegazi I, Alexander S, Teunissen PW. Beyond the struggles: a scoping review on the transition to undergraduate clinical training. Medical Education. 2019;53(6):559-70.\u003c/li\u003e\n\u003cli\u003eOdigwe C, Davidson S. Mnemonics. BMJ. 2005;331(Suppl S3):0509325.\u003c/li\u003e\n\u003cli\u003eAl-Hashimi K, Said UN, Khan TN. Formative Objective Structured Clinical Examinations (OSCEs) as an Assessment Tool in UK Undergraduate Medical Education: A Review of Its Utility. Cureus. 2023;15(5):e38519.\u003c/li\u003e\n\u003cli\u003eSam AH, Westacott R, Gurnell M, Wilson R, Meeran K, Brown C. Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study. BMJ Open. 2019;9(9).\u003c/li\u003e\n\u003cli\u003eNolan J. mnemonic. In: Britannica TEoE, editor. Encyclopaedia Britannica2024.\u003c/li\u003e\n\u003cli\u003eBeitz JM. Unleashing the Power of Memory: The Mighty Mnemonic. Nurse Educator. 1997;22(2):25-9.\u003c/li\u003e\n\u003cli\u003eLanska DJ. On old Olympus? Oliver Wendell Holmes and the origin and evolution of a mnemonic couplet for the cranial nerves. Journal of the History of the Neurosciences. 2022;31(1):20-9.\u003c/li\u003e\n\u003cli\u003eLove N. Remembering the Brachial Plexus: A Hand Mnemonic, Illustrated. Anesth Analg. 2021;133(2):558-9.\u003c/li\u003e\n\u003cli\u003eDue\u0026ntilde;as AN, Kirkness K, Finn GM. Uncovering Hidden Curricula: Use of Dark Humor in Anatomy Labs and its Implications for Basic Sciences Education. Medical Science Educator. 2020;30(1):345-54.\u003c/li\u003e\n\u003cli\u003eLeeds FS, Atwa KM, Cook AM, Conway KA, Crawford TN. Teaching heuristics and mnemonics to improve generation of differential diagnoses. Med Educ Online. 2020;25(1):1742967.\u003c/li\u003e\n\u003cli\u003eSengupta MP, Crawford TN, Leeds FS. \u0026quot;The Heart is a House\u0026quot;: A Heuristic for Generating Cardiac Differential Diagnoses. J Med Educ Curric Dev. 2021;8:23821205211035235.\u003c/li\u003e\n\u003cli\u003eAbdalla MMI, Azzani M, Rajendren R, Hong TK, Balachandran Y, Hassan TR, et al. Effect of Story-Based Audiovisual Mnemonics in Comparison With Text-Reading Method on Memory Consolidation Among Medical Students: A Randomized Controlled Trial. Am J Med Sci. 2021;362(6):612-8.\u003c/li\u003e\n\u003cli\u003eYang A, Goel H, Bryan M, Robertson R, Lim J, Islam S, et al. The Picmonic((R)) Learning System: enhancing memory retention of medical sciences, using an audiovisual mnemonic Web-based learning platform. Adv Med Educ Pract. 2014;5:125-32.\u003c/li\u003e\n\u003cli\u003eSmeltz L, Carpenter S, Benedetto L, Newcomb N, Rubenstein D, King T, et al. ADEPT-CARE: A pilot, student-led initiative to improve care for persons with disabilities via a novel teaching tool. Disabil Health J. 2023;16(3):101462.\u003c/li\u003e\n\u003cli\u003eMartino S, Haeseler F, Belitsky R, Pantalon M, Fortin AHt. Teaching brief motivational interviewing to Year three medical students. Med Educ. 2007;41(2):160-7.\u003c/li\u003e\n\u003cli\u003eHorowitz RK, Hogan LA, Carroll T. MVP-Medical Situation, Values, and Plan: A Memorable and Useful Model for All Serious Illness Conversations. J Pain Symptom Manage. 2020;60(5):1059-65.\u003c/li\u003e\n\u003cli\u003eDyson E, Voisey S, Hughes S, Higgins B, McQuillan PJ. Educational psychology in medical learning: a randomised controlled trial of two aide memoires for the recall of causes of electromechanical dissociation. Emerg Med J. 2004;21(4):457-60.\u003c/li\u003e\n\u003cli\u003eMorisaki R, Bon C, Levitt JO. The use of an imagery mnemonic to teach the Krebs cycle. Biochem Mol Biol Educ. 2016;44(3):224-9.\u003c/li\u003e\n\u003cli\u003eAba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Med Teach. 2015;37 Suppl 1:S33-9.\u003c/li\u003e\n\u003cli\u003eBowyer ER, Shaw SC. Informal near-peer teaching in medical education: A scoping review. Educ Health (Abingdon). 2021;34(1):29-33.\u003c/li\u003e\n\u003cli\u003eYu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Adv Med Educ Pract. 2011;2:157-72.\u003c/li\u003e\n\u003cli\u003eSeto C, Zayat V. A Spoonful of Eponyms Helps the Pathology Go Down: Using Food Eponyms and Visual Mnemonics in Preclinical Pathology Education. Medical Science Educator. 2022.\u003c/li\u003e\n\u003cli\u003eKruger JM, Anteby I, Frenkel S. The \u0026ldquo;Crab\u0026rdquo; Memory Tool for the Actions of the Extraocular Muscles. Journal of Binocular Vision and Ocular Motility. 2020;70(3):86-8.\u003c/li\u003e\n\u003cli\u003eRomeike BFM. Peer creation and sharing of mnemonics in collaborative documents for pathology education: a pilot study. BMC Medical Education. 2024;24(1).\u003c/li\u003e\n\u003cli\u003eRiess H, Kraft-Todd G. E.M.P.A.T.H.Y.: a tool to enhance nonverbal communication between clinicians and their patients. Acad Med. 2014;89(8):1108-12.\u003c/li\u003e\n\u003cli\u003eEpner DE, Baile WF. Wooden\u0026apos;s pyramid: building a hierarchy of skills for successful communication. Med Teach. 2011;33(1):39-43.\u003c/li\u003e\n\u003cli\u003eEloge J, Napier TC, Dantz B. OPQRST(U): Integrating Substance use Disorders or \u0026ldquo;Use\u0026rdquo; into the Medical History. Substance Abuse. 2018;39(4):505-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"medical education models, memory aids, mnemonics, student confidence, teaching strategies","lastPublishedDoi":"10.21203/rs.3.rs-5595921/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5595921/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eMnemonics, both self- created and well- established, are commonly used by medical students to boost their recall of knowledge in exams. Previous studies have evaluated mnemonics’ utility in medical education, but few have demonstrated positive effects on students’ knowledge and confidence. Mnemonics are also more commonly shared directly between peers, as opposed to being formally taught in medical schools. However, previous studies have not specifically evaluated mnemonics in near- peer based teaching. This study explores the impact of mnemonic-based, near- peer-led teaching on medical students' knowledge and confidence. It aims to determine whether mnemonics enhance students' ability to answer exam-style questions and boost self-perceived confidence and future mnemonic use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eOver eight months, 23 peer-led teaching sessions on commonly- tested clinical medical topics were held for third-year medical students, with at least two mnemonics incorporated into all sessions. Pre- and post- session SBA questions and five- point Likert scales were used to assess change in students’ knowledge and confidence, respectively. Post- session, Likert scales were also used to assess students’ self- rated utility of the mnemonics taught and their likely future use of each mnemonic. Statistical analyses were performed using Python and SciPy packages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Students demonstrated a significant improvement in SBA scores, particularly for mnemonic-linked questions (p \u0026lt; 0.05). Confidence levels also significantly increased post-teaching (p \u0026lt; 0.01). Students reported a higher likelihood of future mnemonic use, and a strong correlation was found between improved confidence and increased mnemonic use (p \u0026lt; 0.001). Out of five mnemonic types used, rhymes were the most useful mnemonics across all sessions, though absolute numbers of each mnemonic used were too small to draw any statistically significant conclusions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003ePeer-led teaching with mnemonic integration significantly improved both knowledge and student confidence. Mnemonics proved to be a valuable tool in aiding recall, and students expressed a higher likelihood of using them in the future. This study highlights the potential of both mnemonic-based and peer-led learning strategies in medical education. Future work could assess the utility of different types of mnemonics and follow up learners to assess knowledge retention over time.\u003c/p\u003e","manuscriptTitle":"Weird, witty and worthwhile: Exploring the benefits of mnemonic- based medical education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-20 17:03:54","doi":"10.21203/rs.3.rs-5595921/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6033018f-d9e2-4d17-84f3-eefac53b3d38","owner":[],"postedDate":"December 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T08:09:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-20 17:03:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5595921","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5595921","identity":"rs-5595921","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}