Understanding the Forgetting Curve and Its Impact on Patient Education

We've all been there: leaving a doctor's appointment feeling informed, only to find key details slipping away shortly after. This experience is common and tied to a phenomenon known as the forgetting curve.

The forgetting curve illustrates how memory retention declines over time. It can have a significant impact on patient experience and outcomes in healthcare. Let's explore this concept, its implications in a medical context, and how asynchronous video education can help address this challenge.

How to Beat the Forgetting Curve

The Predictable Decay of Memories: Ebbinghaus' Forgetting Curve

The forgetting curve, first proposed by German psychologist Hermann Ebbinghaus in 1885, illustrates how memory retention declines over time. Ebbinghaus' research showed that we tend to forget new information rapidly, with most of the loss occurring within the first few hours to days. This memory decay accelerates when we don't actively review or engage with the information we've learned.

Ebbinghaus Forgetting Curve

Ebbinghaus studied the memorisation of nonsense syllables, such as "WID" and "ZOF" (CVCs or Consonant-Vowel-Consonant) by repeatedly testing himself after various time periods and recording the results.

The forgetting curve hypothesizes the decline of memory retention in time. This curve shows how information is lost over time when there is no attempt to retain it. A related concept is the strength of memory that refers to the durability that memory traces in the brain. The stronger the memory, the longer period of time that a person is able to recall it.

From 1880 to 1885, Hermann Ebbinghaus ran a limited, incomplete study on himself and published his hypothesis in 1885 as Über das Gedächtnis (later translated into English as Memory: A Contribution to Experimental Psychology).

Here, represents 'Savings' expressed as a percentage, and represents time in minutes, counting from one minute before end of learning. The constants c and k are 1.25 and 1.84 respectively. Savings is defined as the relative amount of time saved on the second learning trial as a result of having had the first. A savings of 100% would indicate that all items were still known from the first trial. A 75% savings would mean that relearning missed items required 25% as long as the original learning session (to learn all items).

Ebbinghaus's experiment has significantly contributed to experimental psychology. He was the first to carry out a series of well-designed experiments on the subject of forgetting, and he was one of the first to choose artificial stimuli in the research of experimental psychology.

Hermann Ebbinghaus hypothesized that the speed of forgetting depends on a number of factors such as the difficulty of the learned material (e.g. how meaningful it is), its representation and other physiological factors such as stress and sleep. He further hypothesized that the basic forgetting rate differs little between individuals.

Forgetting Curve in Healthcare: A Problematic Scenario

In a healthcare context, the forgetting curve can be problematic. For example, patients may forget crucial details explained by their physician during an appointment. This can lead to a degraded patient experience and, potentially, worse outcomes. For instance, patients might not remember critical information about their medication, pre-op instructions or follow-up appointments, which can hinder their recovery or management of a chronic condition.

Strategies for Physicians to Improve Patient Knowledge Retention

To address the forgetting curve, physicians can implement several strategies to improve patient knowledge retention.

The obvious challenge clinicians face in implementing these strategies is severe constraints on our time. If we take additional time to layer in repetition, simplification and visual aides during clinic, we will have a waiting room full of angry patients waiting to see the doctor. So we have a choice between optimizing knowledge transfer manually or keeping clinic running on time.

Most of us try to find a balance, but I think we’d all admit we frequently sacrifice optimal knowledge transfer for the sake of keeping the trains running. Room for improvement!

Here are some strategies:

• Repetition: Repeating important information during a consultation can reinforce a patient's memory of the subject matter.
• Simplification: Breaking down complex concepts into smaller, digestible bits of information can make it easier for patients to remember.
• Visual aids: Providing visual aids like diagrams, infographics, or videos can help patients better understand and recall the information presented.
• Written materials: Giving patients written summaries or instructions can serve as a helpful reference for later review.

Strategies for Patients to Improve Knowledge Retention Post-Consultation

Patients, too, can play a role in improving their knowledge retention after a physician encounter. Here are some strategies I’ve seen my own patients employ:

• Note-taking: Jotting down important information during or immediately after a consultation to solidify memories and provide a reference for later review.
• Asking questions: Engaging in active dialogue with care team to improve understanding and retention of information.
• Utilizing technology: Smartphone apps and other digital tools to track medications, appointments, and other essential health information.

Asynchronous Video Education: A Novel Approach

Asynchronous video education has emerged as a novel way to address the forgetting curve in healthcare. This approach involves providing patients with pre-recorded videos that can be viewed at their convenience, offering a flexible and engaging learning experience. Videos can be paused, rewound, and rewatched as needed, enabling patients to thoroughly absorb and review the information presented.

Patients can easily share links to videos with their family or support team, which lifts the burden of them to “re-explain” everything to family later.

PRIMR: Reducing Patient Anxiety with Better Education

We’re building PRIMR with a mission to reduce patient anxiety with better education. One way we’re executing on that mission is by harnessing the power of asynchronous video education to enhance knowledge retention. By providing easily accessible, high-quality video content tailored to patients' needs, PRIMR aims to empower patients with the information they need to make informed decisions about their healthcare. Instead of letting the forgetting curve decay to zero, we’re resetting the curve every time a patient is primed by re-watching our educational videos.

Additional factors impacting memory

He discovered that information is easier to recall when it's built upon things you already know, and the forgetting curve was flattened by every repetition. Later research also suggested that, other than the two factors Ebbinghaus proposed, higher original learning would also produce slower forgetting. Spending time each day to remember information will greatly decrease the effects of the forgetting curve.

He went on to hypothesize that basic training in mnemonic techniques can help overcome those differences in part. better memory representation (e.g. His premise was that each repetition in learning increases the optimum interval before the next repetition is needed (for near-perfect retention, initial repetitions may need to be made within days, but later they can be made after years).

Table 1: Strategies to Improve Knowledge Retention

Strategy	Description	Benefits
Repetition	Repeating key information during consultations.	Reinforces memory, improves recall.
Simplification	Breaking down complex concepts into smaller parts.	Easier to understand and remember.
Visual Aids	Using diagrams, infographics, and videos.	Enhances understanding and recall.
Written Materials	Providing summaries and instructions.	Serves as a reference for later review.
Note-Taking	Jotting down important details.	Solidifies memories and provides a reference.
Asking Questions	Engaging in active dialogue.	Improves understanding and retention.
Utilizing Technology	Using apps to track medications and appointments.	Helps manage and remember essential health information.
Asynchronous Video Education	Providing pre-recorded videos for flexible viewing.	Allows patients to review information at their own pace, improving knowledge retention.