I often ask medical students what they struggle with the most when it comes to revising. The most common answer is some variation of finding motivation, overcoming procrastination and getting the work done.
In this section, I share all the techniques and tools I have used to overcome procrastination and get things done. Like everyone else, I am not immune to procrastination, and it has been a problem for me at times. However, with the use of the concepts, techniques and tools shared below, here are some of the things I have been able to do in the past 14 years:
- Graduate from medicine with honours
- Bachelor's degree in psychology
- Master's degree in medical education
- Diploma in Child Health (DCH)
- Diploma from the Royal College of Obstetricians and Gynaecologists (DRCOG)
- Membership of the Royal College of Physicians (MRCP) (UK) diploma
- Membership of the Royal College of General Practitioners (MRCGP)
- Fellowship of the Higher Education Academy (FHEA)
- Written 5 books covering medicine, surgery, paediatrics and obs and gynae
- Created over 100 medical education videos
- Created over 500 medical education podcast episodes
- Creating a set of 150 fully illustrated flashcards on medicine
Be patient and accept slower progress
When I look at the list above, it feels impossible for me to have done all these things. I do not work all hours of the day and often feel as though I am wasting time, being unproductive and procrastinating. I often get distracted by a hobby or major life event, spending weeks or months at a time focused intensely on spending time with family and friends, travelling, riding motorcycles, moving house, renovating my home, playing basketball, skateboarding or exercising. However, by focusing on one thing at a time and getting work done on a regular basis, this is what I have been able to achieve.
I often think of the following quote, which has been attributed to a few people, including Bill Gates:
“Most people overestimate what they can do in one year and underestimate what they can do in ten years.”
This has been particularly true in my life. I look back on the past year and feel a sense of frustration that I have not been able to get as much done as I had planned. However, I look back on the past decade and find it hard to believe how much I have done.
When I set myself goals for the future, I almost always overestimate what I will be able to do in a set time frame. When planning for the year ahead, I have a tendency to set myself enough work to keep me busy for the next 5 years. Inevitably, I fall massively short of my expectations. However, I do manage to get focused work done regularly, which builds up over time. Eventually, I am able to achieve my goals, even if they take longer than expected.
Whenever someone asks for my advice about starting their own project or business, the most important thing I try to emphasise is to be patient. I think patience and persistence are the most important factors that determine whether someone will eventually reach their goals.
Modern-day technology and marketing make many things in life seem incredibly easy. You can access the answer to practically any question instantly, from anywhere in the world. You can watch any movie or TV show you want within minutes. You can order almost any product quicker than you could describe it to someone, and have it delivered right to your door.
However, when it comes to achieving personal goals, the experience is very different. Big goals take time and patience, and there are always obstacles and challenges that set you back along the way. Learning medicine will not happen on its own, and you cannot outsource the hours of focused studying that are required.
While others can help make learning medicine many times more efficient and effective, you still need to be patient and apply regular effort to make it happen.
The solution to procrastination
In medical school, I lived with one of my close friends. He is incredibly smart and capable but struggled at times with procrastination. At the end of our fourth year, we had a 10-week-long project that involved producing a 10,000-word report. The report contributed to our grades and determined our progression into the final year of the medical degree.
From the start of the project, I pushed to agree on a topic for the project with my supervisor. Every day, after being in the clinic or on ward rounds, I would go to the library on the way home. I spent 30-60 minutes reading through journal articles and noting down very rough bullet points. At the end of the first week, I sent my supervisor a draft of the report, which was essentially a jumbled mess of bullet points and a list of references I had read.
Over the course of the placement, I aimed to spend 30-60 minutes a day in the library on my way home, trying to slowly mould the report into something that I could submit for the examiners to mark. These 30-60 minutes did not feel stressful, and I ended each session when I got bored or tired. Each week I submitted a draft to my supervisor. He gave me bits of feedback I could use to improve it. I was finished weeks before the deadline and at no point felt stressed.
In contrast, my friend was just as conscientious about attending his placement and engaging with his supervisor. However, he did not agree on the topic for his project early on. The weeks started to slip past. Before long, he started to feel the pressure to get the entire report completed. Rather than spending 30-60 minutes a day slowly shaping the report, he now had a sense that he needed to get the whole thing finished in one big effort. The magnitude of this task was overwhelming and stressful, encouraging him to avoid doing it.
In the final week of his placement, he was still waiting for important clarity and answers from his supervisor. He used this as a reason not to work on the report, delaying the inevitable last-minute rush to scramble something together. He spent days in limbo, with this huge task hanging over his head and a reason not to be able to work on it. The final days trying to get the report done were remarkably stressful. Thankfully, he was able to scramble it together and progress through his career without any issues.
This story highlights the effects of procrastination. My friend kept putting off taking action on the report, resulting in a final scramble to put something together. Thankfully, he is incredibly smart and competent, so was able to eventually get it done and progress through the course. However, there is a real possibility that this approach can result in underachievement or failure.
Other than the possibility of underachievement or failure, procrastination has a second significant result: it is stressful. My friend was unable to enjoy the things he was doing during the days and weeks leading up to the deadline. Even the activities he did while procrastinating were less enjoyable because in the back of his mind was the looming deadline and the weight of the task ahead.
In contrast, I really enjoyed the project and at no point did I feel overly stressed. At most, it was a minor inconvenience for me to stop off at the library for 30-60 minutes on the way home. Most of the time, I quite enjoyed a leisurely read through some research papers while sipping a coffee. I liked the feeling of making a little progress each day. Also, I often bumped into a friend on the way into or out of the library, adding a further enjoyable aspect to the process.
The first place to start when trying to solve the problem of procrastination is to have a clear idea of what it is. Most people would agree that it is essentially the process of delaying or avoiding taking action on something.
Procrastination is characterised by the absence of taking action.
This means the way to eliminate procrastination is simply to take action.
Once you take action on something, procrastination no longer exists and is no longer a problem.
Procrastination is a bit like darkness. Everything can seem scarier in the dark. However, darkness is simply the absence of light. Turn on the light, or wait for the sun to come up, and darkness is no longer something to worry about.
The rest of this section will focus on the techniques and tools I have found most helpful to enable me to take action, therefore eliminating procrastination.
Focus on process, not outcomes
Whenever we witness someone achieve success in something, whether it is graduating from medical school, performing a spectacular dance routine, winning an Olympic gold medal or having a defined physique, we see outcomes.
While we see the outcomes, we usually do not see the process that leads to those outcomes. It takes hundreds of hours of a carefully crafted process to arrive at successful outcomes. Without the process, the outcomes are not achievable.
When it comes to learning medicine, it can be tempting to think about outcomes and neglect the process. When you meet a doctor that seems to know everything, it can seem as though they got to that stage by magic. It can seem like graduating from medical school means you magically know how to treat patients. This is not the case.
The same is true for people that do well in medical school exams. You might think that some people can casually walk through the library the day before the exam and then come away with 95%. Have you ever talked about someone and said, “They always do well, they are so clever”. In reality, their outcomes are the result of their process.
Without carefully considering the process, it can be difficult to get the work done that leads to the outcomes.
Have you ever thought or said one of the following:
“I would love to get honours, but I am not smart enough”
“I just want to pass the exam”
“I am going to work really hard and get a good grade this time”
These are all examples of thinking about the outcome, rather than the process. There is only so far that thinking about the outcome can take you. Being motivated to do well can make you sit down, get your books out and make you start reading, but how long can you sustain directionless effort driven by a desire for outcomes? You need a process that can take you from start to finish.
My friend focused on the outcome of finishing his dissertation, I focused on the process of working on it for 30-60 minutes a day.
Develop a process that gives you daily tasks to accomplish that progressively build your knowledge and skillset towards your eventual goal, and the outcomes will take care of themselves.
Develop a Revision System
The success of your learning process is dependent on a number of variables:
- How motivated you are
- The hours you put into studying
- The effectiveness of each hour spent studying
- Your ability to focus during study sessions
- How well you cover the curriculum
- The many times you cover each topic
- How effectively you practice exam technique
The task of a good learning system is to control and optimise as many of these variables as possible. It should try to minimise the need for motivation, replacing it instead with a structure that makes you get specific work done, regardless of motivation.
During one summer break from medical school, I had a job working at a milkshake shop. When I arrived, I got everything ready for making milkshakes. Every time a customer ordered, I would make the milkshake and hand it out. When the shop closed I would clean everything, mop the floor and help count the money. At no point did I think about whether I was motivated to make the next milkshake or mop the floor. On rare occasions, I may have felt like not doing it, but I never relied on motivation to get it done. I did it because those were the clearly defined tasks that needed completing.
If I had turned up to the job on the first day and they left me in the milkshake shop, saying “do what you feel like doing”, it is unlikely I would have made 100 milkshakes, cleaned everything and mopped the floor. Equally, if someone says “here are a bunch of textbooks, start learning if you feel motivated to”, it is unlikely to be a very productive learning session.
This analogy is designed to highlight the importance of having clearly defined tasks that need completing. Once the tasks and timeline are specified, motivation becomes less of an issue, you just get the tasks done.
When you have a revision system that tells you that on Monday morning you are reading through a specific chapter on cardiology and then answering 30 predetermined multiple-choice questions on that topic, you have a very clear task that needs to be completed at a very specific time. There is less room for negotiation, and motivation is less of a factor. You do not have to decide what you are doing based on how motivated you feel, you know exactly what you need to do and set to work getting it done.
A good revision system defines the tasks and when they need to be done and has a way of tracking your progress throughout the process. Later in this course, I will be discussing in detail the revision system I use and recommend.
Getting started and the law of inertia
Newton’s first law of motion, also known as the law of inertia, says that an object will stay at rest or move at a constant speed unless a force acts on it.
When an object is completely still, all the forces acting on that object are balanced, and it takes an additional force to get the object to move. Inertia is proportional to the mass of the object, meaning that more force is required to get heavier objects to move.
When an object is moving at a constant speed, all the forces acting on that object are balanced. It will continue moving at that speed unless an additional force acts on it.
This is a helpful analogy for studying. It takes a great deal of effort to go from a state of not working to a state of working. Again, inertia is proportional to the mass of the object, meaning the more challenging the study session is going to be, the harder it will be to get started. Once you start and get up to speed in a work session, it becomes relatively easy to continue with that task, provided there are no major obstacles or challenges.
Another analogy for this is the flight of an aeroplane. It takes an enormous amount of force for a 450-ton plane to go from stationary on the runway to cruising at 550 miles per hour, 40,000 feet above sea level. Huge forces, in the form of thrust and lift, need to be applied to overcome inertia, drag and gravity.
Once an aeroplane is cruising at 40,000 feet and 550 miles per hour, the thrust required to overcome the drag and maintain a constant speed is far less. Additionally, at 40,000 feet, the air is much thinner, meaning there is less drag on the plane. Provided the thrust and lift are equal to the drag and gravity, the plane will continue moving at the same speed and altitude. Eventually, the plane will run out of fuel and have to land, but it can travel a remarkable distance during a single flight.
You can think of a study session like the flight of an aeroplane. When you apply enough force to get your study session off the ground and up to cruising altitude and speed, it becomes much easier to carry on at a steady pace. Of course, you will eventually run out of energy and need a break, but you can get a lot done before you run out of fuel.
The top three pieces of advice I have for overcoming inertia are:
- Shrink the size of the challenge
- Isolate time and space to get work done
- Tackle the biggest challenges when you can apply the most force
Break big tasks into smaller, achievable chunks
It is impossible to learn medicine in a single revision session. You may sit down to study and spend an hour trying to tackle cardiology. Once you realise that you spent an hour just trying to get your head around supraventricular tachycardias, and you still need to learn all the other arrhythmias, the rest of cardiology, the rest of medicine and also surgery, paediatrics, obs and gynae, psychiatry and pharmacology, it can feel overwhelming and make you want to give up.
Inaction can come from feeling like you have to do everything at once and not knowing where to start. You cannot learn all of medicine in a single study session. By breaking medicine down into smaller chunks that can be covered in a single session, you set yourself up for success.
My friend avoided working on his report because he felt he had to sit and get the entire thing done in a single sitting. The closer the deadline got, the more he had to get done in each sitting. In contrast, I went to the library expecting to get 30-60 minutes of rough work done on a small section of the report. After a 30-minute session, I had not made much progress. However, those sessions added up and I was finished well before the deadline. At no point did I feel overwhelmed by the scale of it, because I focused on a small section at a time.
The bigger the task you set yourself, the less likely you are to get started. Imagine you have always wanted to get good at running, but never really got started. If you aim to run a marathon, there is a high chance you will keep putting that off, saying “I’ll sign up for the marathon when I have more time”. If you aim to run a 5k, the challenge is much more achievable, and you are more likely to think “I’ll sign up for that 5k in 6 weeks, I’m sure I can manage a few short runs per week until then”.
When learning medicine, the amount of content you need to learn can feel overwhelming. I recommend figuring out what you need to know for your next exams and working back from there, breaking it down into smaller chunks. For finals, I split my revision into the specialties. I was able to gather together a concise set of notes on cardiology, respiratory, urology, obstetrics, gynaecology and so on. I could sit down for a single 1-2 hour session and study the key facts I needed an entire specialty. I stuck with the same set of notes, filling in gaps when I realised it missed important information. Breaking my revision into these smaller, manageable chunks made the process far less intimidating and made it easier to get started with each revision session.
Isolate time to focus on one thing
A side-effect of being an adult, especially as you take on more responsibility, is that you end up with an increasingly long list of things you need to do. There is always something important you could be doing. If I wrote a to-do list of jobs I need to get done, my list would not fit on a single A4 sheet of paper.
By not properly compartmentalising all the things you need to get done, you run the risk of getting none of them done. For example, let’s say I have three important things to do: task A, task B and task C. If I decide to work on task A, I feel like I am neglecting task B and task C. Therefore, I decide it is a bad idea to start working on task A because then I will be too busy to do task B and task C. But if I do task B, I will be neglecting task A and task C. Somehow this thought process results in me binge-watching a TV show instead of doing any of the important tasks.
Have you ever created a to-do list for the weekend, only to get to Monday and realise you have not checked a single thing off the list? I have. Is it possible that the list is the reason I got none of those things done?
As a GP, I regularly get patients attending with a list of problems. A standard GP appointment is 10 minutes long. When a patient attends with a list, we end up spending half the appointment establishing what is on the list and making sure we prioritise the most important problem. The second half of the consultation is spent rushing through and trying to be safe, rather than properly addressing the issue.
These examples highlight the importance of focusing on one thing at a time. Of course, it is not a good idea to completely neglect everything else in life while we focus on only one thing. But it is important to put together strategies to ensure we block out time where we only focus on one thing.
Choose one thing you need to work on and figure out how to isolate time to get that thing done.
During my GP training, I decided to write the Zero to Finals Medicine book. At the time, I had my full-time job, on-call shifts, workplace-based assessments, GP teaching, postgraduate exams, portfolio obligations and the rest of life’s responsibilities.
It would seem impossible to write a book with all these other things going on at the same time. So how did I do it? By figuring out how to isolate time dedicated to focusing on that one objective.
I looked at my typical work week to figure out where I could isolate time for writing the book. I figured out that there was a Tim Hortons coffee shop on my commute to work that was open 24 hours. If I could get to the coffee shop at 6 am, I could get 1.5 - 2 hours of work done before finishing the commute to work. It was almost empty at that time of day, which meant no distractions. That time was completely isolated and dedicated to working on that specific priority. Combined with further isolated work during evenings and weekends, I was able to get the book written while continuing with my other responsibilities.
Isolate your work environment
I find it almost impossible to get deep work done at home.
This has been a problem as far back as my time at school. This meant I was never very good at homework, often frantically completing it on the train on the way to school or finding some way to get away with not doing it. When it came to revision, I made myself get into school early or stay behind after school and work in the common areas. Luckily, my dad was able to find a spare desk in the office where he worked, which I could use to revise during exam periods.
At university, I discovered the power of working in the library. At Manchester, I had access to several libraries and study spaces and made full use of all of them. When I found my concentration starting to wear thin, I would go for a short walk and find a new area to work in, resetting my concentration for another study session.
In the later years of medical school and after graduation, I added coffee shops to my list of places to get work done. I did most of the work for my master's degree and postgraduate exams in coffee shops. I wrote almost the entire Zero to Finals Medicine book in coffee shops. At the weekend, when I was not working as a doctor, I would visit 3 or more coffee shops in a single day, spending 1-2 hours in each before resetting my brain by walking to the next.
For the past few years, I have rented office spaces where I can spend the day working. With the right environment, I can get four hours of deep work done in a single sitting. After that, I need a decent break. That might mean working from 7.30 am until 11.30 am, going home for a long break, and then returning to the office to work from 4 pm until 8 pm.
Suppose I had an entire day free to get work done. By using libraries, coffee shops or offices, I can get 4-8 hours of deep, meaningful work done. When I decide to work at home, I find it difficult to get 10 minutes of work done. For me, the right environment makes all the difference.
Libraries, coffee shops and offices are not the only suitable places to get work done. There are loads of places I have used over the years, such as trains, hotel lobbies, airports, sports centres, waiting rooms, workshops and rented holiday homes.
Here are the key things I look for in a useful place to work:
First, the work environment has to be separate from my home environment. When I am at home, the endless options for things I could be doing are too much of a distraction for me. Home is used for relaxing, family, eating, housework, non-work-related projects and generally enjoying life. To get deep work done, I need to put all these things out of my mind, which I find almost impossible at home.
Second, there needs to be a clear transition between home time and work time. When I arrive at a library, coffee shop or office, I immediate get my work out and get started. When I am done with work, I pack away my stuff and leave. I do not have to convince myself to start working. I know that when I arrive, work begins. Right up until it is time for me to leave, I keep working. I give myself no other options.
Third, there needs to be a suitable, empty area to work in, such as an empty desk or table. I pack up the things I need to get the work done and take them to the new environment. When I arrive, there is a blank space waiting for me to get work done. I do not need to tidy up or create a space as I might do at home. I can get things out of my backpack, immediately start work, and then clear them away when I am done.
Fourth, I like to have other people in the background and use them to hold me accountable. Although in reality, nobody cares what you are doing, I find having people around stops me from wasting time, scrolling through social media, watching YouTube videos or messaging friends. It adds subtle peer pressure, which helps me stay focused and productive.
Finally, it needs to be free from distractions and interruptions. I find it very difficult to work when there is a TV or radio playing. I cannot concentrate if there is a conversation going on that peaks my interest. Any interruptions from family or friends will break my concentration, requiring 5-10 minutes for me to get focused again (if I ever manage to).
Tackle the biggest challenges during peak times
Overcoming inertia requires force. The force required is proportional to the mass of the object that needs to get moving. Applying this analogy to studying or working, the greater the challenge of what you are about to study, the more effort needs to be applied to start studying and get up to speed. The more difficult the task, the harder it will be to get started on it.
When you look at your list of important tasks you need to do or topics you need to cover, there will be some tasks that look easy and fun (usually things you are good at), while others look difficult or uninteresting (often the most important things). It is a good idea to schedule the most difficult and important tasks for the time of day that you can apply the most effort or force.
For me, first thing in the morning is when I am most fresh, have the most energy and can tackle the biggest challenges. I have 4-5 hours where I can sip coffee, engage my brain and power through challenging work. After mid-day, I am much better suited to easy tasks that do not require a great cognitive load. I can manage challenging things, but they need to be fun and engaging to stop me from getting distracted.
I schedule the most important tasks for first thing in the morning and accept I will be less productive in the afternoon. By 8 pm, I can just about manage the washing up.
I recommend putting some thought into what time of day you are at your peak in terms of productive capacity and mental acuity. Is it at 5 am, midday, afternoon or evening? Schedule the most challenging, least engaging and most important tasks for your peak time to make sure they get done. Schedule the tasks you want to do and come more easily for the times where you have a lower capacity for concentrating and getting difficult things done.
I consider my peak time, from about 7 am to 12 pm, as a golden window of opportunity. I try to protect it, avoiding low-value activities during this time, so that I can apply my effort to the highest-value activities for that day.
Use feedback for motivation
I love playing basketball, even on my own. To improve my shooting, I go to the park or gym and shoot over and over again. I set myself challenges, such as hitting five 3-point shots in a row, or 20 free throws, or shooting from every position around the key without missing. I practise moves, such as dribbling behind my back, changing direction, spinning then hitting a fade-away jump shot. Often, I find it difficult to stop, even when I am tired. I can practise shooting for hours at a time.
Why do I find it so easy to stay focused and practise shooting for hours at a time? I believe it is the instant feedback I get every time I try a move or shoot a shot. When I miss a shot, I get immediate feedback on what the problem is. The shot may be too short or long, low or high, left or right, or too flat or arched. I can immediately make a correction and try again. When the ball goes in, I get a nice dose of positive reinforcement and satisfaction.
Suppose there was a basketball rim on the other side of a fence, completely out of sight. To shoot the ball, I had to throw it over the fence. There was nobody around to tell me whether it went in, and I could not hear what happened after throwing the ball because there was loud music playing nearby. Essentially, I was throwing the ball over a fence with no feedback as to whether my throw was good or not. There is no way I would feel as motivated to shoot the ball over and over without the satisfaction of having that immediate feedback. I might throw the ball once or twice then go and do something else.
Having non-threatening, constructive and immediate feedback can be incredibly motivating, encouraging you to keep trying until you succeed. The purpose of this basketball-related analogy is to make you consider how you can use immediate feedback to improve your motivation to learn medicine.
Many medical students prefer revising with question banks or flashcards. I am not sure how many of them identify that it is the immediate feedback that makes this a more motivating way to study when compared to reading or other methods.
There are also ways you can build immediate feedback into others forms of studying. For example, when reading a topic in a textbook, after each paragraph you can attempt to scribble down, from memory, the key facts and terms you just read before checking how well you did. When listening to a podcast, you can pause the podcast and recall what you just heard, before skipping 30 seconds back and checking how well you remembered it.
Not only does immediate feedback help with motivation, but it is also an incredibly powerful tool for learning. In fact, it is almost essential for effective learning. I would not get better at shooting a basketball without receiving immediate feedback on each shot. Likewise, my knowledge of medicine will improve much more slowly without immediate feedback on how well I am understanding and retaining the information I study.
Summary
Be patient and accept slower progress. Big goals take time and patience, and there are always obstacles and challenges that set you back along the way.
Taking regular action is the antidote to procrastination. Even if each session seems to make little progress, those sessions add up to big results over time.
Focus on process rather than outcomes. Develop a process that gives you daily tasks to accomplish that progressively build your knowledge and skillset towards your eventual goal, and the outcomes will take care of themselves.
Develop a revision system that controls and optimises as many variables that contribute to whether your learning is successful or not. A good revision system minimises the need for motivation.
The law of inertia says that an object will stay at rest or move at a constant speed unless a force acts on it. It requires greater effort or force to start studying and build momentum than it does to continue studying once up to speed.
Break big tasks into smaller, achievable chunks. The bigger the task, the more effort is required to get started. Breaking up the task into smaller chunks makes it easier to get started and make progress.
Isolate time to focus on one thing. Setting yourself too many things to do often means getting none of them done. Focus on one thing and set aside time to get that one thing done.
Isolate your work environment. Find places to work that are separate from your other activities, have a clear transition from regular life to studying and allow you to focus and get work done. Use those places only for work activities, and leave when the work is done.
Tackle the biggest challenges during peak times. Figure out when you are your most productive and reserve that time for your most important and challenging activities.