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No Motivation? Study Better and Learn to Love Med School

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by Alec Palmerton, MD in Uncategorized

Tell me if this sounds familiar. It’s Friday afternoon. You’ve finished a long week, and thank God for the weekend. Your to-do list kept growing all week, but you’ve been saving everything for Saturday. Then maybe you’ll take some time off Sunday, and rest for the first time in forever.

Friday evening, you get sucked into your favorite activity. Maybe it’s surfing the web. Maybe you get in a Netflix/Youtube binge. Whatever it is, you tell yourself it’ll be ok; you can sleep in.

Now it’s past midnight. You finally go to sleep and wake up tired the next morning. You rub your eyes. It is 3 hours later than you usually wake up. You stumble out of bed, telling yourself it’s ok. There’s all weekend, remember?

You pick a task to do, but you keep dragging. What should have been a 30-minute task is taking over 3 hours. By the time you finish, you know more about the latest celebrity news than you do about the Krebs cycle. (Thank you click-bait articles!).

If this sounds familiar, you’ve come to the right place. Motivation (or its lack) is a muscle we need to exercise. You can strengthen it. However, most people don’t know how.

Instead, low motivation leads to distraction. Distraction leads to poor results. Poor results lead to self-hate. Self-hate corrodes motivation. The cycle repeats.

Recap of Intrinsic Motivation/Self-Determination Theory

This is Part 2 of a 3-part series on improving our intrinsic motivation. (Click here to read Part 1 and Part 3).

Extrinsic motivation means doing an activity for an external reward. An example of extrinsic motivation would be if we worked solely for money. Or if we studied for the sole purpose of getting a good grade.

Intrinsic motivation means doing an activity because the activity itself is the reward. An example of intrinsic motivation would be studying because we enjoyed learning. Or if we worked because we loved doing our job.

Self-Determination Theory describes what makes us intrinsically motivated. In other words, it literally describes how we can become more motivated and love what we do.

When people feel passionate about their work, Self-Determination Theory describes why. Jump out of bed because we’re so excited to start the day? Yep, Self-Determination Theory there, too.

The first two components underlying intrinsic motivation are autonomy and purpose, covered in Part 1. The more choice and control we have over our lives, the more motivation we feel. If we infuse our choices with meaning it is even more motivating.

Finding Competence When We Feel Like Imposters

Part 2 of this series deals with the third component of self-determination theory: competence. Being good at something is motivating.

What’s that? You feel like everyone around you is better? You suck at medical school/life?

If that’s how you feel, you’re not alone. It’s called Imposter Syndrome, and it is rampant in med schools around the world.

It’s almost impossible to feel skilled at something in medical school. Superstars surround us. (At least that’s what it feels like). The culture of invincibility is real. No one shares their weaknesses, so we only see the best of other people. However, we are painfully aware of our own shortcomings.

The good news is that you don’t have to be the best to feel motivated. I never felt close to being the best student in my class. One of my Stanford friends won an international math competition…during medical school. As a result, he earned a free trip to Paris! (He also took his mom – what a sweet kid).

How can we grow our motivation level through increased competence? The key is to stop thinking about good and bad as black and white. Instead, we need to train ourselves to see the infinite shades of gray in-between.

We need to learn to recognize progress, rather than position.

What do I mean?

Marginal Gains: The Secret To Dramatic Improvement

In med school, I felt like the most stupid student there. My first day, the only thing I could think of was, “I shouldn’t be here. I should have deferred for another year.” (I had already deferred admission for two years so I could live in Korea on a Fulbright grant). Everyone seemed to know everything, and I felt like an idiot. Even worse, no matter how hard I tried, I never felt like I was measuring up.

Instead, I learned to compare myself to the only one who mattered, myself. As corny as it sounds, I learned how to compare myself to previous versions of Alec. I started to ask myself, “what can I do to get 1% better today?”

The concept of marginal gains was motivating to me. Instead of asking, “am I good or not?” I would ask, “am I a little bit better than yesterday?” If I could wake up 10 minutes earlier, that was a win. Same for paying attention for a little bit longer. Or if I could do more Anki cards in an hour. Or review my lectures and master the material a little bit more.

Yes, it’s motivating to be the best at something. But the big secret in medical school is that NO ONE feels like the best. While we will never feel like the best, we can still get motivated by recognizing our small gains. Especially when you see those small gains adding up over time.

The British Cycling Team: Marginal Gains At Their Best

Let me share a story about the power of marginal gains. In the lead up to the London Olympics, the British cycling team needed to improve. They didn’t want to be embarrassed as the host nation for winning few medals.

But there was one problem. The British cycling team was one of the worst teams in history in any sport. They had won a single medal in ~100 years. No British cyclist had ever won the Tour de France. They were so bad that a top bike manufacturer refused to sell them equipment.

That’s like Nike refusing to sell to the Cleveland Browns because they are afraid it’ll hurt sales.

So what did the British cycling team do? Instead, they focused on 1% experiments. They looked at getting a little bit better at everything.

They did the obvious things, like nutrition, or different training methods. But they also looked at less obvious things. They:

  • Tested different massage gels to see which gave the fastest recovery times;
  • Experimented with different pillows/mattresses to see which gave the best sleep;
  • Hired a surgeon to teach them how to wash their hands. (If they had fewer respiratory infections, they’d train better.)

The results were astonishing. Between 2007-2017, they won 66 Olympic/Paralympic gold medals. They also won 5 Tour de France’s, and 178 world championships. Many consider it to be the most successful decade in the sport.

1% Experiments Improve Competence and Intrinsic Motivation

So how can you improve your sense of competence and start loving what you’re doing? By doing your own 1% experiments.

Think of these as simple randomized controlled trials (RCTs). The steps are intervention, outcome, purpose, results, and interpretation.

Intervention and Outcome

First, start by asking yourself what you want to improve. This improvement target will be your “outcome measure.” Maybe you want to do your Anki cards in less time. Or you want to do more QBank questions. Or improve your question percentages.

Then choose what your “intervention” will be. What are the things you’ve thought you should change, but haven’t? Some of my students’ favorites are:

  • Putting your phone in the other room while you study
  • Deleting Facebook/Instagram/Twitter/etc.
  • Studying in a different location (coffee shop, library, etc.)
  • Blocking the internet from 10 PM to 10:30 AM every day (I’m currently doing this)

This list is by no means exhaustive. You can probably tell from my list that distractions are a big thing that I try to eliminate. But your interventions can be whatever you want – the key is to measure the outcome!


To boost intrinsic motivation even further, ask yourself what your purpose is. What larger purpose does this experiment fulfill?

For example, more concentrated work will facilitate your mastery of these concepts. Mastery helps you love learning and, ultimately, achieve the career you choose.  Mastery helps you love learning, and love the ongoing knowledge that will inform your future practice. Reminding yourself of this broader purpose builds intrinsic motivation.


If you chose a quantifiable outcome, the results should be straightforward. For example, when I blocked my internet until 10:30AM, I started to work much more effectively in the morning. I found I could work at least 1-2 hours more, and accomplished more per hour.

My interpretation? Internet was hurting my productivity, and relying on will-power alone was insufficient. Since that time, I’ve continued to block my internet until 10:30AM. As a result, my morning productivity has improved dramatically.


Let’s look at a full example:

  • Intervention: block the internet from 10 PM to 10:30 AM every day
  • Outcome measure: number of uninterrupted hours of work accomplished
  • Purpose: help med students master – not memorize – for impressive Boards scores and fulfilling careers
  • Results: achieved 1 extra hour of focused work in the morning
  • Interpretation: blocking the internet allows for more concentrated, productive work

While this example focuses on obtaining time and concentration, these are the keys to mastery. Little is more powerful than knowing that you control your destiny. Experimentation builds intrinsic motivation by showing your actions lead to results.

Also, remember the concept of marginal gains. 1 extra hour of focused work won’t suddenly raise your scores, but over time, that extra hour will make it more likely you will achieve that 1% gain, and then 1% more, and so on.

Concluding Thoughts

Being a medical student is hard. It takes time, dedication and, sometimes, sheer willpower. If your sense of motivation is at a low, stop blaming yourself. Instead, rebuild your drive by developing your competence, autonomy, and purpose.

Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.