On the STATMed Podcast: Conversations About ADHD in Med School: Part 4
It’s happened to the best of us. You’ve got a laundry list of things to do, but before getting started, you sit down for a second and glance at your phone. Then, suddenly, it’s 3 hours later, you’re hungry, you’re confused, and you’ve inadvertently memorized three TikTok dances. (Maybe that last part is just us…) But, the point is, your day got away from you. When this happens occasionally, it’s not that big of a deal. However, if you keep finding yourself 3-hours later and very little to show for it, you may have a problem. Issues with time management and ADHD can go hand-in-hand, and the strategies you’ve used previously may not be cutting it anymore.
In the fourth episode of our podcast miniseries, Conversations About ADHD in Med School, host Ryan Orwig returns with Mike, a former STATMed class participant. They share how issues with time management and ADHD can derail medical students as they study or take boards. During this conversation, they share specific strategies med students can use to overcome these issues.
“I think time management is probably one of the biggest problems [with having ADHD in med school]. You’re fighting against time. You’ve got a set amount of hours between one test to the next. And so, you know you have a set amount of work that has to be put in, in that set amount of time. But that’s the fight against time because your ADHD is making you want to do other things. So, when you should be studying, you’re looking at your phone, watching videos, and doing anything else besides studying. And it’s a constant fight against time that you’re wasting and losing.” – Dr. Mike
We’ll dig even deeper into various ways learning in med school is complicated by ADHD in future episodes. Be sure to stay up to date on our latest podcast episodes, videos, and posts by joining our mailing list!
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Transcript
[Announcer] Welcome to the STATMed podcast, where we teach you how to study in med school and how to pass board style exams. Your host is Ryan Orwig, a learning specialist who has over a decade of experience working with med students and physicians. In the fourth episode of our conversations about ADHD in med school mini-series, Ryan and Mike, a former STATMed class participant, discuss the struggle of time management and ADHD in medical school and explore strategies to mitigate this issue. [Ryan] Time management is the fight and it doesn’t, I’m not saying there’s a single silver bullet to this. I think there’s multiple ways to approach it for multiple people. But this is a pretty big thing you had to sort of learn to contend with. Is that fair to say? [Ryan] Hey, we are back. Ryan and Dr. Mike here talking more about issues med students with ADHD might experience in the first few years of medical school. Learning to drink from that fire hose we call lecture-based learning. We want to talk about time management and how this can be a challenge when starting out in med school, especially if you have ADHD, time management is a huge issue, but I think talking about time management just sounds terrible. I think it’s often used in a punitive manner, sort of as a way to punish med students with ADHD and in general, to make people feel guilty because they’re trying to guilt them into focusing more on getting more done, being more productive. So I think a lot of people bring a lot of negative feelings to the table when we talk about time management. Mike, what are some of your thoughts just broadly about time management and ADHD for those first few years of med school? [Mike] I think time management is probably one of the biggest problems. You’re fighting against time. You’ve got a set amount of hours between one test to the next. And so, you know you have a set amount of work that has to be put in, in that set amount of time, but that’s the fight against time because your ADHD is making you want to do other things. So when you should be studying, you’re looking at your phone, you’re watching videos, you’re doing anything else besides studying. And so it’s a constant fight against time that you’re wasting and losing because your ADHD is distracting you and getting into other things. And so, you know, there’s only a set amount of time and you, if you’re wasting that set amount of time, you still have the deadline of the next test. [Ryan] Yeah all med students are being forced to drink from this fire hose. This is what we call the speed, volume, density equation. There’s so much, so fast and you’re accountable for all of it. So everybody has to deal with this, right? But I feel like everybody’s swimming in this, this swimming pool and they’re churning through the water. But the ADHD med student also has like a cross current hitting them, that’s pushing them sideways, backwards, and the slog is that much more. And we have to recognize that. You were saying earlier how it has to at times certainly early on and at whatever point. It has to just feel impossible to make it through med school because of all of the speed, volume, density, so much information being thrust at you. And certainly that’s a feeling that you had at multiple points in your career, right? Like how on earth is this doable? Was that a fair, I don’t want to put words in your mouth. [Mike] You look at this stack of notes and paperwork and you try and figure out how anybody is getting through it. And you think this is impossible. There’s no way anybody’s going to pass this test. There’s no way anybody can look at all this stuff and know how to go through it. But then you, everybody takes a test and then 80 plus percent of the people just passed it or did well. And you know, varying degrees of well. And so then you’re looking at yourself and you’re saying, “Oh, I didn’t spend enough time.” But you know you spent eight plus hours. You were still at the library until one o’clock in the morning. You were there longer than other people, but you have no idea what they’re doing different and it’s incredibly disheartening. [Ryan] It’s disheartening and frustrating because again, a lot of the times, like when I’m talking to these students, it’s not for lack of time. It’s not for lack of effort. It’s not for lack of desire and commitment and even ability. But again, ability gets, we got to break that down a little bit, right? And it does all come down to time. When I was creating STATMed, I was thinking about study methods and test*taking methods, but I’d always taught time management along with it. I just sort of grudgingly did, but I was talking to one of my former students and we’re, sort of putting this all together back in 2012 or 11, whenever it was. And he’s like, “You’ve got to put the time stuff in.” And I was like, “You hated the time.” He’s like, “I know, “but that’s the glue that holds it all together.” And I was like “That is true.” Right? And obviously, I mean the time management tools we use, we’ve developed so much over the last decade, but this is where you make your money, is in the efficiency of your time use that ties into the efficacy of your tools. But, but time is the most scarce resource, right? I mean, wars are fought over scarcity. Value is in scarcity. And when it comes down to it, time is the most valuable resource, I guess, probably everywhere, of course, but within med school because you’ve got to optimize everything you’re doing, right? Typically, I don’t like talking about time management without talking about study methods, because I think that is where that optimization does come from. But I think we can, we can get into some pretty interesting things here as we talk about time management, but what’s some of the worst advice you were given early on Mike, when really trying to, I don’t know, overcome that initial hurdle when you first started med school, before you, you know, slammed into that proverbial wall, what’s some of the worst advice you got about this time management stuff? [Mike] I feel like along with a lot of the advice you get, it’s all very generalized. So the advice I got was, “Oh, just make a schedule.” “Get a calendar by the hour.” “Make a schedule out, make sure you stick to the schedule.” “Make sure you’re going through it” “and make sure you’re having it out by the hour.” And that way you just follow the schedule, you make sure you put enough time in and then it’s easy. But realistically you, one, you take time to make a schedule, which has no, you really don’t know how to make a schedule. You don’t know how much time to spend on each thing. [Ryan] Yeah. [Mike] And then also you have a schedule. So you say, “Okay,” “I have an hour to do lecture X.” And so you say, “Okay, I’m gonna sit down.” And then within the first 15 minutes, if you get distracted, then you are now at the second hour. And so then the whole first hour that you would have already gotten done, you’re now 45 minutes behind, the schedule’s blown up and it’s worthless. And then you’re more frustrated because you can’t even stick to a schedule. [Ryan] Well, Mike, so that’s one example. The other one is, and I, and you and I’ve talked about this is, “Okay, I’m going to start studying at 8:00 AM.” And then for whatever reason, you, you don’t start until 9:00 AM. Now the schedule is useless because you started late. Or I want to start at 3:00 PM when I get home from lecture, but you don’t factor in the commute time or the fact that it takes longer to get from point a to point B or you get sidetracked. You don’t get home until 3:30. You don’t get turned around until 4:00, another hour lost. I just feel like it’s so, the schedule, this idea that just make a schedule. Like if you’re not, if you don’t get specific feedback on “What am I doing right versus wrong?” If I’m not using the schedule as a learning tool, but instead using it as a judgment tool, as a, as a black and white mandate, it is just instantly frustrating and alienating and frustrating, or maybe even just makes you feel guilty. Maybe the schedule you made is 100% unrealistic, but how’s it gonna make you feel? Like you’re not going to say, “Oh, I made an unrealistic schedule.” What are you going to say, as that med student, Mike? [Mike] Or you just stop using it. You don’t look at it. And the other weird thing with a schedule is you say, “Okay, I’m gonna have it out by the hours.” And so you, you come in and you get there at 8:30, but you don’t have anything on the schedule till 9:00. And so you just, instead of starting studying, you wait until that hour, or you get distracted to 8:30 and you, instead of just starting back, studying at 8:45, you wait till 9:00 because that’s when the next thing on the schedule is. So it can kind of backfire because you’ve got a schedule and say, “Oh, well, I can wait till 9:00.” “That’s when I’ve got the next thing to do.” And so it just never worked for me. [Ryan] I also think they make you feel guilty. I think they make you feel like a failure, all these negative, negative things that just stirs up. And we don’t teach people how to really do this stuff. How to, how to optimize time, how to plan time, how to learn and train ourselves. If I’m trying to learn how to better manage my time. Obviously it’s study skills on the one side, but also using feedback to determine When am I on? And when am I off and how can I get better? You know, day by day, week by week. That’s not the mindset, I think, of a lot of this stuff. It’s just like, use it. And if it’s not working for you, shrug, it kind of falls on you. I just, I feel like it’s a hot potato type thing. They can just throw it to the students. They make the schedule and use it as a generic panacea. And if it doesn’t work, it kind of falls on you, the student isn’t that part of the situation? [Mike] Yeah, because there’s no feedback once you actually are able to make a schedule. And so there’s no reflection on the schedule, you just say, “Oh, it didn’t work.” “And I’m not gonna use this schedule.” “And I failed.” And so then you go back to where you were before, except you wasted an hour making a schedule. [Ryan] Well, then you throw it out and then you roll for another week or two without any kind of scheduling until things get even more dire. And then you try to make another, then you come back, it’s like an abusive relationship thing. You come back, try to make it again. Immediately fall off the wagon, get frustrated. Don’t do it for another few weeks. And it’s just this real back and forth thing. I think time management can, can mean many things and it can be handled in many ways. And I think it’s going to be different for each student and each learner. So what, you know, after we worked together, you did a version of our class between your first go, as your first year as a med student between going into second, coming back to repeat it. And you know, then with board study, we teach a variety of time management tools, but I don’t expect people to use all of them. It’s just finding out what’s one thing that might work for you. One thing that we use at a really low level is just something like the 50-10 model, 50 minutes on, 10 minutes off. Rigid, some people like that. Some people don’t. I like it because it cuts out distractions and it makes things a little more bite size. That might be a way that someone manages their time. That’s not making a schedule. That’s not planning things out ridiculously meticulously, but maybe that cuts out distractions. Like I jam all my distracting activities into the 10 minutes and I do what I can within the 50 to work progressively through what I’m studying. You use some version of that, I think Mike. Whenever you were studying for boards. What was your modification to the 50-10 model, applying that to your own time management? [Mike] Yeah, so a couple of things. One, I think it’s really interesting. If you want to do a little experiment, have a little stopwatch, try and study for 50 minutes straight. Every time you get distracted, stop it. Or every time you get distracted, you know, make a little tick mark or count the amount of times that you get distracted and get off track. Even in a 50 minute time, it’s really hard to just sit, focus on one thing, especially with ADHD for 50 minutes. [Ryan] Yeah. Treating yourself like the subject of your own experiment, what does that show you and what does it do for you? How many might you have seen in yourself in one 50 minute block? How many ticks do you think you make on the tracker paper?Mike] A lot, I mean, you know, it would either be a lot or very few.
[Ryan] Throw me a number, throw me like a realistic number that young Dr. Mike, you know, first year repeating med student, dealing with his ADHD, sitting in his space, studying. Are we talking like seven ticks in an hour? Are we talking 50 ticks? I mean, give me a number that you feel like could be realistic. [Mike] So, if you’re, you’re probably getting distracted five or six times, but if each time you’re getting distracted for five minutes, you just lost a half an hour of your 50 minutes. So it’s significant amount of time, probably over half of the time that you’re saying you’re studying, you’re distracted, you’re doing something else. [Ryan] Yeah. [Mike] And as the day goes on, that gets worse. The more tired you get, it gets worse. [Ryan] Do you think by making those ticks too, it also creates a little bit of self accountability? Does the awareness help you self-regulate a little better? [Mike] You know, I failed boards twice. And so after the second time we did the boards workshop and so I was just studying for boards. And so I had, every day I would sit down and every time I would finish a 50 minute block, I would make a little mark. Some days that would be six, some days that would be two. Even though I’m sitting there for six or eight hours, some days were better than others. Some days you get the full eight. And I would even break that up and further as, my goal every day was to do two, four hour blocks of like, four 50-minute blocks. And so if I could, if I could make it four hours studying 50 minutes an hour, that was a good day. [Ryan] And you’re tracking this on, on a calendar. Is that right? [Mike] Yeah, it was just on a calendar. Just write down a little tick mark, every time you hit the 50. And so, because the other thing that’s important is you’re counting the 50, but the most important thing is timing the 10. You’re never going to study over the 50 minutes. You’re never going to be like, “Oh, I want to, you know,” “I just lost track of time” “and studied an extra three minutes.” But with that 10 minutes you’re doing something else you’re on the phone, whatever, you’re gonna, you’re gonna go over if that’s not timed. So that was another big thing that was important was timing the break, as important as timing the studying. [Ryan] I agree. Imagine you go over five minutes, every break, add that up every day and then add that up over the course of a week, add it up over the course of the entire time you are studying for your boards. We’re talking hours and hours and hours of lost time. And it’s low yield. It’s not quality. I tell people, you know, if you want to build in, you want to watch a TV show. Maybe you like that in the middle. Maybe like that at the end, put that on, put that on there. Like maybe you have like a special symbol and you, “I get to watch one show in the middle”, or something. When we’re talking about, when you’re just doing long-term dedicated study, that can be, that can be applied in any which way. And then it’s like, it’s going to prevent you from watching three episodes on a run. And you’ve just lost this time. I mean, it’s all about finding this balance with this stuff, but yeah, the 50-10 model is a way that you can sort of use this. I mean, that falls under a time management tool. Another form of time management tool could be what we call the Academic Study Agenda, which is simply a study to do list, it’s a checklist. We only put study based activities on there. We don’t mix in a personal to-do list. That can be a separate list. And the whole purpose of this is to break large tasks into smaller tasks, just so we can have the pleasure of crossing items off a list. There’s something just profoundly human about that. And I think one of the problems is people make really huge items like master this chapter, master this lecture, that’s so big, you’re talking hours and hours before you get to cross something off. Learning to break it down is a skill. It’s an art, but I, I really encourage it. Everything with this time management stuff notice how Mike’s talking about little tick marks on a calendar. That’s making things external and explicit, writing down things you’re going to cross off, breaking large items into smaller items, offloading our cognitive processor. That’s already overloaded, building out workflows. So we can do this. The opposite of the Academic Study Agenda would be what we call our Study Manager. This is where you make, it’s a macro chart of all your lectures or all of the chapters. And this is where you’re just checking things off that you’ve done. Like “When have I frameworked it, or previewed?” “When have I watched a lecture?” “When have I read it?” “Have I come back to it?” Just real big picture stuff, so that you know what’s done and what’s not, because we do tend to not have a proper balance of distributing as we go across the various lectures. We don’t want to try to keep that stuff in our head. And there are various scheduling things you can use. Like Mike, you were talking about how for you, it was more about managing within the study blocks, right? And how many study blocks can I get? That’s great. I like things for certain people, but again, this isn’t for everybody. You have to figure out which one’s good for you. But the real time tracker, I got this from a book on entrepreneurship and we teach this in our class. This is not about making a plan for the day. This is about just writing down what you do. “Oh, well this is when I ate breakfast.” “This is when I left the house.” “And this is when I got to school.” or “this is when I got to the library.” “And this is when I sit down to study.” And “this is what I’m studying.” And you’re just, you’re just logging it multiple times, as many times a day, logging this sort of thing out. And then you have this artifact at the end of the day, or at the end of the week, you can look back on and reflect Mike, you and I were talking about this, sort of like there’s some, some diet strategies that are similar to this, right? [Mike] Yeah, it’s very, it’s very similar. Like it’s just a mental thing. And so basically there’s a lot of diets and they think that, you know, before you eat something, you write it down or you keep a journal of the food you eat. And so that way you can see what you’ve eaten through the day. [Ryan] The flash diet, right? You just take a picture of everything you eat before you eat it. Like if you go to Subway and you eat a foot-long sub you take a picture of it. If you fill up your 32 ounce soda, you take a picture of it. And then if you refill it, you take another picture. I mean, it really it’s this idea of what, like some sort of just up-front blunt force accountability. Is that sort of how you see it, Mike? [Mike] Well, yeah, especially with ADHD, like I think it makes you stop and think about what you’re doing. So if you’re, if you’re writing down, watch YouTube for 20 minutes, when you know, you’re supposed to be studying, you’re gonna have to, you’re going to have to think about it for more than just the second that you go and switch over to YouTube. And so I think it just provides a little bit more self-accountability and self-tracking that you’re able to see. [Ryan] Self-accountability, self-tracking and it’s putting a little bit of the locus of control outside of that impulsivity, the running wild impulse. And it’s putting the locus almost on the sheet where you then have to be accountable by saying, “Oh yeah, like I was on a video” “about west Nile virus,” “which is kind of sort sorta related to what I’m studying,” “but not really.” “And then after 10 minutes,” “I was on stuff about soccer drills” “and watching stuff about the Italian soccer league,” “which I kind of sort of am or interested in,” “but not really, but hey, here it is.” “The algorithm knows what I like.” And then I’ve got to write down, “I watched a, you know, “a bunch of videos of the Italian soccer league” “for 30 minutes”, and that has to go on the tracker, right? And Mike, I’m sure that I’m speaking to you, you know, like, this is the world we live in, right? And I think having it down there helps. [Mike] Yeah, and because the time’s set, so then that 30 minutes that you could’ve been doing something productive, or even that 30 minutes could have been after you studied, you could have been going to the gym or you could have been doing something with your family. And so you feel much guiltier about those 30 minutes when you’re supposed to be studying. Than if you would have studied when you were supposed to be studying and then gone and taken that time later, even more time than that, you could have taken an hour as a reward, but you’re taking 30 minutes when you’re supposed to be studying. And so you don’t feel good about it. It’s not relaxing. It’s not helpful. And it doesn’t help you study better. It just makes you feel worse. [Ryan] It’s, and it’s junk food, right? Like I didn’t really, I didn’t even really care about those YouTube videos about the Italian soccer league. I was just watching them. Like, it’s just, it’s like eating a bunch of calories that I don’t even really like, and I don’t need and are really bad for me. Instead, I could have banked that time and watched something that I really like and value later in the day when I’m tired, when I’ve done my work. Or spend it with my family or go to the gym or go for a hike or whatever that might be. So like not all downtime is equal. And I think something like the real-time tracker is a great way to be, to start to get your head wrapped around it. You cannot tear yourself up over like, looking at the horror show of what the real-time tracker will show you. Because if you’re like, going to just beat yourself up over it, you’re misusing the tool. You have to remove your emotions a little bit from it and track it honestly. I mean, I think the act of tracking probably does alter the behavior a little bit, but then you look back at whatever it is, good, bad, ugly, whatever, and say, “okay,” “What can I learn from this?” Again, day by day, week by week, however you want to use it. And then you shape yourself. That’s feedback. Time management, all the stuff that we talk about requires discrete feedback to change these negative behaviors. And I think when we can externalize them and actually look at it, it’s going to help. The flip side of the real-time tracker would be what we call the Ideal Optimal Schedule. And this is where like on Sunday, you sit down and you map out what you think your week would ideally, optimally look like, and now look, that’s, to me, I like this because if I’m super duper, duper busy, which every med student is, how am I supposed to optimize my time? If I don’t know what an ideal week would look like? I’m not saying like, I’m going to watch this show here and there. I’m gonna like, “What am I studying?” “What am I off?” “When am I transitioning?” “When am I going to the grocery store?” And all this stuff. “What’s my optimal bedtime”, all that jazz. I just don’t know how you can optimally hit those things, if you don’t even know what it looks like. And some people, Mike, I don’t think you ever did this. This probably wasn’t up your alley. It’s not, it’s not for everybody, but for certain students, including some of our ADHD students, it’s a great way to really have a hypothesis of how you might spend your time. I mean, it’s a weird, it’s a weird experience. It’s a weird exercise. But if you do it all the way, it can really illuminate stuff for you. Now, if you use it to judge yourself, it’s immediately not gonna be actualized for whatever reason. But if you use it to judge yourself, you are going to make this valuable tool into a very damaging tool. You just have to look at it and say, “That’s what I thought I was going to do.” “And this is what I did”, and learn from it. And you can combine the real-time tracker with the ideal optimal schedule, sort of side-by-side. This is what I wanted to do, this is what I did. Again, don’t use it as a judgment tool. Use it as “Oh, okay.” “I can learn some stuff from this and make my scheduling better in the future.” That’s all. I mean, you’re living your life anyway. You’re living it in the mixer, in the fire hose, in the speed, volume, density equation. You can just, week by week collect some data, reflect on it, get some metacognition about how you’re spending your time. And then three weeks, four weeks, five weeks later, be better off. Which, I mean, Mike that’s that has to be a part of this, right? You said like, time management is the fight and it doesn’t, I’m not saying there’s a single silver bullet to this. I think there’s multiple ways to approach it for multiple people. But this is a pretty big thing you had to sort of learn to contend with. Is that fair to say? [Mike] Yeah, and it’s kind of a weird deal too, because you would wake up in the morning and you would be anxious because you’re not studying. And so the only thing that could make that anxiety go away is to go study. But then you go study and you’re spending the time and you’re there and the anxiety goes away enough that then you want to, then you get distracted and you go to something else. And so, but then that worsens anxiety worsens the, you know, “I can’t go to sleep.” “I have to get up early and I have to spend more time.” And so you’re trying to overcompensate with the total time, because, you know, of the hour, you’re only spending 15 minutes actually studying. And so your total time that you’re quote, unquote, “studying” is much higher, but your effective studying time is much lower. [Ryan] Yeah, the output, right? Like, the quote, it’s like, it’s like you’re working out, but like, you can’t get a high output. So what are those, I mean, I guess the secrets to overcoming this number one, I think acquiring better study methods, I think is definitely a part of this. What else though? Mike, do you think it’s just, it is about that awareness? It is about some of these time management hacks that we’re talking about? Those are a piece of it as well, correct? [Mike] Yeah, and I think, you know, there’s, your brain does weird things with studying your brain is gonna, is gonna gravitate towards the things you know better. You’re gonna want to study the things that you know better, the things that you’re interested in, the things that you already know, your brain wants to go to those things because you know them, it’s not as hard to think about them or you enjoy studying them versus the things that you don’t enjoy versus the things you don’t know as well, because it’s self gratification that then goes, do questions or go do recall on those issues and then not get the things right. So if you’re studying the hard things that you don’t know that you don’t want to study, and then you’re getting questions wrong, then it’s a cycle that you’re like, “I don’t want to study that stuff anymore because I’m not good at it. I’m not getting it right.” And so it’s exactly the opposite of what you should be doing. And so then you, you have a deal where you have 20, 30, 40 lectures in a two week period. And so you’re spending too much time on one lecture where you’re supposed to be either balancing out all those lectures or one lecture is more dense. And so you’re trying to, that’s a hard thing that nobody really teaches is how much time to spend on each thing when to move on to the next lecture and then go that way. [Ryan] Yeah, so now we’re, we’re talking about specific type of imbalance. I think imbalance ties into time management in so many different ways, but this is my, Mike sort of like, slid into this notion here of like, how long do I spend on lecture A before moving on to lecture B? And then that ties into, well, when do I come back? We know like, interleaving and distributed learning. I think these are concepts that are permeating the culture now, as opposed to 10 years ago, nobody ever heard of these things. And people are chasing this. Like, how do I get that? How do I come back? Or how do I, again, when have I studied lecture A enough and when do I move on to lecture B, you know? And then as Mike was saying, one of the traps here is while we blindly, we just don’t know. But then the other thing is, you know, maybe we do sink in on the stuff that’s more familiar to us or that we like more and that we know better. And then we stay away from the things that are harder for us and that we struggle with. And that’s going to rear its head and be damaging at some point. So again, if you offload this stuff, if you are at least keeping some kind of study manager, that’s showing you how, how have I allocated my time? Keeping it in your head and tracking it blindly is a recipe for disaster, I think. I mean, this is definitely where I am with this stuff now, Mike, I mean, this wasn’t something we did way back when, when you did your version of the class, but now it’s at the heart of, of everything we do where we want to really externalize a lot of this stuff. And you know, I think everybody knows going into med school, the speed, volume, density is a killer. Everybody tells you this, you heard this Mike like, “oh, “there’s so much, there’s so much.” But as you said, like, you’d heard that before, right? We all hear that going from what? Like from high school to college, oh, you got to study so much more, right? So you heard this whole horror story of the speed, volume, density equation before you started med school, but it doesn’t prepare you for it, right? [Mike] Right, I mean, you feel like you can turn it up a little bit. You know, you work hard in spurts and in college to get through whatever paper test or whatever, but there’s nothing for the actual volume. Again, it’s not even close. [Ryan] Nothing. The speed, there’s so much so fast and you’re accountable for all of it. Like even familiarity, might’ve been, supreme familiarity can really be extremely rewarding in a lot of undergrad, or even master’s programs, familiarity at this level is only going to frustrate you ’cause you can narrow it down to two or three, but you don’t know which one it is. Cause your knowledge goes three feet deep and it needs to go five feet, six feet deep. So there’s just nothing out there. Nothing can prepare you for it. That’s I mean, that’s just the rule of the game and that’s okay, but this is why we need to have tools to wrap our heads around so that we can be a little more nimble. We can start to adjust early on, once we get in there. Because again, there’s just no way to really prep for the speed, volume, density equation. [Mike] Right, and I always thought one of the hardest parts was you come in, you’re getting all this information. You’re expected to know it, you’re expected to do well in the test. You’re not doing well. It’s way more than you thought it was gonna be, it’s way harder than you thought it was going to be. And then you have this test. You don’t do well on it and you’re right back into it. So then you’re, you’re trying to learn how to study, but also trying to learn how to do the information. And you’re just falling farther and farther behind. I always thought it would be a good idea to have some kind of training camp where you come in, you have a week or two at the med school or with the med school. And so you basically just have a practice run. And so you have a practice run where you have two weeks, you get the same amount of volume, you get the same amount of information. And then you have, you know, you have those two weeks, you have a test at the end and you see where you’re at. You know, the people that are, you know, getting 90s, 100s on the test. Okay, great, they’re not probably not going to have any issues, but if you come in those two weeks and you get a 50, then you have another month or six weeks in the summer to figure out how you’re gonna fix it before the real deal starts. I mean, every professional team does that. Every professional team has a warmup of, you know, a training camp where you go in, you’re getting used to whatever the workload is instead of just, you know, starting the season on day one, hopping in and then just getting killed. [Ryan] You can’t imagine a sports team being like, “All right, guys, here we are, we’re all here. We’re assembled. The first game of the season in the NFL is tomorrow.” Right? And it would be insanity. We treat sports and other walks of life very differently than we do with our medical professionals, because they’re like, “Hey, our medical professionals,” “students are smart.” “They can handle it.” Now here’s my dream scenario. And I’ve talked to a few programs about this and it’s just, it’s a whole thing. So what I would do is this, wouldn’t it be a fascinating model? You come in a month earlier than you actually would. So if you start September 1st, we’re coming in October 1st, whatever, you come in and you do a legit two weeks of school, like you said, full volume, the fire hose is turned on, speed, volume, density, and the content matters. So they can’t just blow it off. Like this is a grade. And then, and maybe there’s some self-selection you get 90 or above, you’re out. You’re good to go. But if you’re below, 90 below or whatever the threshold is, then I would put in the STATMed, a version of the STATMed class, we then, so instead of like letting them figure it out themselves, we then teach a STATMed class over say, 8, 10 days using the school for the content from the material or the content from the school. And then you have like say another week of practice and maybe we give them a few, they get some assignments, maybe, however that works. And then school resumes at the end of the month where they’ve now tasted the bitter fruit of the fire hose. They get the skill intervention, they get some dedicated practice with some feedback, and then they reenter. But what does that do for your life, Mike? If you entered med school and that’s what you experienced, it saves at least a year of your life right? [Mike] Easily, because you know, right now the model is, you’re going until Thanksgiving. The first break you have is Thanksgiving or Christmas. And so, you know, you’re, you’re picking up a lot of people late in the fall, Thanksgiving, Christmas, but by that point, it’s already over, by the time I got to Christmas, I was, I’d already failed and I was already repeating. And so by, you know, by that point, it was already over. [Ryan] Yeah, yeah, yeah, yeah, absolutely. Well, and people contact me and they’re asking for help in that first month, in the second month, I tell them, like, “I can’t change the tire on a moving car.” Like we can pull the car over and we can, we can obviously intervene, right? So this would be something where you could totally come in and address this, the study methods, the time management methods and the test taking methods in a direct, in a directly interventional way. And, and maybe, you know, we’ll figure out a way to do that. I mean, the STATMed class is a great intervention for this. It’s a great thing for people to do in the summers, great thing for them to do over the December break. But I do have goals of, in my ideal world, where we do actually change medical education as those are some of the loftier goals, but that would have to tie in with start dates and tying in with schools. And those, these are some lofty, lofty things here. So anyway, time management, time management, like it is a legit thing. That’s where you have to make your mark. You have to become more effective. You have to be more efficient as with everything we with, especially with the ADHD med student, we want to make tracking and planning, external and explicit, written out in a dedicated spot. It can manifest in a variety of ways. It can be by tracking your time with a real time tracking log, it can be like, “Hey, I’m doing 50 tens.” “And I’m going to keep track of” “how many I successfully complete on my calendar” “or on a document, on my phone or whatever that might be.” It can be anywhere in between. I just think that everybody needs to embrace, especially if you’re struggling with time that you can get better with time. And it doesn’t have to be something as simple as make a schedule, fall off the wagon and get mad, wait a few weeks and do it again. So, anyway, I think that this is one of the big ones that we always want to think about. And I know that like, time management gets a bad rap, but I think it’s often taught wrong. So try to wrap your head around that, try to figure out small ways, incremental ways you can bring time management into your daily and weekly life. And that should help obviously, in the classroom years, but obviously also with independent board prep, if you are just prepping for step one, step two, level one, level two, into residency, into specialty board training. So thanks for listening and we’ll be back with another talk sometime in the future here. Thanks a lot. [Announcer] Thanks for tuning into this episode of the STATMed podcast. In future episodes, Ryan and Mike will continue their conversation about ADHD and med school. If you like the show, be sure to rate it on iTunes, Stitcher, Spotify, or wherever you listen to your podcasts. And be sure to subscribe, so you don’t miss future episodes. You can find more test-taking and studying strategies, specifically designed for med students and physicians over at our blog, statmedlearning.com Thanks for listening.