3 Ways to Improve Study Methods for Med Students With ADHD
In this video series, STATMed founder Ryan Orwig examines life as a doctor or medical student with ADHD. He outlines how ADHD affects your ability to study, take tests effectively, and manage your time. And he shares common patterns he’s observed with ADHD-affected medical students and physicians.
Time management is a big buzzword and a big industry. Countless books, blogs, apps, and podcasts are dedicated to it. There are seemingly endless pieces of advice on ways to be more productive and make the most of your time. And, in med school, it’s more crucial than ever. Between the massive amounts of information students are responsible for and the compressed timeframe for absorbing the material, it can feel impossible to get ahead. And if you have ADHD, time management issues may feel like insurmountable obstacles. But, there are several ways for med students with ADHD to improve their time management and studying.
ADHD and Time Management: 3 Strategies to Maximize Your Efforts in Med School
Time management is crucial in med school because time is the scarcest resource. In this video, Ryan takes an in-depth look at how students are affected by and can mitigate ADHD while maximizing time management skills in med school.
Struggles with ADHD and time management are rarely more apparent than when trying to get through a study session. With no plan and no workflow in place, med students can easily get distracted and off-track. Add in random breaks and interruptions, and your focus and memory start to degrade, making the time you’ve spent far less productive. Plus, alternating between tasks — like studying and checking messages — can take double the time to complete things, putting you even farther behind.
“The quality of workflow determines how effective and efficient we are every time we sit down to study. But, for many students with ADHD, this is where the battle is being lost.” – Ryan Orwig
In this video, Ryan shares three ways to improve time management with studying with ADHD. These include optimal study structure, explicit study agendas, and external study trackers.
In future videos, Ryan will dig into additional ways ADHD manifests for medical students and doctors and offer strategies to overcome these challenges. Be sure to subscribe to our email list for updates!
Welcome back. I’m Ryan Orwig with STATMed Learning where we talk about the challenges of learning in med school and on boards, continuing our exploration of what it’s like to be a med student with ADHD. In this section, we’re going to do a deep dive into the problems a med student with ADHD might have with time management.
Time management is a pretty huge umbrella term. It can refer to how you’re planning and spending your time. It can be about productivity. It can relate to how you generate workflow. It can be about how effective and efficient you are with your time. It can also be about how you make and follow – or struggled to follow – study plans. I think it includes managing work-life balance. And it’s safe to say anything else related to managing or maximizing your time as a med student fits under this umbrella as well.
So why is this time management so much harder for the med student with ADHD? Well, first of all, time management is hard in med school because of the speed-volume-density equation where med students are dealing with a ridiculous amount of information. So, this is already hard for lots of med students in general. Then you have to factor in issues with executive functioning skills, which is often a part of the ADHD profile.
Think of executive functioning as like the control center of the brain. In part, this is where we plan, adapt, self-monitor, manage time, and organize, among other things. So if our med students have ADHD, then they are likely weaker in these incredibly important aspects of self-management.
Then the third piece of the puzzle is the fact that time is the most scarce resource in med school. So, if you can’t effectively and efficiently maximize your time, it makes everything harder. Most of these struggling med students with ADHD could indeed manage the workload in the time they had using their executive functioning bandwidth in whatever academic setting they were in before, be it undergrad, master’s program, PhD program. But med school is uniquely challenging for them, and it can certainly overwhelm whatever compensatory mechanisms an ADHD student have been using thus far. All of that leads to the main time management issue I want to talk about now, workflow.
Workflow is the ability to break large tasks into smaller tasks, put the tasks in order, make adjustments on the fly, know how to prioritize, how to shift from one activity or topic to the next. It’s knowing when you’re done with one task and when move on to another. The quality of workflow determines how effective and efficient we are every time we sit down to study. For many med students with ADHD, this is where the battle is being lost. So, if this is the problem, what’s the solution strategy-wise? The secret is this: instead of keeping our plans and our workflows internal and implicit, we need to make them external and explicit instead.
I mean, that’s the big, broad answer. Stop keeping stuff in your head. I don’t care if you were successful doing that in the past, the arena has changed, so you have to change your approach. I don’t care if your peers don’t need to do this. This is about you, the struggling med student with ADHD. It’s what you need. I want to stop tracking stuff internally and implicitly in my head, and instead I want to offload this as much as I can and make much of my navigating throughout my day and my week, external and explicit. Look at what happens when I ask a struggling med student to describe what they’re studying looks like.
He might say something like, “Well, I struggle to get started and I usually get started later than I want. But then when I do start, I really try to lock it in and study as long as I can, until I can’t study anymore.” He talks about the struggle to know what to study and where to start, focuses on the fight to stay on target and keep moving. This is very superficial to me. I can’t see what’s happening, you know? Then I might say, “Does your studying look like this?” Then I show him a model I’ve used before to illustrate unstructured, distractable, fragmented learning during a supposedly locked in three-hour study block. So this student also starts off struggling to get set, struggling to get started. And then, as he starts his three-hour study session, he immediately gets interrupted by a ping on his phone then he gets sucked into Twitter for a second. And he keeps on moving, but, hey, you know, I need to go get some coffee. Coffee makes me concentrate. So he gets up, go gets some coffee, he comes back, studies. And then if the dog comes up like, hey, give me some affection because, you know, you’re my master and I love you. But then he starts getting a series of texts, seem pretty funny but also mindless. Back to studying, back to studying. Ends up taking a small break to talk to the significant other. Then back to studying, back to studying, back to studying. And then checks out this thing on social media. Back to studying, back to studying. Then he answers his phone. Not really urgent, not important. Then makes a decision to dive into the internet and say, “Hey, let me check out West Nile virus because I’m studying something about that could be semi-related to that.” But then before you know it, he’s reading about Star Wars, which leads to, hey, let me check my email. I see a thing about my AT&T minutes, let me check that. then all of a sudden I’m thinking, hey, check out Zappos. I got this thing for some shoes I’m going to get. Then I’m reading about the U.S. national soccer team. Then I see this really cute video about penguins and look at this hilarious video about this dog who can’t catch his food. And so now I’ve lost another big chunk of time. Moving forward, moving forward, moving forward. Answer some texts again, get back and forth in that. Back and forth on social media. Back to studying, back to studying, back to studying. And then, oh, my dog comes up, interrupts me. Now I’m done.
And I’ll say, yeah, maybe not so great. There’s no plan at the start. There’s no workflow in place here. Random breaks and interruptions degrade focus and memory. Alternating between tasks can take twice as long to complete them. And there’s no sense of when to start or stop, and it’s so easy to get off track.
Now that story is supposed to be an exaggeration, but many students have sheepishly admitted, that was creepy, it was like you were taking a secret snapshot of my brain. So how do we improve issues with time management while studying? There are a lot of ways to address this by being external and explicit. I think we would want to add some explicit structure to our study sessions. And then I think we need to build explicit workflows and track our progress with external lists. Again, there are so many ways to do this, but here are three specific tools. The first one we’ll talk about is the optimal study structure. I think every study hour should have a rigid structure with some built in flexibility. A simple way to do that is the 50/10 model. This means 50 minutes of continuous uninterrupted studying followed by a 10-minute break when you don’t study. I also like using a dedicated timer as an external locus of control. And look, these timeframes are absolutely flexible, but you need some sort of explicit rules to build off of. And the 50/10 rule provides that.
So, what happens within the 50 minutes of a dedicated study block? I want these study blocks to be sterile. So only study-based activities happen here. Phones are off. Internet use is either eliminated or used very selectively. I recommend not getting online at all, personally. No multitasking. Multitasking is great in other aspects of life, but multitasking when studying is very bad. It drags down the quality of the learning, and it can take twice as long. Then what happens in our breaks? Basically anything you want, as long as you can cut it off when the timer says it’s time to go back to studying. Gorge yourself on social media, multitask as much as you want. Get in some exercise to fire the large muscle groups and increase the highly oxygenated blood flow to the brain to improve cognitive functioning. If you want to sit in dead silence, whatever floats your boat. This non-study break is intended to reboot the learning circuit and also is a way to help propel you through the study block. Because you know at the end of the 50 minutes, you can do all this non-study stuff.
Some benefits of the 50/10 model include being in primacy and recency more. That’s the beginning and ending of the study sessions where we retain more. And in the intermediate phase less, meaning we retain less in the middle of the study session. That’s some kind of bonus I suppose, but what I really like about the 50/10 model is that it compartmentalizes when we study and when we do non-study stuff. That’s the real power, in my estimation, especially with a distractible, impulsive ADHD-style mind. So, let’s just look at how two different four-hour study blocks might look. Example one is broken into four 50/10 blocks, whereas sample two is just one long four-hour slog. Example one puts the student in more primacy, recency and less in the intermediate zones. And, more importantly, it compartmentalize the learning versus distractions, off-task activities.
Whereas with example two, there’s no division between studying and all the stuff we were trying to avoid, like multitasking, distractions, unplanned breaks, et cetera. When we think about how we utilize the 50/10 model, it’s pretty flexible. Here you can see someone has a four-hour block early in the day then a three-hour block later in the day. At this phase, I recommend that you plot out when you want to try to study but not what you will study. I think that is a separate activity. That’s not a golden rule or anything, but that’s just how I like to have our students do it to compartmentalize and not overwhelm any one phase of planning and building workflow.
So that takes me to our second way to build external and explicit tools for workflow, creating explicit study agendas. This is where you plan what you will study any given block or any study day. I think there’s a ton of flexibility here as well, but I think we should externally and explicitly build a list of things we want to study every day as we go. A study agenda is like a limited to-do list, but it only contains study-based activities. So, a study agenda basically starts off with writing out the items we want to address or activities we want to accomplish over the course of a study day or a study block before we start to study. These are super flexible, and they roll from one hour to the next. We want to break large tasks into smaller tasks. This is key. Some students will say, well, I want to master lecture X and lecture Y. Those are two huge tasks. How long would it take to cross just one of those two items off of the list to mark it as done? I mean, way too long. I want break to these two things into multiple small steps as I go so I can cross items off as I progress. But as we go through the study session, we will add items as we go, cross items off, skip certain things, and work out of order.
This list generating creates workflow. It lessens mental burden; it helps with prioritization; it generates positive reinforcement; and helps us know where to start and creates a record of progress. This can become very fast and often it becomes part of our offloading system and your own workflow process. And for the ADHD learner, it is quite liberating to not have to try to keep all this stuff in our overloaded executive functioning systems. Every example will be different, but here is one student’s study agenda as she preps for and works through a lecture on motility.
So, she starts off listing the thing she knows she’s going to do. Listing the name of the lecture and the slide count. Then the initial things she knows she has to do first of all, like building out the framework, which is a skill we teach in our STATMed class for extracting the hidden structure of the lecture before watching it. You know, then she has to watch the lecture. And then she has to do what we call DR&M, which stands for dynamic reading and marking, because you have to read it purposefully and ideally just do it one time. That’s it for her prep. She knows she’s going to offload her planning as she works her way through the studying, which means building her workflow as she goes. Workflow doesn’t have to look anything like this. But in my 15 years of working with med students building better study methods, I just think this is such a powerful concept to build out a flexible list as a workflow plan as you go.
So anyway, you can see how she crosses items off as she goes, starting with framework and lecture, meaning they’re already done. Then she starts adding things, like breaking down the lecture into five main parts. I really like this. Now, instead of just slashing off DR&M once when it’s done after reading the whole thing, she can cross off each section as she goes getting five slashes for the price of one. This can be very motivating and rewarding. And yes, this is an example of building out workflow. Then she might set goals for herself, like making two test-style questions per page. And that’s a way for her to be more transactional as she reads. She wants to be aware of slides that really stand out for her. You can see she’s marking off sections as she goes and adds more key slides. Not saying she will self-test off of them, but that she might want to. You can see how she jots down her temptations to dive into the internet looking for a video to further explain the peristaltic wave of contraction. But she had to ask herself, is this essential right now? And she decides it’s not essential. So she stays on task moving forward with her dynamic reading and marking. And what is more crucial, not getting sucked into an internet wormhole. She keeps crossing off items as she progresses, adding to the key slides list. She thinks it could be good to make a chart from info on sides 53 through 54. And she starts to make a list for items that might make good memory palaces if she has the time and still sees the need later on.
So, the key here is she knows she’s not going to do all the stuff she’s generating onto her list. It’s a scary notion at first, but that’s the reality. So, once she embraced that, she was able to learn to move much more efficiently through her sessions. Then she sets a goal of self-testing off her framework, and she delineates the sections again. All of this is building literal workflow. And she even starts to list tasks for the next few lectures she has on her agenda, laying out the track for where she wants to go next. We can see she actually completes a few more tasks, like self-testing off of a few slides, making one memory palace, and doing a few frameworks section self-tests. Then she can decide: do I move on to the next lecture or do I spend more time here? Since she has all the parts clearly externally and explicitly delineated here, she can make a more informed decision, but she’s sitting in the cockpit, actually in control of driving her study session.
Then we have a third way to make external and explicit workflows, what we call study managers. Again, lots of ways to do this. And there is not a set template, so I’m just going to try to keep this very simple. If the study agenda is the micro-view of the study process, then the study manager is the macro-view. Remember, we want to offload cognitive load and make things externalized, right? So, I like the idea of making a study tracker at the start of the block on the weekend after the test but before the next block begins. This is a very utilitarian task. And you just list out all the lectures or whatever structure your school uses on the one on one axis, and then list out all the tools or strategies or passes you want to deploy for each lecture across the other axis. Then you just check off when you complete the task. You can just use a check mark or you can use the date in place of the check mark so you have a date. There are all kinds of ways to execute this. And, of course, learning how to use enriched, diverse study methods makes all this time management stuff better. But anyone can improve productivity by using these workflow tools in whatever combination works for them.
For example, let’s revisit our out of control, multitasking ADHD med student from earlier. No structure, no organization, no workflow, no regulation. They’re not using any external and explicit tools, just heads down, working hard, grinding away. Now let’s take the same student, apply the external and explicit tools we just talked about, like adding the 50/10 structure and the study agenda, knowing that he can track it all big picture wise in his study manager. Let’s presume he already frameworked and watched the lecture. He can do a few things to get prepared like a runner before a race. He can listen to some music to put him in a good mood. He can send out a few texts before turning his phone off. He can make sure his study agenda is set up and primed. And he’s probably gonna use a standalone timer for his 50-minute study block monitoring. Then he presses start and he goes into his 50 minutes study block using his agenda to break large tasks into smaller tasks, using it to choose what to do next, offloading, concerns, or distracting ideas like getting on the internet to search for an alternative explanation to a random pathway that is not pressing at the moment and stays on task, studying until the timer goes off. Then he takes a 10 minute break where he can multitask and choose from giving his dog some affection, check Twitter while getting fresh coffee from the kitchen, have his significant other show him a funny YouTube video on the way out of the kitchen, then check social media, and shoot out a few texts before turning off his phone and going back into the next study session where he stays on task using his study agenda, using his growing list to track back or move forward in a tactical manner, staying engaged as he goes. Then on the next break, he listens to music and does five minutes of large muscle activation exercises, like squats and pushups, not to get fit, but to get the blood flowing, and then checks his phone and social. Then back to studying where he focuses on getting stuff done. Then he needs a real break and feels like he got more done in these three hours than you might’ve gotten done in five, five plus hours studying in his old way, impressing even himself by staying on tasks so well.
The 50/10 blocks help to keep him focused, cut out distractions, and kept the finish line always in sight. Then having his breaks be a bonanza of activity worked to keep him stimulated and kept all kinds of interruptions out of his study session. The study agenda freed up a lot of processing power and reduced anxiety since he knew it was all written down in a dedicated spot. And then big picture, he knows he will track what he did accomplish in the study manager very quickly. Again, never having to keep track of it since it is always maintained in a dedicated document. So that sums up our talk on time management for med students with ADHD.
Now keep in mind if you have ADHD and do not suffer from these issues, that’s great for you, but plenty of med students with ADHD, and of course some without ADHD, will really connect with these scenarios and the tools we’re talking about. The bottom line is make management tools as external and explicit as possible. It really can make a huge difference for those in need. I think these insights can help a lot of students on their own.
But if you want to learn more, feel free to look into our STATMed study skills class, where we teach all of these skills in much greater depth and context.
In our next video, we will look at a very specific way ADHD might lead you to declare, “I know the material, I just can’t show it on test day.” So yes, we’re gonna look at how ADHD might be the underlying cause of bad test-taking at the medical boards level. And with all that said, make sure you like and subscribe below to hear more of our insights on learning and test-taking in medical school, on boards, and in related medical fields. Thanks.