Productivity

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Spaced Repetition: How to Learn Medicine Faster

We all know the feeling. We spend long hours studying, desperately trying cover everything ahead of exams, only to feel that we’re not making any progress.

Yet there is a better way, which is grounded in neuroscience and psychology research. It’s called Spaced Repetition.

 

What is spaced repetition?

Spaced repetition involves reviewing content at gradually increasing intervals. Research has shown that it dramatically increases the memory retention and thus efficiency of learning[1]. The first scientist to demonstrate this phenomenon was Ebbinghaus[2].

Fig 1. Ebbinghaus forgetting curve

 

A system for incorporating spaced repetition into daily medical life

A practical way to use this in medicine is as follows: when you learn some new information, recall it from memory and review your notes after about one hour, then one day, then one week, then one month, then six months and then one year.

The principle is more important than the exact time spacing and can be adjusted around your life and schedule as required. You can organise this in a number of ways, on the micro (facts and concepts) and macro (topics) levels.

 

Micro (facts) level

One option for the micro level is to use electronic aids, such as Anki (where you can make your own flashcards) and Memrise (where you can use those created by others). These present you with flashcards and will re-present them at increasing intervals, based on your ease of recollection.

I found Anki most useful for fuelling active recall by having a condition name or an important concept on one ‘side’ of the card and lots of reference information copied from my notes on the back.

For example, Anki presents the card like this:

 

I would then spend about thirty seconds writing out as much as I can about Mallory-Weiss Syndrome (often using the rough format; aetiology, signs and symptoms, pathophysiology, complications, investigations, treatment).

I would then click ‘show answer’ at which point it would show the reference information, as below, for me to see how much I got and what I missed out.

 

Based on how easy I found it and how much I was able to recall, I would select the appropriate option at the bottom and would then be re-presented with this card after the relevant period of time.

 

Macro (topics) level

I created a Review System which is easily organised through a central document as shown below. This is only one way to incorporate Spaced Repetition, but I will explain it to demonstrate the principle.

 

 

The system works as follows:

At the end of each day, I spend about an hour recapping things that I have seen, learnt and been taught that day. Anything worth reviewing the next day is added to the ‘Daily Reviews’ column.

At some point during the following day, I will review topics in the ‘Daily Reviews’ column (by recalling content from memory and often doing some further study to clarify important concepts). If I feel the topic is worth reviewing again, I will move the topic into the ‘Weekly Reviews’ column. This means that I will review it again in approximately one week’s time and perform the same process (putting some into the ‘Monthly Reviews’ column and so on). Some smaller topics will be grouped into larger topics as they progress right-wards.

 

Here’s how this works on a daily basis:

Whenever I have a free moment during the day (such as between teaching sessions, before a clinic, between theatre operations or any other time when no learning opportunities are present), I open up the central document and work through the topics for review in the priority order shown above, from left to right. This usually involves grabbing a piece of paper and recalling as much as I can on the topic before later referring to my notes (which I sync to my phone). If necessary, the recall can be purely mental, such as if bored during a long operation.

I have found using this system a very effective way to make the most of gaps during the day. I can recount numerous occasions where I had a gap of 10-30 minutes, during which previously I would have killed time checking my phone or emails, but instead reviewed some content. I would often get home in the evening having covered the majority of my reviews during the day so I had the option of taking the evening off knowing I’d made good progress.

 

I would estimate that this system alone enabled me to spend 30-40% less time studying with a noticeable improvement in long-term retention. It also meant I was far less stressed during exam period, particularly finals, as the majority of the content was in my long-term memory thus reducing the need to ‘cram’.

 

[1] Melton, “The Situation with Respect to the Spacing of Repetitions and Memory.”

[2] “Classics in the History of Psychology — Ebbinghaus (1885/1913) Chapter 1.”

 

 

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This article is an excerpt from my latest book, The Modern Medical Student Manual, which offers guidance for succeeding at medical school, while finding deeper fulfillment in work and setting yourself up for an impactful medical career. For more information, click here. It is available now on Amazon.

By | 2018-01-10T18:10:36+00:00 December 6th, 2017|

Don’t go or don’t zone out.

Phones in Lectures

I’m sitting in a lecture, typing onto my phone.

Around me, many people are checking their phones and not paying much attention to the talk.

This makes me ask — why are we here?

We should value our time highly. We only have so long to learn things that will improve our life. There are some things that we must learn for our career or job — if we don’t learn these now, we will have to learn them later and this will require sacrificing something else. Therefore, not using our time effectively now is a false economy.

Most talks are not high yield, so I can understand why people may wish to zone out. However, attending and then zoning out shows a fundamental disrespect for the value of your own time.

Thinking rationally, therefore, we have two options:

1. Don’t go to the talk

The decision when NOT to do something is arguably the most important decision. In the information age, there is limitless amounts of information available. We must be selective.

I have written before about how I read 50–100 books a year. Even after 80 years of life, I will have only read a tiny fraction of the number of books that exist — millions of new books are published every year.

I appreciate that not attending semi-mandatory talks goes contrary to the expectations of society. However, we shouldn’t let the implicit rules of society influence us too greatly, particularly when they are not rational, as rules should never be followed blindly.

2. Don’t zone out

The ability to maintain focus, even when bored, is important for two reasons; developing the ability to focus and the experiential benefits of presence.

The default pattern of most is to be ‘switched off’ most of the time and then ‘switch on’ when it is required. A common pattern is to push ourselves at work due to the demands of the job and external pressures, then collapse back into unproductivity in our free time, whether that’s long periods of watching TV, browsing the internet or any other activity requiring little focus.

In his book Deep Work, Cal Newport argues that we should be taking breaks fromfocus rather than breaks from distraction. Our default should be periods of sustained focus, then short breaks away from this.

Some may argue that this is difficult to do but it is an ability that can be trained over time with discipline and yields large rewards.

The second reason is the benefits of being present where you are. This is an increasingly popular idea in the West with the flourishing of ‘mindfulness’. One element is avoiding ‘psychological transporting’, where our mind leaves the room and we think about other things.

Yuval Harari in an interview said “a huge range of human experience exists on the other side of boredom”. He is referring to experiences that people who continually look for something to ease their boredom will never realise.

 

In summary, we must respect our time through conscious decision making. We should decide what to attend and what not to. We should not let distractions, such as modern technology, steal our attention and disrupt our focus.

By | 2017-11-30T14:47:53+00:00 November 30th, 2017|

Phones in Lectures

Phones in Lectures

I’m sitting in a lecture, typing onto my phone.

Around me, many people are checking their phones and not paying much attention to the talk.

This makes me ask — why are we here?

We should value our time highly. We only have so long to learn things that will improve our life. There are some things that we must learn for our career or job — if we don’t learn these now, we will have to learn them later and this will require sacrificing something else. Therefore, not using our time effectively now is a false economy.

Most talks are not high yield, so I can understand why people may wish to zone out. However, attending and then zoning out shows a fundamental disrespect for the value of your own time.

Thinking rationally, therefore, we have two options:

1. Don’t go to the talk

The decision when NOT to do something is arguably the most important decision. In the information age, there is limitless amounts of information available. We must be selective.

I have written before about how I read 50–100 books a year. Even after 80 years of life, I will have only read a tiny fraction of the number of books that exist — millions of new books are published every year.

I appreciate that not attending semi-mandatory talks goes contrary to the expectations of society. However, we shouldn’t let the implicit rules of society influence us too greatly, particularly when they are not rational, as rules should never be followed blindly.

2. Don’t zone out

The ability to maintain focus, even when bored, is important for two reasons; developing the ability to focus and the experiential benefits of presence.

The default pattern of most is to be ‘switched off’ most of the time and then ‘switch on’ when it is required. A common pattern is to push ourselves at work due to the demands of the job and external pressures, then collapse back into unproductivity in our free time, whether that’s long periods of watching TV, browsing the internet or any other activity requiring little focus.

In his book Deep Work, Cal Newport argues that we should be taking breaks fromfocus rather than breaks from distraction. Our default should be periods of sustained focus, then short breaks away from this.

Some may argue that this is difficult to do but it is an ability that can be trained over time with discipline and yields large rewards.

The second reason is the benefits of being present where you are. This is an increasingly popular idea in the West with the flourishing of ‘mindfulness’. One element is avoiding ‘psychological transporting’, where our mind leaves the room and we think about other things.

Yuval Harari in an interview said “a huge range of human experience exists on the other side of boredom”. He is referring to experiences that people who continually look for something to ease their boredom will never realise.

 

In summary, we must respect our time through conscious decision making. We should decide what to attend and what not to. We should not let distractions, such as modern technology, steal our attention and disrupt our focus.

By | 2017-11-30T14:13:27+00:00 October 12th, 2017|

Is it important enough to finish? (What I learnt from one month of daily raps)

For a long time, I have wanted to write about projects that I am trying, reflections I have had and ways I am trying to improve.

This has been useful and I have learnt many skills from doing so. For example, the act of writing my thoughts has improved my clarity of thought. Writing reflections based on projects has helped me to identify what I have learnt from the projects.

However, it’s a slow way to learn. If serious about learning quickly, you don’t have time to undergo the slow process of writing it all out in a way that others can understand.

The only valid reasons for doing so are (i) if it is infact time and energy-effective and (ii) if you create a great resource.

Last month, I did a 30-day experiment where I wrote a rap every day. I planned on writing a ‘what I learnt’ blog post. However, many people have already done this before and put in more effort than I am willing to. Therefore I don’t think it’s worth my time to try.

I wrote this post in less than five minutes and am not going to go back and proofread it. I’m sharing the thought but it wouldn’t be time-effective for me to enhance how easily the audience can understand it. The lesson is not important enough for that so it wouldn’t be beneficial for me or you for me to do so.

(I loved writing the raps by the way, in case you were wondering)

By | 2017-11-30T14:13:12+00:00 September 25th, 2017|

Make the most of your free moments

A system for regulating inputs and outputs

Everything that we do (from a productive point of view) can be divided into input or output.

Input is receiving the ideas of others. Studying is input. Reading is input. Listening to others is input.

Output is creation. Writing a blog is output. Brainstorming solutions to a problem is output. Working on a project is output.

Free periods of time pop up at a number of occaions each day. Waiting for a bus. A lunch break. (Right now I’m on a plane.) These moments can be insufficient to work on a larger projects due to time restrictions, distractions and lack of resources (eg. no computer, no desk)

To benefit from these free periods we should decide what to do in advance. The default response is to plug in to the internet and browse social media or our other ‘go-to’ websites. While this is technically a form of input it has between minimal and negative value.

We are better off consciously deciding to do something which is either a form of input or output. This post presents some guidelines for doing so.

1. Decide what type of input and output is you priority

I love to learn about psychology, practical philosophy and innovation. I find reading and listening to books on these subjects pleasurable and enlightening. These are my main inputs.

I love to write (to gain clarity in what i think) and I love to think of solutions to existing problems. These are my main outputs.

2. Use context to decide output vs input vs neither

The first thing to ask yourself is: Do I have a defined output task? Is it achievable in the current context?

If the answer is yes, DO IT.

If the answer is no, decide an output (see later).

Output takes priority as it is the most valuable. Creating something has the potential to benefit others. It also consolidates input through the application of and abstraction from new ideas.

The answer to the first question may be no when you don’t feel you have something to do/say/create. If you feel low on ‘inspiration’, you may benefit from new inputs.

The answer to the second question can be no when you don’t have long enough, you don’t have the required resources or you don’t have the mental energy.

Deciding input

I have a hierarchy for forms of input as follows:

  • reading a book
  • listening to an audiobook
  • watching a long educational video/documentary
  • watching a film or TV episode
  • watching short educational clips
  • listening to music

There is one main factor that justifiably allows you to move down a rung of the hierarchy is input saturation. (the alternate reason is lack of motivation, which I won’t cover here)

This is where you have undertaken so much input recently that your brain is ‘’full’ and has no room for further intake. Your brain continually processes previous information intake on a subconscious level but this machinery can become overloaded. Although, with practice, this processing ability increases and the saturation point raises.

In order to assess whether your brain is input-saturated for a type of learning, ask the following questions:

  • What was my last input?
  • What was the most important thing I learnt from it? How does this fit in with what else I know?

Repeat this for the last 3 or more sources of input. If you can comfortably produce answers then you are input-saturated and can continue to feed your brain new information.

However if you really struggle, it suggests your brain may not be effectively processing new information and it is worth dropping a rung in the hierarchy and repeating the same questions as necessary.

(If you don’t have the energy to even watch short clips or listen to music, you are probably not feeling that well and should perhaps take some medicine and go to bed).

By | 2017-11-30T14:51:58+00:00 May 19th, 2017|

Be where you are right now

19. Fostering sustained focus may be the key to happiness

I often find myself in one place when i would rather be in another. In this situations my instinct is to ‘escape’ psychologically – this may be through daydreaming, trying to think about other things or through connecting to my phone and browsing the internet.

However, after reading Cal Newport’s “Deep Work”, in which he makes the case for fostering the ability to sustain focus, I have made a conscious effort to change this and found great benefits.

Now, when I am in one of these situations (a boring lecture or meeting, eating dinner by myself, etc), I ask myself the following question:

Is it possible, and beneficial, to leave now and do something else?
If the answer is no, I will commit to making the most of the current situation.

To do this, I will force myself to take a step back and objectively consider the situation from another angle. For example, in a boring lecture I may ask myself “what about this lecture is boring? what could be changed? If I had the opporunity to give feedback to the lecturer what would I say? How would I phrase it?”, etc.

In doing so, I ensure that I am still engaged in my current activity, but make it more interesting by engaging at a higher level.

Everything that you experience, no matter how boring it may feel, is a learning opportunity.

There is also an immense benefit from developing the ability to sustain focus, which translates to all areas of your life.

‘Deep’ happiness has often been considered as a sustained focus directed towards achieving your goals (Aristotle talks about ‘Eudaimonia’) and it may be that developing the ability for sustained focus is one of the keys to finding both success and fulfillment.

By | 2017-11-30T14:35:47+00:00 March 13th, 2017|

How to use Facebook without wasting time and energy

The negative correlation between Facebook and happiness has become well-documented (1, 2, 3, 4, etc, etc). I noticed the negative impacts it was having on my own life but I didn’t think quitting it completely was sustainable. So I set it up, as detailed below, in order to get the benefits of using Facebook without the drawbacks.

One of my main problems was spending far longer on Facebook than I intended, so many of the steps below are aimed at preventing the need to log in and, if logging in is essential, facilitating the process of logging out without wasting too much time.

The main benefits of Facebook and how I access them:

  • Organising events: I changed my settings so that I receive email notifications for event invitations. When I get an email, I write the event in my calendar. As long as I know about the event, I can talk to my other friends who are attending and will be aware of any changes in date or time plus other relevant details
  • Instant messaging friends: I have downloaded Facebook Messenger on my phone, which works independent of the Facebook App. So I can be logged out of Facebook everywhere else on my device but still message any of my Facebook friends.
  • Posting articles or sharing ideas: I use Buffer to share articles I write or other ideas that I want to share — remotely, without logging in. This has the added benefit of timing my posts to when the most people are online and thus reach the largest audience. It also means I can share articles and prevent myself from neurotically checking the number of likes or comments it gets. This helps me to worry less about the opinions of othersand ensure intrinsic motivation triumphs over extrinsic.
  • Sharing photos: I use Instagram to share photos, again saving me from logging in and preventing me from checking likes and comments.

The downsides of Facebook include wasting time, subconscious negative emotional effects and increased concern about the perception of others. To minimise the amount of time I spent logged into Facebook, and thus affected by the above, I did the following:

  • I changed my password into a series of letters, numbers and symbols and wrote it down on a bit of paper. I put this in a drawer along with a few relevant inspirational quotes and other stimuli that will make me think twice before deciding to log in.
  • I downloaded the ‘News Feed Eradicator for Facebook’ Google Chrome extension, which replaces your newsfeed with an inspirational quote.

Implementing the above has enabled me to feel like I’m not missing out while still having more time and energy to enjoy things in the real world. I’ve written a more detailed report on the benefits I gained here.

By | 2017-11-30T14:50:16+00:00 December 23rd, 2016|

You Have To Commit.

I’m sitting in a cramped office in rural Botswana with three other people, hunched over a small desk typing into my phone with a Bluetooth keyboard. There are dogs barking outside, the phone is ringing and there’s a woman outside loudly advertising her market stall. I need to head to a meeting in just over an hour, I’m starting to feel hungry and my keyboard is on low battery (so I may need to start typing on my phone screen soon). In other words, I’m fully-equipped with excuses to not to write today.

But I won’t, because I made a commitment to myself.

Last week I publicly declared a promise to myself to write a blog post for five successive days and share it. Keeping commitments to yourself is incredibly important; it is how you keep learning and keep making progress.

Why you should commit

Our thoughts and moods fluctuate from day to day. The solution to a problem may come to you at any time. Actualising this solution requires you to commit to it – it’s important to have the confidence to do so in order to reap the benefit from this moment of clarity. Conversely, if you come up with a great idea while in a good state of mind but fail to follow through when you aren’t in the same state of mind then that idea has gone to waste.

Often we are afraid to commit to something because we are afraid of the outcome. We endlessly ask ourselves if it is the right or wrong thing to do, and can become exhausted from the back and forth. However, we are calculating using the wrong criteria. In reality, no matter what the outcome is you will still learn something from seeing the commitment through. A ‘failure’ can be an extremely valuable learning experience. Asking ourselves ‘will I learn from it?’ is a useful question for deciding whether it is worthwhile.

Knowing how and when to commit

Our brain is not designed to accurately predict how we will feel in the future. Harvard psychologist Dan Gilbert describes the concept of ‘presentism’; that our predictions our heavily influenced by how we feel at this exact moment. We have difficulty imagining hunger when we are sated, we have difficulty imagining ourselves happy when we are depressed and we have difficulty imagining arousal when we are disgusted.

This can make sticking to commitments difficult. We might feel confident right now that we’ll stick to a fitness program; we get a gym membership, draw up a rota and fully convince ourselves that this time we’ll do it. But a day/week/month later, we don’t have the same enthusiasm that we predicted we would.

Sometimes making a solid, concrete commitment to something in advance and then just forcing yourself to just do it, regardless of the circumstances that you hadn’t predicted, yields positive results you wouldn’t have ‘reasonably’ expected. When I sat down to write today, it would have been reasonable to expect that I would be unable to complete this article for the reasons described above. But I forced myself to do it and I’m happy with the outcome.

By | 2017-11-30T14:41:50+00:00 July 28th, 2016|