NB: This was adapted (mainly refinements on grammar, sentence structure, and a few additions to content) from a physical diary entry I made today.
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Today, I experienced a renewed urge to become truly disciplined again with respect to my academic work – to work on my Anki reviews (ensuring that they are completed promptly every single day). The number of review cards I had to do today was actually higher than the typical daily amount because I had let the reviews pile up over the past few days (not a good habit). Nevertheless, I’m glad I got it done once and for all earlier this afternoon.

It’s incredible how positive habits can quickly morph into an unrecognisable mess if one does not continuously reflect on and examine one’s life, one’s goals, and if one is not intentional and true to oneself in all that one does. In my experience, the inability to maintain the positive habit that was previously established isn’t typically due to a hero-to-zero descent into chaos. The decline is typically gradual and progressive. Think of a cancer that is slow-growing and typically presents in the terminal stages (e.g. pancreatic cancer).

It begins with the subtle lies you tell yourself. If I were to broadcast on a loudspeaker to a crowd of 5,000 of your peers the kind of internal monologue you have in your mind consistently, I’m sure it would be incredibly embarrassing. “Cringe” is the word that teenagers would employ to describe the scene. This is precisely why the author of the bestseller Atomic Habits, James Clear, advocates actually voicing out a significant action you’re about to do before actually doing it.

When applied in the context of a bad habit, you will begin to realise how ridiculous it sounds. For example, suppose you’ve just finished dinner. Let’s suppose that you’re in my shoes and you have to lose 2 kg to get back into the ‘normal’ Asian BMI range (i.e. <23.0) but at the same time, you’re craving for some Häagen-Dazs Rum & Raisin-flavoured ice cream. In this scenario, imagine having to say the following out loud with everyone else at the table being able to hear you: ‘I am going to eat ice cream I am craving for right now even though I don’t like how it makes me feel 30 minutes after eating and even though I am trying to lose weight‘. Only after saying this aloud will you be granted permission to partake of the ice cream.

You’d feel like a complete imbecile!

That’s the whole point. This is one of the strategies that can be used to eliminate bad habits.

So, what happens instead when you choose not to voice things out loud but choose instead to host an internal dialogue?

I say ‘dialogue’ instead of ‘monologue’ because the image that I have conjured in my mind is something similar to that of the characters in the show Tom and Jerry, where it’s quite common to have an ‘angel’ and a ‘devil’ version of the character positioned on either side of the character. These imaginary versions of the character would give the actual character conflicting advice (which is for simplicity’s sake, often dichotomised as ‘good’ and ‘bad’).

“It’s ok if you do XYZ. Doing this on one occasion wouldn’t hurt”. Then, on the second day, you tell yourself, “You already broke the streak, you might as well indulge in the bad habit today too”. Thus begins the downward spiral into the abyss.

It’s so easy to deceive yourself. I remember how on one particular day in the past, I would just disable the Review Heatmap add-on in Anki to avoid having to see the soul-crushing work that I needed to do in the midst of the other things that were going on in my life. I used to be so proud of the streak when life was more smooth-sailing.

However, halfway through my General Surgery posting, I got so discouraged with all the stuff I needed to deal with that I think I basically lapsed in my habit of making Anki cards for newly encountered content. I also lapsed in my habit of diligently and consistently completing my Anki review cards every single day. Having encountered this, it was not a surprise that my Anki review streak eventually came to an end. Although the streak came to an end, I think it’s good that I at least had enough decency to not do a token ‘one review card’ on days where I would choose to skip the reviews just so that I could superficially maintain a theoretical streak.

I’ve been using Anki since June 2019, when my then-senior in medical school (who’s now a doctor), first introduced me to how I could use Anki seriously.

For too long, I’ve been procrastinating and letting things snowball intermittently (mostly because the streak had been broken a while back and I would deceive myself by telling myself it was alright that I break a new ongoing X-day streak because the previous 702-day streak was broken anyway). I have had too many days where I’ve not done the reviews I was supposed to do.

Today is the day this garbage stops.

So, the question you may have is: what makes you so confident that today will be any different from the other days in which you lapsed, Nic?

That is a fair question, given that after all, I have lapsed in my commitment do working diligently multiple times (my inability to reliably continue the 702-day Anki review streak is just one of a few manifestations of the lapse in the focus intensity and engagement duration dedicated to my pursuits). For that fair question, I have the following response:

This sudden urge to start becoming disciplined arose from seriously and deeply contemplating my long-term life goals (in terms of my health, my relationships, my future family plans, my crafts, and my academic performance as a student which will significantly influence my career trajectory) during a dedicated focused session this afternoon where I was just alone in my air-conditioned room without my phone or any form of digital technology. I decided to engage in this reflective exercise after having watched a few video clips from the recently-established YouTube channel of Cal Newport over the past week. During the reflective exercise, I was thinking about the vision of the deep life that I envision for myself.

I’m not sure if Cal is indeed the first person to devise the term ‘deep life’, but he is certainly the first and only person I know who uses it so extensively. The deep life is a concept that requires a lot of unpacking. I’m not able to do that over here, but I encourage you to click on the above hyperlink. That linked blog post made in 2015 is one of many blog posts made by Cal on the concept of the ‘deep life’. To read more elaboration on what is meant by the deep life, just do a simple Google search ‘Cal Newport deep life’. There are plenty of articles on his blog which has been running continually since the mid-2000s for your perusal.

It’s quite exhilarating, really.

As I envisioned the Nic I wanted to become years from now, I could not help but brim with excitement. Attaining the deep life at that state and living the deep life to get to that state look indeed promising.

After that wonder of a reflective exercise, I decided to commit to completing the day’s Anki reviews with the utmost concentration. Overcoming the initial inertia to even start completing this catch-up review session was brutal. The whole session was mentally exhausting, but fulfilling nevertheless. This is what active learning is supposed to be like. Cognitively demanding. Like a muscle getting trained.

The feeling you get when you realise you’ve reviewed the final card in the review pile is similar to the post-run high associated with all-out sprinting the last 100 m of the IPPT 2.4 km run. The sheer intensity with which I worked this afternoon on my Anki reviews and on the reflection exercise was reminiscent of the 2012-2013 period, when I was an Upper Sec student in Maris Stella.

The two years that I spent in Maris Stella from 2012-2013 as an Upper Sec student were some of the most fulfilling and enjoyable years of my life. It was one of the most productive periods of my life. It was when I most diligent and focused in all that would help me attain excellence in the GCE ‘O’ Levels. It was a pity that the momentum didn’t carry on to my time in JC.

You would imagine that upon transferring to NUS Medicine Year 3 in May 2021, I might make a firm commitment that I would give my very best from that point on, right? It’s a natural transition point after all. Such a huge transition – flying all the way back to my homeland in the midst of a pandemic – transferring medical schools.

Things are easier said than done though. When I first started my clinical postings (Internal Medicine at SGH), I felt so overwhelmed and lost, and this was probably exacerbated by the fact that I was a transfer student. I didn’t have the same background as the other fresh Year 3 students. I was used to different conventions. Even overseas medical students who had transferred into NUS Year 2 at least got to spend a year integrating into the local system before starting clinical postings. Most importantly, they got to undergo the CSFP (Clinical Skills Foundation Programme), something that I totally didn’t get to undergo.

To be quite frank, I still feel lost (thankfully to a reduced extent compared to that of the start of the academic year as a Year 3 student). It is precisely this feeling of being lost and the lack of a cohort-wide consensus on a specific effective study strategy on how to overcome all the various components of the clinical phase of medical school that made me feel overwhelmed and discouraged. One frustrating component is the process of learning physical exam manoeuvres, particularly for the sake of school tests. Broad outlines may be similar, but there are essentially limitless variations to how physical exams can be done. I’ve even heard conflicting information and advice dispensed by senior doctors.

My view on the disgruntling variation in the physical exam manoeuvres has evolved to the point where I opine that the most practical approach for us time-limited students is just to settle on a reasonable initial template and just stick with it relatively firmly, and only modifying it or value-adding to it if there is a relatively compelling reason to do so. You don’t have to necessarily incorporate any minor change that some random doctor tells you to (unless that doctor will be supervising you for assessments over a period of time). I suspect that most of the time, such recommendations on the minor changes are made on the sole basis that the suggested revised version is simply what that particular random doctor is accustomed to.

Virtually the same sequence of steps and the same format for doing things should consistently be used in order to get those proper practice hours up. Note the emphasis on same. This is important because if there are always constant minor adjustments to the sequence, then there will never be one particular sequence which one is truly confident in executing. Can it also then be really considered true deliberate practice if there’s always some variation beyond random error?

Well, enough on physical exam manoeuvres .

In sum, as I reflect on the short video clips and various blog posts by Cal Newport concerning the deep life and my specific vision for what I want to achieve in my projected version of the deep life, I have experienced this strong renewed urge to give my best in the various domains (which I have personally defined for my specific circumstances and future; you are also free to define what and how many domains are important to you) of life I want to excel in.

This post has largely focused on the domain of being a current medical student and a future doctor as it is in this domain that I most strongly feel this renewed urge after this afternoon’s reflective exercise. Fortunately, there are also some spillover effects on the domains that I’ve defined for myself: my health, my relationships, my future family plans, the musical domain, and the domain of writing).

The rest of medical school isn’t going to be easy at all. In fact, I will be facing some rather daunting exams pretty soon, but the sheer thought of getting better progressively, day after day, from periods of intense focused studying is deeply appealing. Being able to and choosing to dedicate a significant proportion of one’s time to deliberately hone one’s skill at a particular craft and then being able to eventually perform at an increasingly greater level seems incredibly exciting and fulfilling.

For many, this is precisely what injects a ton of meaning into their lives. I see this in my journey of going from a beginner-level pianist to an ATCL-level pianist. Being able to reach a certain level of competency in piano playing over the years has given me immense satisfaction. It manifests when I am able to play piano pieces that I absolutely would not be able to play if I had not put in all the time and effort over the years. Words cannot describe the joy I feel when I learn the final bar of a challenging piano piece. The same could be said of athletes (e.g. when you see your personal best run timings slowly improve as you put in the hours of focused training). The same could also be said of students who dedicate the time and effort into a particular extra-curricular activity over the years, and getting familiar with and competent enough to be involved in the international arena (e.g. representing Singapore in the Odyssey of the Mind World Finals).

If my writing has failed to relay a tone of optimism and elation for what the future holds, then I shall state it here explicitly:

I’m absolutely bubbling with exuberance for what the future has in store for me.

NL
20 Feb 2022

• medicine