Does this sound familiar? It’s nearing the end of the day. You had a long list of things you wanted to accomplish. But somewhere along the line, you got side-tracked. As the hours tick by, your sense of shame and guilt grow. You know you CAN and SHOULD do your work. But somehow, you end up endlessly surfing the internet, making impulse purchases, or even watering your plant – in short, ANYTHING to avoid doing actual work.
Did you find this article in part because you struggle to get started on what you know you need to do? (Or maybe because you wanted to read something – anything! – so you didn’t have to start your work?) Do you get to the end of the day and wonder where your day went? Do you find yourself procrastinating in med school and don’t know how to stop? If so, like me, you may struggle with procrastination.
Hi, my name is Alec Palmerton, and I am a master procrastinator. I am also a recovering perfectionist with borderline ADHD. Yet when people find out I managed to graduate from Harvard-MGH for residency – and Stanford before that – they are shocked. How could someone with so little natural self-control maintain such consistency and focus in their studies and work?
Med School Procrastination: Self-Discipline Alone is a Losing Strategy
The secret? Counter-intuitively, by not relying on self-discipline.
Procrastination is more like living with a chronic illness we have to manage. Unlike simple bacterial pneumonia we can treat and eliminate, procrastination is with us for the long haul. As such, we need strategies to manage it.
In this article, I’ll tell you concrete steps you can take – now – to stop procrastinating and get your work done. These include how to:
- Effortlessly eliminate the biggest distractions automatically
- Tackle big, overwhelming tasks
- Recognize distractions are a feature – not a bug – in the modern world
- Make learning rewarding, rather than something you dread, and
- Much, much more
Table of Contents
Block the Internet
Internet companies mint billions by monetizing our attention. The unofficial investment strategy of Sequoia is to only invest in companies that let consumers indulge one of the seven deadly sins. “You don’t want to be the site that people should use. You want to be the site they can’t stop using.”
Scary, but true. Internet companies design their sites to monopolize our attention and funnel that to whatever will make the most money. Most of the time that is through advertising.
Long ago, I discovered I lacked the willpower to resist the siren song of email, shopping, sports, news, and other internet vices. So instead of relying on self-discipline, I take the internet out of the equation. Many internet blocking apps are available, including Freedom (the one I use), RescueTime, and Self-Control (Mac). Freedom (and I presume others) allows you to block entire categories of websites, either on a schedule or on-demand.
Rather than let yourself get sucked into an internet black hole, block the internet, and get your time back.
The 1 Push-Up Rule
During college, my dorm room was the cleanest it ever was. It wasn’t because I was a naturally neat/clean person. Instead, it was because, during mid-terms, the prospect of deep-cleaning my room was infinitely more pleasant than the idea of studying.
I am a master procrastinator (not in a good way). The worst is when I have unpleasant and/or a lot of work to do. Consider: if you’re like me and feel overwhelmed by how much you have to do, do you:
- Jump right into it with enthusiasm, or
- Find any excuse not to do work?
Like my dorm-cleaning finals week frenzy, we procrastinators take the least painful path and put it off.
But why do we do this? Because all living things avoid the most unpleasant things.
The More Overwhelmed We Feel, the Less Likely We Will Get Started
We avoid pain and seek pleasure. So we put off scrubbing that weird brown crust that has accumulated on our stove. (Don’t pretend like you don’t). (Unless doing so avoids something more unpleasant – like studying). And when we have a lot of work, we do whatever we can to evade it.
So how do we overcome this? By doing one push-up (figuratively).
Let me explain. I told my father-in-law, a famous voice coach in South Korea, I wanted to exercise more. He is in great shape and exercises all the time. His secret?
“Do one push-up.”
The reason is that the most challenging part of doing anything unpleasant is starting. Once you’ve begun – by lowering the bar so much you can trip over it – you’ll continue via momentum.
If you’re overwhelmed by doing 500 Anki cards, tell yourself you’ll do 10. Are you struggling to get through 80 UWorld questions because you can never seem to get up the motivation? Start with 5.
Maybe you’ll do a single page of your textbook. But chances are, once you start, you’ll either forget your aversion altogether or plain get hooked and keep going.
Master – Not Memorize – to Make Studying Fun and Build Your Sense of Competence
An unappreciated fact about medical school is that a lot of the work you do is not a lot of fun. Nothing is worse than memorizing long lists of facts that show up in lectures, textbooks, and pre-made Anki cards. (At least the Anki cards that don’t come from Yousmle.)
No one loves cramming or memorizing things. Yet, Med students tolerate it – even embrace it – because they think they have to. They don’t know that there is another, better way. And because they learn everything by rote, studying becomes an endlessly painful chore, and they procrastinate.
The alternative? Master, rather than memorize. Now, stay with me as I unpack that statement.
What COVID Vaccines Can Teach Your About USMLE Mastery
I’ll give you a current fun example. The Johnson & Johnson COVID vaccine is given in one dose and requires only refrigerator storage. In contrast, the Moderna and Pfizer vaccines use a two-dose regimen, have much higher efficacy, and need lower temperature storage. If you knew that, you probably memorized it.
But do you understand WHY? It’s straightforward.
First, remember the central dogma of molecular biology
DNA → mRNA → protein
The Johnson & Johnson vaccine is a viral capsid vaccine. It is essentially the DNA coding for the SARS-CoV2 spike protein within an adenovirus capsid. (They presumably use adenovirus because that virus family is a DNA virus). Because a viral capsid surrounds the DNA, it is:
- More stable since viruses have eons of evolution to be more stable in the outside environment, and
- Less efficacious – presumably, because the DNA injected by the adenovirus into our cell’s cytosol must also be transcribed – which is generally in the nucleus.
mRNA Vaccines = Easily-Translated mRNA Surrounded by (Unstable) Lipids
Like the viral capsid vaccines, the mRNA vaccines (Pfizer, Moderna) both code for the spike protein, but that is as far as the similarities go. However, rather than using an adenoviral package, the mRNA vaccines use a lipid monolayer (not unlike the lipid bilayer of our cells). This fat layer makes it much easier to give multiple doses of the vaccine. In addition, because it is mRNA, the translation process can happen in the cytosol directly. However, because the package uses generic lipid rather than a viral capsid, we must be more careful about storage, keeping it at much colder temperatures.
Mastery of information often takes no more time than memorizing it. In our example, you connected the structure of a vaccine with its efficacy and storage requirements – two things with substantial real-world implications.
Now think about the vaccine example – was it interesting? More enjoyable than just memorizing? Memorization is miserable. The cost of memorization becomes even more apparent when we recognize we must learn/re-learn the material. Furthermore, your understanding of the differences among these vaccines allows you to analyze the potential implications of these differences.
Mastery – and learning to enjoy learning again – is an ideal remedy for procrastination. The more excited you are to learn, the more you will study. As an additional bonus, when you master the material, you are in a much better position to apply it to unknown situations. Situations like the vignettes in the USMLEs, and the problems you will encounter in your clinical practice.
Change Your Environment
Just like the internet offers a range of enticing distractions, so do some environments. Can’t get work done in your room? Look for places with the fewest distractions that will pry your mind away from your work. Try a library (if they’re open), a café (many an author has written novels at a lonely table in a café), or even just the great outdoors. My favorite study place in med school was the IKEA food court. Why? There was free tea/coffee, plenty of space, and (at least at the time) no Wi-Fi. I could go and work, undisturbed, for hours.
Remind Yourself of Your Why
Most of us got into medicine for noble reasons. We wanted to help people and stand up for the underprivileged. We love science and want to use it to effect meaningful change in the world.
However, after we entered medical school, rarely, if ever, do we think about why we are here in the first place. Instead, we get dragged into the rat race of memorizing things mindlessly. Gone are the days of following our passion and ideals.
If you find yourself becoming jaded, take time to remind yourself of why you’re here. Even better, tie the most unpleasant tasks to your more profound sense of purpose.
In short, ask yourself, “why am I doing this?”
Example:
- Why am I reading this textbook (unpleasant task)?
- I’m reading this so I can help people in their darkest moment (purpose)
- Why am I doing this QBank block after a long day in the hospital (unpleasant task)?
- Because I want to master enough so I can love learning again (purpose)
Remember, you’re human. We will avoid unpleasant things – procrastination is a normal reaction. However, to help do those unpleasant things, remind yourself of WHY you’re doing it in the first place.
Know Yourself
Whenever I meet with new students, they fill out a questionnaire. The goal is to get to know them as well as possible, to find both their unique strengths and obstacles so they can maximize their USMLE scores. A small upfront investment in time helps us overcome many things holding people back from Step 2 CK (or Step 1) success.
One of the things I have them do is take a test of executive function that doubles as a screen for ADHD. I took it recently and was surprised to find that I am borderline ADHD – in the 90%ile or above in a couple of measures of inattention or impulsivity.
I’ve found that in the students I coach, a fair number have undiagnosed ADHD. Whether you have ADHD or not, it is helpful to seek professional assessment, especially if you suspect something amiss in your studies.
Identify (and Address) Burnout
Burnout is rampant in med school and is a common reason why we procrastinate. In US med schools, roughly 50% of medical students reported burnout within 12 months. More than 11% had contemplated suicide. Burnout, depression, anxiety, and feeling overwhelmed pervade the med student experience.
If you suffer from burnout, you probably have had a sneaking suspicion something was off. For example, you might have read the same paragraph repeatedly without understanding what it is saying. Maybe you have a lot shorter temper with those around you. Or you might be sleeping a lot more but still feeling exhausted.
How can you tell the difference between burnout and depression? If your deepest desire came true (e.g., you got into your dream residency), burnout would disappear. All of your problems would seemingly melt away.
A depressed person? They would still feel depressed.
To assess your burnout level, you can take this free self-assessment. If your burnout score is > 50, I’d recommend taking some time to do activities that give you “flow.” Flow is the experience of losing yourself in an activity because it is so engaging.
For more on how to stay sane in med school, read this article.
Concluding Thoughts
Procrastination is a chronic condition – not an acute illness. Like any lifelong illness, there are times where it is worse and others where it is better. The key is to remember that we are procrastinators and plan accordingly. If, instead, you blame yourself for your lack of self-discipline and vow to “be better tomorrow,” you’re inviting disappointment. Instead, assume that this is part of who you are and base your daily plan around that.
Are you a procrastinator? What do you do that works to get you going again? When is your tendency to delay work the worst? Let us know in the comments!
