key: cord-0019741-ng7q6x1v
authors: Monzon, Anthony; Samara, Omar
title: Cartoons and the internet: preparing the physicians of tomorrow
date: 2021-07-28
journal: Ther Adv Infect Dis
DOI: 10.1177/20499361211033552
sha: 82f166d62aedba518dc6edb72bff1b1b25db8dff
doc_id: 19741
cord_uid: ng7q6x1v

nan

As preclinical medical students, the task of learning microbiology can be a daunting one. There is a great depth of knowledge that needs to be acquired before understanding the clinical presentations and management of a wide variety of diseases. When looking through textbooks, we see lists of unpronounceable, italicized names with dozens of factoids associated with each one; the thought of memorizing it all is intimidating, to say the least. Traditionally, flashcards have been the most powerful tool we have had to aid us in our studies. Flashcards are effective for memorization but do little for understanding and can get monotonous very quickly. With the advancement of technology and access to digital learning resources, this daunting task becomes manageable, and possibly even fun. Companies such as Sketchy Medical (https://med.sketchy.com) have taken those long lists of microbes and numerous tables filled with facts and created colorful cartoons that help us remember all the important details.

Over the past decade, several companies have based themselves around a similar platform: cartoon mnemonics to aid in the memorization of medical knowledge. Founded in 2012, Sketchy Medical began with a couple of hand-drawn videos uploaded to YouTube. Andrew Berg -the founder of Sketchy Medical -experienced first hand the difficulty of remembering such a high volume of information and decided to approach this task in a different way. Since then, they have quickly grown and now produce intricate digital pieces of artwork that can hold anywhere from 10 to 50 pieces of information. After a long day of class lecture, many medical students will be watching cartoons, with the purpose of solidifying the information presented earlier. Through conversations with colleagues, the general consensus is that the most effective method for studying information-dense materials such as microbiology and pharmacology is to synthesize the traditional method of flashcards with the cartoon mnemonics: using flashcards based on the scenes. Even 2 years after watching dozens of these scenes, we can still think back and recall much of the salient information from each one. Of course, there are gaps in our memory, but this is a simple fix, just by looking back at the flashcards we have for those scenes, the details come back.

Preparing us for a career beyond the classroom, these cartoon mnemonics help us establish a base of knowledge wherein we can begin to understand many diseases and their treatments. It is similar to learning to speak a new language. Before being able to have a conversation, one needs to build up a vocabulary. To those unfamiliar with microbiology, Trypanosoma cruzi might be nothing more than an exotic sounding name. However, with the help of visual mnemonics we can remember a great deal of information. For T. cruzi, Sketchy Medical created a scene in which a group of people are doing yoga on a cruise ship ( Figure 1 ). Looking around the scene you will also see a map, a grandfather clock, heart shaped pool floats, and some clouds of noxious fumes, among many other important details. The noxious fumes will remind us that the stink bugs (Triatomine bugs) are those which carry T. cruzi, which can then cause Chagas disease. The map reminds us of where this disease is endemic to (Central and South America). The grandfather clock hints at chronic disease and the pool floats will remind the viewer the association with megacolon, dilated cardiomyopathy, and mega-esophagus. This learning tool by no means pretends to be comprehensive, rather it gives the learner the basis from which to understand and put context to a clinical picture, which is a big part of medical school in general.

With standardized licensing exams looming over our progression from medical students to physicians, we must balance studying for board exams and our school's curriculum. There are many online services that are marketed toward medical students for precisely this purpose. Over the recent years, many other companies have ventured into the visual mnemonic space, to the point where we as students often have resource overload. 1 Like Sketchy Medical, there are other companies that provide a similar service. Pixorize and Picmonic are two similar companies which also have a subscription-based service that gives students access to their content for a limited amount of time. Sketchy Medical offers a 2-year

Step-1 plan which costs $599.99. This gives access to videos in Microbiology, Pharmacology, Pathology, and Biochemistry. This cost could definitely prove to be a barrier for many students and is not a resource that is provided by medical schools in a broad sense, since, theoretically, this information is covered in class lectures. Access to WiFi and the cost itself can be a deterrent to many students across the United States and internationally, but there are free, less comprehensive resources online that can help with some of the material. However, the information in these resources is not necessarily reviewed for accuracy and are of a lower quality due to the limited budget which with they are made. No resource is without its flaws, which makes it important for us students to be judicious with not only our money, but also with our time. While these mnemonicbased resources can be helpful for us to pass our licensing exams and do well in our classes, there is still a gap between building this foundational knowledge and being able to treat a person with the disease in question.

Watching videos and reading textbooks is not sufficient to become a competent physician. There is much more knowledge and many more skills and nuances to learn before being able to care for a patient. For example, through the use of Sketchy we have learned about the numerous pharmacological agents to treat hypertension: angiotensinconverting-enzyme (ACE) inhibitors, calcium channel blockers, diuretics, and so on, but none of these resources (class lecture included) would tell us how much medication to administer, how often, the financial costs, or many other very important pieces of information necessary to have before beginning to treat a patient. While these resources do help us establish a framework within which we are able to understand the theory, the practice of medicine is learned in the hospitals and clinics where we continue our education. It is in the hospital, seeing patients, where we can gain the knowledge necessary to make a difference in patients' lives. 2 As a student in the 21st century, it is difficult to imagine how it might have been like to study medicine 30, 20, or even 10 years ago. Textbooks and libraries have become relics of the past as most information is available online and through videos. 3 The necessity to be physically present in class has also waned, especially during the times of COVID-19, when the use of recorded lectures and other video lectures became a necessity. It is Reproduced with permission from Sketchy Medical. journals.sagepub.com/home/tai 3 our opinion that, although quite radical, some of these changes have allowed us to become more efficient learners. There once was a time when answering a question required a student to go to the library, find the book that was related to the topic, and hope that the book could resolve the query. Now, regardless of location, it takes moments to look up information on a mobile device. This does put a greater emphasis on the learner to be self-directed, as there is more freedom and a greater risk of getting lost in the sea of information. 4 There are important considerations with having such rapid access to so much information: not all of it is accurate or relevant. However, the beauty of gaining knowledge through studying and practicing medicine is that we have the ability and responsibility to judge what is accurate and relevant.

Medical students are expected to learn, understand, and remember a great wealth of information in a very short amount of time. Most, if not all, of what we learn is crucial to our development as physicians and the care of our patients. Although watching cartoons may at first seem like a childish way to spend our time, it is possibly the most efficient use of time. These cartoon mnemonics engage multiple senses and learning modalities, which have ultimately made memorization-heavy topics such as microbiology and pharmacology much more accessible and memorable. This foundational knowledge is necessary for us students to understand the diseases afflicting the patients we see, and the pharmacologic agents used to treat them. This knowledge, however, is but the cornerstone on which we will build our clinical skills and reasoning, with the hopes of identifying the diseases and the appropriate treatments we have learned so much about.

As we do so, we will think back to the cartoons that have prepared us to become the physicians of tomorrow.

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Visit SAGE journals online journals.sagepub.com/ home/tai

Author contributions AM, OS: idea, writing, corrections

The authors declare that there is no conflict of interest.

The authors received no financial support for the research, authorship, and/or publication of this article.