GTD in Medical School

[bardamu]

Hi All,

I recently finished my Ph.D. in the humanities, and am thankful to have discovered GTD (albeit towards the end) and to have integrated my workflow in David Allen's system.
I'm now transitioning to medical school, and although it's a very different beast altogether, I'm hoping that here again, GTD principles could help me stay organized and on top of things (not to mention mentally and emotionally sane!).
I've recently set up OmniFocus (Mac+iPhone) as my principal GTD tool (with some twists), and I started a thread in the OF forum relating more precisely to the use of this software in med school: http://forums.omnigroup.com/showthread.php?t=13282
However, I'd be interested to hear the feedback of GTDers here on the more general questions, particularly: how do you deal with studying for a number of very differently taught classes? E.g. do you set up a "Study Time" context and block times on your calendar dedicated to studying vs. some more flexible form of studying (next actions?)?

Looking forward to hearing your input!

[ScottL]

One piece of advise not GTD related: for each topic find the thinnest book you can and read the whole thing, as opposed to trying to read all of the large tomes that are often recommended.

Good luck.

[Julian]

First of all, congratulations on med school.

I think some of the most valuable GTD principles for med school relate to mapping energy to next actions.
It will be difficult to plan your med school study and survival techniques before you get a feel for the coursework. But, the amount of memorization surprises every med student. Developing an approach to track the scope of material for each test, and the status of learned (= memorized) work should be helpful. Having lists of NAs that will help move things forward even when energy levels hit a low, will help.

Caveat: A few things may have changed since my med school days in the 1800s.

Good luck,

[bardamu]

Dear Scott and Julian,

Thanks for the advice!
Julian -if I'm getting you right, you would perhaps keep a list of material that has been learned (as matched against the syllabus, e.g.) as a project support material, and you would actually stick to classic GTD in terms of learning objectives, using NAs to track current learning points. This sounds very interesting, especially you recommendation with respect to energy levels -one thing I definitely need to implement better into my current system.
Out of curiosity, do you or anyone else have any experience dealing with the basic science coursework through mind maps? I'm not fully comfortable yet using a mind mapping software (or any form of electronic tools, for that matter) to take notes in classes; but I'm thinking it might be an interesting idea to use mind maps when skimming over a lecture's notes as a preview and/or review.

Thanks again,

Francois

[ScottL]

[QUOTE=Julian;69921 But, the amount of memorization surprises every med student.

Good luck,[/QUOTE]

This is probably a point worth emphasizing.

Figure out how you learn best, visual? Auditory, etc and try to tailor things to meet your needs.

One way that someone in med school taught me that worked well e.g. with the daily note service was to review the typed notes for a lecture many many times, with the first few times just trying to get the over view and filling in the details during subsequent re-reads of the notes. Other people liked only reading each set of notes once but went over it much slower not moving on they understood each thing. Again try different things and figure out what works best.

I actually remember using mind maps in pharmacology in med school and found them very helpful. BUT I created the mind maps with colored pens and it was the act of creating them that helped me learn the material. MIndmaps with software would not be nearly as useful for that purpose.

For the information to be learned in each course you could try one thing I toyed with using spread sheets listing the new info to be learned on one axis of the spreadsheet and how many times/how well you knew the info on the other axis.

As far as your GTD system David comments that your system must be something that you can do e.g. when sick and low energy and not just when you are enthusiastic about it. If you are comfortable with omnifocus and whatever else you use and can use it without having to think about it, or have any part of the system be an issue/source of stress than great. Otherwise when school gets busy the system may not work for you.
Edit: I've been trying to tactfully say that i gather Omnifocus is great software, but you may not need that degree of complexity for medical school, and you may later regret not using something simpler.

[Sflwrgirl]

First of all, congratulations! Welcome to the challenging world of getting things done in medical school.

(I'll apologize in advance for the length, as well as the many references to my experience - but it's the best way to describe what I learned trying to integrate GTD into my medical student study plans.)

I'll echo Julian's sentiments - the amount of memorization surprises and challenges almost every medical student. The shear volume of material is difficult to conceptualize until you're knee-deep in it - I certainly was unprepared. We joke a lot about trials by fire and "drinking from a firehose" - it's totally true, and it never really stops. My background coming into medical school out of college was as an education student - that curriculum fit well with very traditional GTD concepts - there were a lot of projects and assignments to complete, objectives were well-defined and actually sometimes useful; there was emphasis on understanding concepts and using analytical skills.

The first two years of medical school are generally NOT this way. Occasionally there will be a paper to write or a discussion to participate in, but by far, most of what you will do will be to memorize and to transfer the information in your lecture notes and textbooks into your head so that you can answer many multiple-choice questions. Yes, you need to understand the concepts from the basic sciences, but, in medicine, "concepts" are not big ideas as much as they are complex pieces of an intricate puzzle. I say all this because I caution you to avoid trying to break things down too much to fit nicely onto next action lists so that you feel like you're "doing GTD" - I wouldn't break things down smaller than the lecture level - there's just too much. (I don't know if you've started yet or how your curriculum was organized - I remember something like 3-5 hours of lecture daily, with miscellaneous afternoon labs or small groups - for me, this generated an equal or greater amount of time to spend studying / actively reviewing material for each day.)

If you read nothing else, consider this: the next action is usually "study." (As in, sit down in whatever quiet place you've created, open your materials, and go through them again.) "Actively review" is better. Most people find that they need about hour-long blocks. The goal is to put all that information back into your brain again (and again) until you understand it well enough to answer questions about it. There are a lot of different ways you can do that - you can make flashcards, re-listen to lectures, review notes, read the textbook, talk to yourself, whatever, as long as it works for you and is efficient. The "next action" concept works really well for me for the rest of my life, and it worked well for projects and papers, but not for weeks of studying in preparation for 3-4 big tests all at once.

(If you can't tell, it took me a long time to learn how to memorize and do traditional studying all over again. I tinkered with "how to learn _____" and wasted a lot of time. I did much better when I developed better discipline, skills, and tricks for just sitting down and working through the material, every day, rather than trying to organize it all in terms of concepts or objectives or whatever.)

Given all of that, you will be immensely well-served by the many good GTD habits you have - for example, you will find that you SHOULD collect, process, organize, everything else in your life - the project for ethics class, the email you need to send your professor about a question you have, the non-"study" projects you do have - groups to prepare for, the occasional paper to write, the summer research project to set up, as well as all of your personal life - if for no better reason that you'll be able to study better (and enjoy your personal life more) with all of it off your mind. Doing items from your next-action list is a productive way to make a break between long stretches of reading or listening. The weekly review will save you.

So here's the summary. If I had to do it all over again (and thankfully, I don't), this would be my action plan:

1. Collect ruthlessly. GTD provides a great framework for everything EXCEPT sitting down and working through endless amounts of basic science. Make your next action lists and projects lists, but don't try to break "study" down too much.

2. Block out several hours every day to sit down and actively review your lecture or reading material. (I recommend starting with lecture material, and supplementing reading only for what you don't understand or what you're directed to specifically look at. YMMV.) You may certainly refine your methods to your learning style as you go, but don't let tinkering get in the way of actual studying.

3. Take breaks. Short breaks every hour-ish, longer breaks after 2-3 hours. This is often a good time to knock out some Next Actions. Whatever you need to rest your brain.

4. If you need to block out time specifically to work on your next action or project list, you can. I highly recommend Cal Newport's Study Hacks website (www.calnewport.com/blog) for suggestions about how to transform the typical student's big, amorphous blocks of time into manageable studying, as well as for specific study tactics. (Specifically, look at the Autopilot schedule, Focused Question clusters, the Sunday Ritual, and, of course, Getting Things Done for College students.) (I'll warn you that a lot of the study methods are designed for other types of courses and may not fit well with medical school. And you will spend more time studying than any college student should.)

5. Review Weekly. At first, also use this as an opportunity to reassess how you're spending your time. Eventually, you'll settle into a routine.

Again, the sooner you develop good tactics, the better you'll do. And you'll use these for the rest of your career. (I just finished residency, am doing a fellowship, studying for boards, and expect to have an academic career. I'm still using a lot of the skills I learned from my first 2 years of medical school.)

Use this network - I, and others, are here for more help as you need it.

--Sara
SYBaker [at] gmail.com

[kewms]

Find a spaced repetition software (SRS) package that you like, and get familiar with it before the term starts.

I haven't been a medical student, but have used SRS for language learning, another highly memorization-intensive task. It's a vast improvement over flashcards and similar methods.

(The idea is that the software shows you questions more frequently in the beginning, less frequently as you answer them correctly. That way you automatically focus your review time on your weakest areas.)

Katherine

[kelstarrising]

Your thoughtful and insightful exchange here about GTD in Medical School was picked up in a top 100 blogs list:

100 Blog Posts You Should Read Before Going to Med School

Thanks!

[Julian]

Kelly,

They assembled a interesting compilation. I sent the url to my daughter who is starting med school next year.
Perhaps she'll see the post by her dad

[bardamu]

Hi all,

Well it's been an (academic) year since I started this thread, and after making it through MS-1 (barely!), I finally have time to come back here and re-evaluate this journey.
First of all, thanks again to all for your advice, which has proven very true. And Julian—things definitely haven't changed since your med school days in the 1800's (at least at my school)
The amount of memorization is indeed unexepectable. I'm using this word deliberately, as the contributors to this thread had exactly the right warnings: you cannot be prepared for the amount of stuff to rote-memorize. I'd love to pontificate from my pedagogical experience how this might really not be appropriate for a continuously evolving science (see: Paul Bert or Richard Feynman), or how I think it is pretty scandalous that medical students are not instead better trained in the search for and evaluation of up-to-date information (e.g.: they're being told constantly not to use Wikipedia, but not *why* they shouldn't use Wikipedia or what to use instead; and of course insert <rant about disgraceful lack of statistical training in med school>)... But I'm sure you're all familiar with these questions, and here is not the appropriate forum. Instead, I'd like to revisit my GTDing experience (or lack thereof) through med school, including switch in tools, etc.

To give you some context, my school indeed turned out to be one of the note-based ones: each class had a pack of notes provided, and studying pretty much revolved around them. Depending on the class, there was or wasn't any value in studying "outside of the notes." In general, I tended to do it anyway out of personal interest, and because I couldn't care less about my GPA (we're one of the few remaining letter-grading schools). The curriculum was very heavily lecture-based, and the small group interactions were not heavily team-based at all, or weirdly so (don't get me started). [Full disclosure: I've been a great supporter of problem-based learning in my past life, including using it myself and promoting it in parts of my research.]

I started the year with a beautiful GTD paper system, complete with paper Tickler and all, and using OmniFocus (across Mac & iPhone) for my electronic inbox. Scott's comment: "Otherwise when school gets busy the system may not work for you" proved prophetic. Having recently moved to get closer to campus, my paper inbox became re-filled with tons of stuff to process anew. I naively wasn't scared by the process, having done it before. Unfortunately, admin stuff hit me right before starting classes, and that was just enough delay to throw me in the thick of things before I had a chance to clear my inbox. I believe it is currently filled with the exact same stuff that was in it a year ago, as I tended to "process" most stuff that came through directly and/or rely on my extra-patient wife to deal with it. That's my one big regret from not having been able to follow Sara's advice, as I now find myself rushing to catch up with all the accumulated stuff that I might have been able to deal with during the year. That said, and although it took me a little over a quarter to learn how to do it, I'm glad that I finally was able to figure out how to juggle med school and a personal life.

So, as all of you had suggested, traditional study plans or GTD hardly applies to the medical school curriculum. I tried taking notes in class and adding questions I had about lectures to OmniFocus for about three weeks before giving up on that system (O anatomy, how persuasive you can be!). I still felt the need to have a basic to-do organisation, but my GTD contexts and next actions, as Sara suggested, promptly became very limited. Contexts: School (I toyed with having library as a sub-context, simply for recalled books); Home; Pharmacy (I developed hypertension within the first few months).
I switched back to reQall having noted some improvement of their service. Combined with the eventual Evernote integration, this became a very useful model for some of my stuff. Location-awareness meant that my few contexts became really relevant in the David Allen sense: if I hadn't entered 'buy fish at grocery store' or whatever else in my to-do list and pulled it by context, there's no way I would have had any space in my brain (really: any inclination to recall) for this stuff. More interestingly, reQall provided an option to add not just to-dos, but also notes, which is not only closer to the gospel of GTD, but also terribly useful when you have many, many tidbits of information to store. Katherine's suggestion came to fruition thus: reQall can send a daily email and other reminders, refreshing your memory of lab values, pathologies, etc. E-books made it possible for me to harvest pictures into Evernote, which became automatically linked to reQall's notes. As I started studying/reviewing out of board review Q-banks, this became a particularly natural workflow. Perhaps I'm not getting so much out of seeing the info again (I tend to dismiss it a lot of the time before reading it fully), but the process of entering it and the ability to search it was useful to me.
I also quickly gave up on making flashcards etc.; although of course for neuroanatomy I spent countless hours drawing and re-drawing pathways like a madman.

Finally, I think that Julian's plan to "mapping energy to next actions" took me about a year to learn and implement informally (i.e.: not by entering it into my GTD system), but was definitely the trick. As all of you emphasised, it takes a while to find out what studying methods (plural, because I think it might change with the individual subject/course) works *for you*. It took me about a year to realise that as much as I love and respect many of the subjects we're taught and would love to find out more details about certain topics, I had to (temporarily) give up on "learning digressions" to focus on memorizing what we were expected to know for the next test; and exactly how long it takes to do that, subject by subject. If nothing else, this definitely boosts one's confidence about the possibility to learn anything (in my case: finally getting to the rules of the road this summer [I don't drive yet!]), or at least *memorize* anything.

At the end of this year, I can fully confirm and subscribe to everything that was said in here. I can only foresee more of the same for the next year, but I'll be interested to know how you wise people apply GTD going forward: because I do hope to eventually use again all my shiny toys and methods!... Speaking of which, my summer is packed with research, fellowships, publications (from my former life) and the like, and I feel in desperate need of the granularity of GTD again. I guess that's my only true comment after this year: while GTD is supposed to be grand because it's entirely scalable, it is not actually *that* scalable. I think it becomes useful only when a certain number of actions/projects amenable to it are conducted. My "personal life" as it existed this past year was far too limited for GTDing (with the above-mentioned caveat that I might have done more if I had been more consistent with it), and I didn't really have anything much to do outside med school, other than volunteering and working on self-limiting projects that were essentially single-step ones and had to be scheduled (calendar).

Oh, and seeing how right you all were with respect to first-year, I'll take any and all advice for second-year