Is the Internet Impairing Your Medical Memory?

You don’t need to know the role of the artery of Adamkiewicz or mechanisms of liver failure. You can Google it. And, you don’t need to remember it once you’ve looked it up — Google will remember for you!

The internet, with its limitless trove of content, revolutionizes the concept of memory — including within medicine. For medical students and physicians, the presence of unlimited information that exists just a click away has diminished the need for internal memory, or the retention of facts in our brains. Many of us quickly turn to digital resources like Google, UpToDate, or PubMed when confronted with complex medical questions or to confirm a differential diagnosis. Having these tools is empowering, as we’re now able to complete within minutes research tasks that once required hours of poring through medical libraries. But this convenience often comes at a cost.

The availability of a “web-base” of external knowledge allows us to bypass the more labor-intensive task of memorizing information that can easily be retrieved later. Ideally, online tools can serve as an adjunct for clinicians, supplementing brain-based, internal medical knowledge and memory so we are less burdened by the need to remember every lab value or rare syndrome.

However, when material can be accessed with such ease online, individuals are less likely to remember. While digital amnesia, or the tendency to forget the content stored in a digital space, can free up our brain to function more creatively by focusing on different information, issues can arise if clinicians mistake the existence of retrievable online material with mastery of it.

Data suggest that the capacity to search online changes our internal cognitive ability. People may be less likely to retain material that they think has been saved externally, whether on a computer or in notes.

Though a growing number of care providers may ascribe to the idea that it is less necessary to remember facts they can find online compared to knowing where to find critical information, there appears to be a direct link between readily accessible internet content and a failure to store that material in the brain’s internal memory. Externalization of cognitive processes may improve the immediate goals of performing a task faster and/or with fewer mistakes, but it also decreases subsequent memory performance in our brains if the aid is not available.

The shift toward digital reliance in medicine significantly impacts the mastery of procedural skills. The American Medical Association recognizes that physician adoption of online tools in recent years serves to bolster everything from clinical decision-making to remote monitoring and engagement.

Post-pandemic, there has been a shift away from hands-on medical training in medical schools in favor of online education, such as watching instructional videos or participating in simulations. While observing procedures online may help with basic comprehension, it doesn’t reliably translate to real-world competency. Repeatedly observing others can facilitate an illusion of skill acquisition and lead to an overestimation of one’s actual ability. Watching a surgical knot-tying tutorial is not the same as the ability to initiate and tie a secure knot in a high-pressure surgical environment.

Medicine is particularly vulnerable to the illusions fostered by digital convenience, especially illusions of knowledge. Overreliance on these digital tools, coupled with cognitive fatigue from long shifts, decision fatigue, time pressure, and the sheer volume of clinical data physicians must process, all contribute to the challenge of retaining information. Repetitive tasks or procedures viewed as routine or unimportant may be more easily forgotten, especially when reliance on external memory is high. While only preliminary studies on this topic have been done, the rise of digital education and the paring back of clinical education, especially in the wake of the pandemic, have correlated with feelings of less preparedness among recent medical trainees.

When working in a field that requires recognizing and distinguishing between the nuances of clinical presentations and diagnoses, it is important to bear in mind that the passive receipt and storage of online content can lead us to overestimate what we actually know, and can preclude or bias us from making the best decisions for our patients. This is especially important during medical school and residency, a time when trainees lay a foundation of knowledge and clinical competency.

Above all, it is important to approach our practice with humility, to recognize that self-perceived competency does not correlate well with actual skill, and to understand that knowing how or where to access information is not equivalent to mastering it. As clinicians, we must actively engage with material through self-explanation, hands-on practice, and real-world application to ensure we’re not just relying on external memory, but truly integrating knowledge into our brain’s internal cognitive framework.

Nidhi Bhaskar, MSc, is a third-year medical student at the Warren Alpert School of Medicine at Brown University in Providence, Rhode Island, and a member of MedPage Today‘s advisory board, The Lab. Edward Feller, MD, is a clinical professor of medical science at Brown University. He was co-editor of the Rhode Island Medical Journal from 2018-2021.

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