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Always have an objective on the wards: Advice for medical students

So much happens in a hospital on any given day. It’s easy to just go with the flow and hope that you passively absorb all the things you need to. With this approach you may have the occasional great clinical experience and will gradually pick up the required knowledge and skills with enough time. However, the more self-directed you are, the quicker you can learn and the better you can become.

This is achieved by deciding your objective in advance. For me, this involved making a weekly priority list as well as a daily objective list. For the latter, at the end of each evening, I would take a piece of A4 paper and fold it in half three times. On this, I would write six things that I would like to achieve the following day, as in the example below. I would carry this in my pocket at all times, and cross things off when I achieved them, providing a small sense of achievement each time. Sometimes I would add a priority order by numbering them 1-6.

 

An example of my priority six:

  • Write in patient notes
  • Take blood from ≥3 patients
  • Recognise hepatomegaly
  • Understand Liver Function Tests (LFTs)
  • See 2 or 3 endoscopies
  • Understand 2 patient’s cases from the ward in depth

 

This list can be tailored to the opportunities that you know you will have, for example if you know there is an endoscopy list tomorrow. When you write the objectives, you can think of ways you will achieve them. For example, for the list above you could plan to join the ward-round and ask to write in the patient notes (1) as well as choosing two interesting patients from the ward-round to study later (6). You could ask to leave the ward-round early to attend endoscopy (5), then after lunch come back to the ward and ask if there are any bloods to be taken (2), any patients to examine with signs (3) and if any of the doctors are free to explain LFTs (4). However, it’s important to be flexible as you can’t always predict how things will go. Maybe the doctors won’t let you write in the notes on the ward-round, or they are all too busy to teach you about LFTs. In these cases, you must be adaptable and seek alternative ways to achieve your aims, for example finding a guide on LFTs on the internet and then looking through the blood results of patients with deranged LFTs. Or maybe there are no patients in the hospital with hepatomegaly, in which case you can think of another sign you want to learn to recognise. It is on these days where having the objectives is so important, as otherwise you may spend a lot of time waiting around and achieve very little.

A great little book with suggestions for objectives is “101 things to do with spare moments on the ward” by Dason Evans and Nakul Patel. (The title is self-explanatory.)

 

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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 | 2018-01-07T15:20:10+00:00 January 7th, 2018|

3 things I learnt from “Surely You’re Joking, Mr Feynman”

Learning through examples

A technique Feynman uses to check his understanding of new content is to create an example based on what he understands and check with the person explaining it is true.

I can’t remember the exact examples he gave in the book but I will use a personal example that just occurred.

I was opening a new bank account to increase the interest on my savings. The sales assistant explained the different accounts and rules. There was a lot of technical jargon. I wasn’t sure if I understood it all so I framed a question as something along the lines of:

“Am I right in thinking that if I open account X, pay Y amount into it each month and then transfer Z amount into account B then I will get C percent on this amoutn and D percent on this amount?”

This is a rather mundane real-life example, but I use it to demonstrate the principle. It is a useful tool when trying to understand any concept subject that someone else is explaining.

 

Embrace childlike enjoyment

Richard Feynman was one of the greatest physicists of the 20th century. He did not set out to be, but ended up that way by doing what he enjoyed the most.

His enthusiasm for learning and academia is evident throughout the book. For example, he became fascinated by the ability to crack open safes for no reason other than he thought it was fun and could use it to play pranks. One time time he broke into the safe of a high ranking official and moved confidential information about their work developing the atom bomb from one drawer to another. He then watched the guys reaction as he experienced the moment of panic at realisation.

 

The first principles approach

Elon Musk has re-popularised this concept by citing it as one reason he is able to achieve all that he has done.

Reasoning from first principles is working up from the ground first – i.e. from things that you know for certain.

For example, when Elon Musk was thinking about building a rocket, he studied the science beyond rocket propulsion. The way all the other companies (NASA + some Russian companies) were building rockets involved buying parts specifically made for rockets. This meant the items were expensive and looked outdated because little research had been done to improve them since the Moon mission.

By understanding the fundamental requirements for rockets, Elon was able to use parts designed for cars and include them in certain elements of the rocket. He build the rocket from the ground up and in doing so dramatically reduced the cost of production.

Elon describes the converse as ‘reasoning from analogy’. This is where you look at rules accepted by others to decide how best to do something.

By | 2017-11-30T13:12:38+00:00 October 9th, 2017|

Utopia for Realists – A Book Review

This book is a manifesto for three ideas that the author believes will enable us to achieve a ‘utopia’. These are universal basic income, a reduction in work hours and inreased immigration.

The author uses the term ‘utopia’ loosely; to denote a situation in which certain ideals have been achieved. He states that the abolishment of slavery was a previous ‘utopia’ and the emancipation of women another. He argues that we should continually be striving for the next ‘utopia’.

He points out that while GDP has been improving for decades, it is a poor indicator of quality of life. Above a certain GDP threshold, the main determinant of quality of life is the level of inequality in the society. He suggests that the genuine poorogress indicator (GPI) or index of sustainable economic welfare (ISEW) are better metrics as they include inequality and other factors.

He argues that a universal basic income and a reduction in work hours will lead to improvements in these better metrics. While I agree that this is the case, I don’t believe that these will be attained from mere ideological discussion and rather must be dictated by market forces. He touches on how technological advancements enable us to work less but we haven’t done so for fear of dropping a rung in the socio-economic ladder. In the future, he argues, increases in machine capability may further decrease this need for work.

However, I believe it is less a case of people deciding to work less but rather a case of being forced to. As companies utilise machine technology more, an increasing number of jobs will become superfluous. I don’t believe that universal basic income will come out of an ideological movement, as this author seems to suggest, but rather out of necessity in order to support the increasing proportion of the population for which no real jobs exist. Correspondingly, the reduction in working hours that he argues for will also be forced rather than chosen.

With regards to his third point, that we should increase immigration, the book does not go deep enough into the subject. He outlines some of the common arguments against immigration (increasing crime, reducing social cohesion, ‘taking our jobs’ nd others) but dismisses each with a citation or two that doesn’t really get to the bottom of things. I feel this can be forgiven, though, as the book is focussed towards the universal basic income and one chapter on immigration is included almost as a foot-note.

This book attempts to make a rational, evidence-based argument for why we should strive towards a universal basic income as our next ‘utopia’. This is supported throughout with citations from different studies and quotes from philosophers from different periods of history.

Having only read the book and not delved deeper into the research behind his arguments, I am unable to say whether I agree with the author’s argument or not. As this is such a deep and complex issue, which is not directly related to my current line of work, I don’t feel it would be a worthwhile time-investment for me to do so. This is one reason why I question the utility of books such as these. They may be useful for ‘armchair philosophy’ discussions with friends, but I suspect the ultimate impact is very small. The book may be a nice primer on the subject but only those who delve much deeper into the issues will really be able to say anything of value. And the only ones who should do so are those who will actively change the way they live as a result, not just change the way they discuss these topics with their friends.

It is for this reason that I think there is a fundamental limitation to the benefit of books which aim to present political ideologies supported by an evidence base. I don’t believe our ideology will be the main driving force towards adopting a universal basic income. Rather, it will be dictated by technology and market forces.

By | 2017-11-30T13:12:38+00:00 October 8th, 2017|

Why three things?

 

I will give you three reasons.

I am a generalist more than I am a specialist. I am not the type of person to make comprehensive summaries. I often leave tasks unfinished and resist investing too long into any one thing.

Being forced to select the top three things makes you hone in on what is important.

I want each idea to be interesting or actionable in itself. If there are three ideas it increases the chance of you benefitting from at least one. Perhaps you’ve heard the first and are uninterested by the second… third time lucky.

By | 2017-11-30T13:12:38+00:00 October 7th, 2017|

Self Improvement as a Stepping Stone to Greater Things

 

The ‘self improvement’ industry has many flaws but it can serve an important purpose.

It’s easy to never attempt self-improvement. We may be skeptical or not consider it a worth goal.

It’s also easy to get stuck in self-improvement, by giving it enough signifcance in our lives that it actually has a negative impact. E.g. always looking for someone else to motivate us or give us answers that it hinders our development. This is one reason for it’s bad reputation – many of us can think of someone like this. I feel it’s a cop out when someone is mentored by a self improvement guru and then become the next self help guru expounding the same ideas.

However immense benefits can be gained from the self help industry if we recognise it’s inherent limitations. It can help us to solve personal problems up to a point. But we must do the rest of the work ourselves.

It is not going to tell you that as some point you have to stop consuming it. It wouldn’t make business sense for them to do so.

In this way it can be a great stepping stone. It can help you to re-align the direction of your life.

However, it is a tool and a tool only. We must not focus on it as an end goal or get trapped. Our ultimate aim should be to move onto bigger and better things to the point that we have forgotten about the notions expounded by the self help industry.

If you feel that you may benefit from self help but are skeptical about its benefits, give it a chance. A good place to start is Tony Robbins’ unleash the giant within or 7 days to personal power.

If you think theres a chance that self improvement may be hindering you, critically assess it’s role in your life.

By | 2017-11-30T13:12:39+00:00 September 29th, 2017|

Books are conversations

Sometimes we are fortunate enough to meet someone that inspires us and changes how we think. They may be excellent in a domain that interests us and conversations with them may remain in our minds for a long time.

However, this does not happen often. The vast majority of us are ‘normal people’ who, although inspiring in our own ways, don’t routinely stimulate this profound personal change in others. I can think of at most ten people who have done so in my life.

Books offer us the opportunity to have a conversation with many more of these great thinkers and expand our minds. We are no longer limited by chance and circumstance. By reading the books of great minds, you can have inspiring conversations more often and change the way you think.

By | 2017-11-30T13:12:39+00:00 September 28th, 2017|

Directed vs undirected writing

Directed writing — when writing for a specific audience with a specific aim in mind. For example, a blog to bring viewers to a website, an article to present an argument or change someone’s opinion.

Undirected writing — writing things that come into your head without any particular aim or agenda in mind.

Directed writing follows the following process:

  • what am I trying to achieve?
  • what shall I write about?
  • how shall I write about it?

Undirected writing follows the process:

  • that’s an interesting idea
  • start writing about it
  • (no/limited consideration of the wider relevance)

I’m experimenting with undirected writing at the moment. One of the advantages is low activation energy to start writing, meaning it is easy to produce a constant flow of ideas and writing. One of the disadvantages is that it will get fewer reads and some people won’t “get it” (due to a lack of consideration of the audience by the writer).

By | 2017-07-11T22:07:07+00:00 July 11th, 2017|

Art of Learning by Josh Waitzkin

Josh Waitzkin has been an national chess champion and world martial arts champion. While becoming elite in these two separate entities, he realised a number of principles which are true of elite performance in any area. Josh uses his experiences to take the reader on a journey through the most important insights that he has acquired. The result is fantastic; an enjoyable, engaging read abound with sagacious insights into learning and elite performance. After a first read-through, I am confident this book is one that should returned to repeatedly with new insights to be obtained each time.

Some key concepts from the book (far from comprehensive):

  • Fixed vs growth mindset – encourage growth in others by praising process rather than results
  • Develop the ability to concentrate in different situations – Josh learnt to play chess in noisy streets but then got used to playing in quiet competition rooms. He started to get bothered by small sounds. To overcome this, he created artificially noisy situations during training so that he no longer thought about it.
  • Fame is not a benefit – if anything, it makes it more difficult to perform. Josh found this after becoming famous (after the movie ‘In Search of Bobby Fisher’ was made about him); he transitioned from an intrinsic to extrinsic motivation (“I stopped immersing myself in the game and found myself imaging how I looked while playing”) and found his performance suffered.
  • The benefit of a state change – sometimes in a game he would go outside for a quick sprint up and down then re-join the game and find his focus much improved. This is similar to the ’30-second ice-cold shower’ recommended by several people. The principle is that physiological change leads to psychological change, much like a ‘reset’ switch.
  • Maintaining a connection to primal inclination – to perform at your best you must stay true to yourself. Josh found this when a world-renowned trainer encouraged him to use the trainer’s style of chess which was very different to Josh’s. Josh’s style of play related to his love of complex situations – he loved having an open board with lots of possibilities but the trainer encouraged him to play more closed. Again, his performance dipped until I realised this and re-connected to his primal inclinations.
  • Creating a routine to enter a state of deep, intense focus – for use before an important event (competition, exam, important interview, etc) This routine should be things that naturally puts you into a good state. The case study used is a guy who loved playing catch with his son, so his routine started as 30 minutes meditation, 15 minutes music then playing catch with his son. It can start long but with practice will be able to do it shorter (gradually less time meditation/music/other), until you have conditioned yourself to be able to enter that state on command. For example, Josh can now take one big inhalation or a quick visualisation and enter this state, which he used before competitive martial arts fights.
By | 2017-04-09T15:52:17+00:00 April 9th, 2017|

What I Gained From 30 Days of Writing Every Day and What Next?

#30. Consolidating the next step of my writing journey

Today is the 30th day of my 30-day writing experiment. I set out with the aims of developing the ability to write well and contributing positively to those that read my writing. To achieve this, I focused on quantity first and quality second.

I must now reflect on what I’ve learnt and decide where to go next.

What have I gained?

1. Enjoyment

First and foremost, the whole experience has been thoroughly enjoyable. At times it’s been hard to write and some days have been frustrating to say the least. However, the feeling of pushing the ‘publish’ button after pushing through this resistance is fantastic.

Writing has been a way for me to enter a state of flow, which has carried over into other parts of my life. Away from writing, I have been more positive with friends and family, more motivated to work hard and more attentive and receptive to life in general. I get out of bed with energy in the mornings and have greater appreciation for the simple things, like a beautiful view while taking my dog for a walk. Who would have thought that writing every day could have this effect?

2. Finding solutions to problems

Writing and spending more time in a state of flow has also helped me to solve real-world problems. By forcing myself to write on a subject, I force myself to think deeply about it. If writing about a problem, I wouldn’t publish without offering solutions so the commitment to publish every day ensures I keep thinking.

This extends beyond just the period spent writing — practicing output makes me more receptive to input. I have noticed I learn and retain information much more quickly as my brain continually tries to form links with other ideas floating about in my brain at that time. I guess writing ensures you keep picking up and using your knowledge, rather than letting it lie dormant in your brain.

During these 30 days, one recurring theme has been reflections on the process of writing — the following solutions, which I came up with during these period, are all things I am still using to facilitate my writing process:

This reflects the fact that my focus right now is on developing my writing ability, but writing could equally be used to solve problems in other parts of life.

3. A sense of progress

Progress and growth are one of the six fundamental needs for fulfillment. I’ve certainly had my doubts, but every time I overcame a personal hurdle during these 30 days (most notably Day 9 and Day 27) I felt an overwhelming sense of accomplishment. It didn’t matter if these were relatively small achievements compared to others, and I feel good going forwards.

Writing is an attractive area to pursue growth, as there is infinite potential for improvement — there is no such thing as a ‘perfect’ writer, in the way that there may be ‘perfect’ exam scores or ‘perfect’ performances in other areas.

Also, I have produced a body of work which I can look back on and be proud of. Sure, many of my articles are pretty rough around the edges, but that’s the stage I’m at right now. This is simply a documentation of my life at the moment which I hope to look back at in future years with fondness.

What next?

I am faced with a number of options to choose between.

1. Take a break from writing, with a view to pick up regular writing in the future

I heard the following quote:

“A writer is someone who can’t not write”.

This is pretty much how I feel right now so I’m not going to consider this as an option.

2. Extend my daily writing challenge: 6 months? 1 year?

It is with sadness that I must acknowledge my current time restrictions and other commitments. Therefore it would be unwise for me to continue writing every day. While it would be achievable, I wouldn’t be able to devote the level of focus and energy that I would want to and trying to do many things at once prevents real progress in any. I must practice what I preach and choose only the most important things.

3. Continue at a lower frequency

This is the obvious middle ground so the next question is how often. Many popular bloggers write exactly 2 times a week and this sounds sustainable alongside my other commitments, so I will try this for the next month and then re-assess. Commitment made.

Other: Publicising my work?

Up until this point, I have made minimal effort to publicise my writing on social media platforms or elsewhere. As a result, I have just built a modest following of 130 people on Medium plus approximately 10–20 friends who regularly my articles.

However, a writer needs an audience and so at some point I should start attempting to build one. Am I at this point now or should I wait longer? I have now written 50 articles. Considering the amount of time I have spent writing those 50 (I would estimate ~75-100 hours), I don’t think it’d be unreasonable to spend 1 hour or so gaining more publicity. If I do so, I will write about the steps that I take.

If you would like to read about that or you enjoyed this article and would like to hear more, click the heart below and follow me on Medium here.

By | 2017-03-24T22:07:19+00:00 March 24th, 2017|

Today I just wanted to say thank you.

#22. Being grateful

Thank you to everyone who encouraged me to keep writing, something which has been a large source of joy.

Thank you to Derek Sivers for giving me permission to be a slow thinker and being okay with that.

Thank you to the writers of every book I have read.

Thank you to everyone who has taken their time out to help me work on projects.

Thank you to my housemate for cooking me dinner tonight.

Thank you to all readers of my blog.

Thank you to my parents.

I have many, many more thanks I would like to give but I have to go.

Being grateful

Sometimes you just have to be grateful for everything you have.

Sometimes things suck but this can help you to appreciate the good things.

Thank you for reading.

By | 2017-03-16T21:28:48+00:00 March 16th, 2017|