For many of us, forgetting something on the job isn’t a mortal mistake, but for healthcare professionals, one instance of forgetfulness can compromise a patient’s safety. Running a few minutes late to a meeting that slipped your mind doesn’t have the same fallout as a nurse forgetting to administer time-sensitive medication. There are many documented reasons as to why healthcare professionals may experience forgetfulness on the job. Clinician burnout is at an all-time high and stems from many causes, from frequent staff turnover to the exceptional emotional and physical demands of the job. There have been calls to action to improve patient safety systemically by developing standard care processes around common causes of patient harm and to align those processes with continuing education initiatives. But sometimes, it’s not the system that fails. It’s also not the burnt-out healthcare professional. It’s simply our biology: we forget things. But what if there were ways to forget less or remember more? In the high-stakes role of patient care, less forgetting can be the difference between life and death. 

Why do we forget?

Although it may seem counterintuitive, there is actually a biological advantage to forgetting that is beneficial to humans’ overall cognitive abilities. Our brains are constantly processing and storing information, so it’s important to clear out unnecessary or irrelevant information to make room for new memories and learning. The forgetting process is crucial to our ability to adapt and respond to new experiences and can also help prevent overload and confusion in our brains. While the ability to remember anything and everything sounds good in theory, it is debilitating in reality. One famous example of such a condition is Solomon Shereshevsky, a Russian journalist who had an extraordinary memory, but also struggled with daily tasks due to his inability to forget irrelevant information. Shereshevsky was paralyzed by the constant flood of memories at the cue of even the most mundane stimuli. We’ve learned from Shereshevsky’s example that forgetfulness can be beneficial to our cognitive health by allowing us to filter out unnecessary information and focus on what’s important. 

The Forgetting Curve

While forgetting is inevitable, that does not mean that we can’t understand how it works. Forgetting occurs at a generally fixed curve for all learned information. German psychologist Hermann Ebbinghaus first discovered the forgetting curve in 1885 while conducting a series of experiments on himself, where he memorized a list of nonsense syllables and then tested himself at various time intervals to measure how much he had forgotten. He found that there was a rapid decline in memory retention during the first hour after learning, with over half of the information forgotten within the first 20 minutes. The rate of forgetting slowed down after that, but there was still a significant decline over time. This curve is used throughout cognitive psychology to describe the natural rate of forgetting without any strategic intervention. As one can imagine, as humans with memories that can forget this quickly, this can have negative implications when training healthcare professionals on critical practices. 

A graph showing Hermann Ebbinghaus' forgetting curve. The graph shows a steep decline in memory retention over time, with a rapid drop-off in the first hour or so after learning, followed by a more gradual decline over the next few days. The x-axis represents time in hours and days, while the y-axis represents memory retention as a percentage of the original learned material.

Clinical Implications of Forgetting

Forgetting healthcare training has serious clinical implications, particularly in the context of patient safety outcomes. Forgetting training can result in incorrect care or missed care, which can lead to patient harm. In a 2018 literature review of missed nursing care, clinical outcomes affected by missed care, as reported in nine studies, included: pressure ulcers, medication errors, nosocomial infections, patient falls, critical incidents, 30‐day hospital readmission and mortality.  

Research on human error mechanisms suggested that, when highly trained, competent, well-intentioned human operators interact within complex systems, failures are inevitable. Trying to curb the inevitable process of forgetting with more training is fruitless if the training doesn’t stick. Ebbinghaus himself found that something as simple as incorporating repetition into learning can help flatten the forgetting curve. As it turns out, there are more strategies that can “hack” memory and prevent what we assume to be the inevitable process of forgetting. 

Hacking the Forgetting Curve

The learning process is driven by the relationship between cause and effect. Causes out in the real world can lead to learning effects in the brain. In the cognitive science world, causes are known as “triggers” and the effects in the brain are known as “switches.” Some of the world’s most renowned cognitive scientists have identified which triggers are more conducive to faster, lasting learning compared to others. Some examples of triggers that flip memory-enhancing switches in the brain include repetition, spacing, and feedback. By incorporating these techniques into training strategies, retention greatly increases.  

correlating cognitive triggers and switches

For example, incorporating spacing into learning can boost memory by 300% (Pashler, Rohrer, et al.). Research has shown that when restudy takes place too closely following the initial study session, there is little effect on memory. But it has also determined that the optimal study gap to test interval is 10% to 20% (ex: If the time to the test is 1 week, the optimal study gap between initial study and restudy is 1 day OR If the time to the test is 1 year, the optimal study gap is 3 weeks). 

Another example is incorporating retrieval practice in the form of testing. In a study (Roediger and Karpicke) where groups of students were asked to 1) read a passage four times, 2) read the passage three times and test memory once, and 3) read a passage once and test memory three separate times, the third group that prioritized memory testing rather than only repetition retained 62% of the original information, whereas the first group retained just 39%. This demonstrates the power of activating the brain’s natural retrieval process to commit information strongly to memory. Learners can compound repetition and retrieval for better memory. Incorporating these strategies in training ensures that information sticks in the long run and is accessible in high-stress situations, like those experienced by healthcare professionals. 

Despite the impressive effects of these memory “hacks”, we’re only human, after all, and forgetting will still happen — even to the most noble among us working in healthcare. However, in healthcare, forgetting can have serious clinical implications and compromise patient safety. The forgetting curve, discovered by Hermann Ebbinghaus, shows that forgetting occurs at a generally fixed rate for all learned information. To prevent forgetting and improve retention, training strategies should incorporate triggers like repetition, spacing, and feedback. By hacking the forgetting curve with training that sticks, we can ensure that healthcare professionals retain critical practices and reduce the likelihood of medical errors that can result in harm to patients.  

From the beginning, Amplifire has relied on innovative brain science to guide its product development to create the most effective learning and training solution, perfectly tailored to the way the human brain works. Learn more about how Amplifire helps people learn better and faster with online learning by requesting a demo.