How I stay focused studying long hours in medical school11 min read
How do you stay focused for long periods of time? Are there certain evidence-based methods that work better than others? What works best and what have I learned in college, post-grad, and now medical school about focusing? In this post, I’ll tell you how I’ve maintained my focus and, therefore, maximized my performance when studying for long hours.
Have a “Start” and “End” time
“Tomorrow, I will study all day for the test.” Sound familiar? This is a quick way to not actually study all day. Something I have found extremely helpful is to set certain times for studying and certain times for not studying. When I am in that time, it is study time. When I am out of that time, it is not studying time.
For example, during the first two years of medical school, we would usually have four-five hours laid out for us, time we had to spend doing something such as anatomy lab or lectures. During this non-exam time, I would treat school like a workday. I would usually:
- Wake up around 6:00 am
- Study from 7:00 – 9:00 am
- Go to required things from 9:00 am – 2:00 pm
- Study again from 2:00 – 5:00 pm
Then I would be done. That’s it. My “Start” time was 6, and my “End” time was 5. No more, no less. It helped me focus during the day and made sure I could also not focus after I was done for the day.
Sometimes the most productive thing you can do is relax.Mark Black
Now, during exam time, these hours changed. Usually, I would just spend another couple of hours studying, so my “End” time would be 7:30. Still, I had an “end time.” I’m not an all-nighter kind of person. I never was. I would usually work from 7-4 on Saturday and 7-12 on Sunday during the weekend.
Having a start and end time allowed me to know, ok, this is study time, and, ok, this is not study time.
Bottom Line: Have a start time, have an end time, stick to it.
Do the worst thing first, “eat the frog”
If it’s your job to eat a frog, it’s best to do it first thing in the morning. And if it’s your job to eat two frogs, it’s best to eat the biggest one first.Mark Twain
I recently discovered this quote and agreed with it wholeheartedly. However, I have been practicing this method long before reading it. I don’t know if it’s because my mom used to make me and my brother do our homework before we could play outside, or if it’s because I just want to get the sucky things over with. I just remember I would always start with the worst thing.
Also, who wants pages of math homework hanging over their head while they are playing outside? I don’t.
I would always do the thing I least wanted to do first. For example, writing essays for school, I hated (funnily though I really enjoy writing posts like this, go figure). So, what would I do? Well, I would do the school essay first, get it over with, then do the rest of my homework, and then play outside.
Another way to look at this is as the day goes on, as you do more tasks, your mental strength starts to wear down. Task after task, job after job, your brain is a lot like a muscle, and, like a muscle, it can wear out.
Some scientists even believe the brain builds up chemicals, “toxic biomolecular accumulation,” as the day goes on, only to be cleared out after a night’s sleep.7
Maybe you notice that the 17th task at 3:30 pm on Thursday is more difficult than the 9:00 am task on Monday. That makes sense. Your brain has been working. Do you think a marathoner runs faster during mile 3 or mile 22? Have you ever had your computer seem very slow, and then you restart it, and it’s good as new? It’s essential to do the hardest thing first. To eat the frog. Doing so will allow you to commit the most brainpower, the best effort you have, to the hardest thing.
So do it. Get it over with. People in France seem to like it.
Bottom: Do the task you least want to do first.
Remove all distractions
I cannot ignore the phone at my desk. Even if my attention is fixed on the screen, and I think I cannot even see the phone on my desk, it is present. I feel its presence, and, inevitably, I pick it up.
Whenever I am studying now, I remove any possible distractions from my desk. I literally throw my phone to another part of the room where, importantly, I can’t see it from any angle. I can still hear it if I get called or something happens, but I cannot see it.
Distractions harm performance. In one study where 13 medical students and surgical residents were asked to perform laparoscopic surgery via a virtual reality trainer, some were distracted, and some were not. The distraction would be answering arithmetic problems (11 x 14) while performing the surgery. DO JOKE B ROLL HERE
The result? Residents and students that were being distracted took 30-40% longer to complete the task than others that were not distracted.1
Marie Kondo’s amazing book, the life-changing magic of tidying up, is all about removing these distractions, as she feels tidying up will improve not only your performance but also your life.
The question of what you want to own is actually the question of how you want to live your life.Marie Kondo
I feel like when my desk is cluttered, my mind is cluttered.
My desk has very little, a keyboard, two screens, some plants, and speakers. My phone is never on the desk. A random notebook is never on the desk. Food and drinks, never on the desk. Unused papers are never on the desk. My First-Aid book, never on the desk because I keep it taped to my chest at all times, so we are never apart.
But, seriously, why do I need a notebook at my desk? My phone? Food? I don’t. Often I will just take my laptop and go somewhere, like the park, where I truly have access to nothing else (even the internet), so I can just get things done.
The next step is removing distractions from whatever you are working on. Most of us, nowadays, use a computer. I use the Self-Control app. It blocks the internet, even mail servers, for a certain amount of time, so I can’t access them. Restarting my computer won’t fix it. Deleting the application won’t fix it. I can’t access those apps no matter what I do when I use Self-Control.
Anything that I can do to make it easier for me to focus, just get the work done, I will do.
Bottom Line: Remove everything from your workspace that you are not actively using right now to get the work done. Block any websites or applications on your computer that are not being used to get the work done.
People who take breaks perform better. The data supports this.2,3 This is why certain professions have breaks mandated, especially in more dangerous conditions. For example, medical residents, supposedly, aren’t allowed to work more than 80 hours a week.
However, I also know this first-hand. When I began implementing break-study-break-study strategies, I 1.5x my productivity. How do I know this? Well, I used to do flashcards in the morning when I had no set breaks, and I would complete about 100 flashcards per 30 minutes over 3 hours. When I began implementing breaks, every 25 minutes for 5 minutes, known as the Pomodoro method, I would complete 150 flashcards every 30 minutes, even with 5 minutes of that time being a break. So I went from completing 600 flashcards in 3 hours to 900 flashcards in one hour. That’s a serious change.
This happened for a couple of reasons when I took no breaks:
- I goofed off a lot more, scrolling through my Instagram feed or going on Reddit.
- I found it harder to focus, there was mental fatigue that constantly built up, and I knew the end was not near.
- I got into the habit of not focusing, a very very bad habit to get into.
Breaks eliminated 90% of that for me. I knew, when I was studying, it was study time. I knew I had a break coming up. I knew it was focus time.
As a final point, I was trying to research the perfect amount of time breaks, and I couldn’t find it. However, there was one certain break strategy, one certain break, the evidence consistently supported that.
There is one magical break time that applies to nearly 100% of people. One strategy that the smartest people across the globe unilaterally support. Can you guess what that break is?
Excessive sleepiness […] is a serious safety hazard, and insufficient or disrupted sleep results in numerous accidents and adverse mental and physical health outcomes.Neuroscience & Biobehavioral Reviews, 2018
Bottom Line: Take breaks, and please get a proper amount of sleep.
Keep the Lights On
The most recent change I have made to my studying during the day is keeping the lights on in my apartment until my “study” time is over. Or, at the latest, when it’s 3 hours before bed. I used to come home and like having the lights off. It made me feel calm, sleepy… But isn’t that a bad feeling to have if I want to study?
Light is a dominant player in the regulation of our circadian rhythm. It seems blue light pushes us towards a more awake state, while red light allows us to fall away from that more awake state.4
I find this extremely interesting. In college, I studied Biomedical Engineering. My final project was based on designing glasses that would dim or brighten to help adjust the user to a certain circadian rhythm.
During this project, I learned a large amount about circadian rhythms and how many professionals, even NASA astronauts, are using light manipulation to regulate circadian rhythms.
When you are more awake, your cognitive performance is better, and when you are more sleepy, your cognitive performance is worse.6
So, if we believe all of the above, we should push for a more awake state while working, studying, and improving our performance. Notice how offices seem to always have lights on? There is a reason for that.
The light above has a large portion of this specific wavelength of light that hits our retina, which then tells our brain, “it’s daytime.” The brain then turns on certain “awake” chemicals like orexin and norepinephrine and forestalls certain sleep chemicals like melatonin.5
Now, during the summertime, and if I am working at a place where there are large windows, this isn’t an issue. Natural light is streaming through the windows, and the room is fully lit for the duration of my “work” time. However, overhead artificial lighting is essential in the wintertime, or on a particularly cloudy day, or if I am studying in a closed-off room. A closed dark room will let the sleepiness, and therefore worse performance, creep in.
If you still don’t believe me try this: go to your bedroom, close all the doors, close all the windows, and turn off the lights. Bring in your computer, set the brightness to a minimum, and try and study. See what it feels like. Is it tough? Do you feel sleepy? Now, turn the brightness up to a max on your computer, turn all the lamps on, and, if you have any extra lamps, shine them on your face, or at least in your general direction. How do you feel? More awake? Alert?
So shine some lamps in your face and get studying!
Bottom line: keep the lights on when you are studying.
Now, get focused, and start working!
1. Goodell KH, Cao CG, Schwaitzberg SD. Effects of cognitive distraction on performance of laparoscopic surgical tasks. J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):94-8. doi: 10.1089/lap.2006.16.94. PMID: 16646695.
2. Caldwell JA, Caldwell JL, Thompson LA, Lieberman HR. Fatigue and its management in the workplace. Neurosci Biobehav Rev. 2019 Jan;96:272-289. doi: 10.1016/j.neubiorev.2018.10.024. Epub 2018 Nov 2. PMID: 30391406.
3. Hudson AN, Van Dongen HPA, Honn KA. Sleep deprivation, vigilant attention, and brain function: a review. Neuropsychopharmacology. 2020 Jan;45(1):21-30. doi: 10.1038/s41386-019-0432-6. Epub 2019 Jun 8. PMID: 31176308; PMCID: PMC6879580.
4. Yin J, Julius AA, Wen JT. Optimization of light exposure and sleep schedule for circadian rhythm entrainment. PLoS One. 2021;16(6):e0251478. Published 2021 Jun 8. doi:10.1371/journal.pone.0251478
6. Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105-29. doi: 10.1016/B978-0-444-53702-7.00007-5. PMID: 21075236.
7. Dijk DJ, Neri DF, Wyatt JK, Ronda JM, Riel E, Ritz-De Cecco A, Hughes RJ, Elliott AR, Prisk GK, West JB, Czeisler CA. Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights. Am J Physiol Regul Integr Comp Physiol. 2001 Nov;281(5):R1647-64. doi: 10.1152/ajpregu.2001.281.5.R1647. PMID: 11641138.