It’s another in a long string of grueling days. You come home from class/clerkships, and you’re exhausted. Your QBank icon sits unclicked, and your “30-minute break” is now on hour #2. By the time you finally start, it’s past the time you said you’d be in bed. That little voice of guilt keeps reminding you that whatever you do is not enough. Maybe the problem is you.
If you feel tired, unproductive, and guilty for not doing more, it’s hard not to blame yourself. But what if it’s the time of day you’re studying that’s the problem? What if it’s the quality – not the quantity – of your work that is keeping you behind?
In other words, what if the problem isn’t you, but your routines? In this article, you will learn:
- How focusing on quality – not quantity – of studying allows you to do more in less time.
- The number of hours available in a day for peak work
- How to maximize productivity by scheduling your most difficult tasks for the morning
- Why morning routines are ideal for medical students
- How to develop a morning routine and sleep 8+ hours a night while checking off all your to-dos
The Best Hours of the Day
Pop quiz: what is the maximum number of hours of peak studying/concentration available in a day? Your choices:
- 0 hours (No studying I do is productive)
- 4 hours
- 8 hours
- 12 hours
The answer according to research on deliberate practice? Roughly four hours. It’s also a surprisingly common finding in accounts of some of the most creative minds in history.
Here are a few examples, including a description of the deliberate practice findings:
Later in life, he worked 3 hours a day and finished his serious work by noon (Yes, you read that correctly – he was done with work by noon!).
The creator of Dilbert writes for roughly 4 hours every morning, then stops. “My value is based on my best ideas in any given day, not the number of hours I work.” He only has four high-quality hours a day, so that’s how long he works!
He created the first residency program for training doctors and is considered the father of modern medicine. His advice to medical students? Work “four or five hours daily…directed intensely upon the subject in hand.”
Deliberate Practice “Experts”
Have you heard of the “10,000 Hour Rule?” It’s the idea that it takes roughly 10,000 hours of deliberate practice to become an expert in something. Anders Ericsson – a professor of psychology – studied experts in domains like classical music and chess to determine what enabled superlative performance.
In deliberate practice, you use laser focus on improving one skill at a time. It’s challenging and exhausts our mental resources.
Know how many hours a day the “experts” could do? Roughly 3-4 hours, just as the experience of Osler, Adams, and Darwin suggested.
People at the height of their craft can give their best for 3-4 hours a day. It’s such a consistent finding I call them “The Four Golden Hours.”
The Hourglass Theory of Peak Concentration
What is the nature of the Golden Hours? Can we bottle them up, and use them whenever we have a spare moment?
I have yet to find any definitive research on the subject. However, experience (and common sense) suggest we cannot bank our Golden Hours. Instead, it seems more like a “use it or lose it” system, much like an hourglass. We’ll call this the Hourglass Theory of Peak Concentration.
When our attention is at its peak, the hourglass begins. During this time, we have the capacity for our best work. Once the hourglass is empty, however, our studying gradually worsens. Our Theory explains why I can do 50+% more Anki cards/hour in the morning than at night. Or why my QBank scores were always worse after a long day.
It also explains why, if you don’t study for five hours one day, you can’t “make up for it” by studying ten the next.
When Should You Do Your Most Important Work?
By now, it should be common sense to do our most important work when our attention is the best. But when is our focus best? In other words, when does the hourglass begin?
Research suggests most people’s peak attention and capacity for flow occurs in the morning. Our focus tails off in the afternoon. With our Theory, this implies that the hourglass begins in the morning.
In other words, to have maximum productivity, be a morning person.
Why Doing Your Best Studying After Class if a Losing Battle
How are you using this time of peak concentration? If you’re like most people, your best hours occur in class or the hospital. Is your maximum attention best spent listening to endless PowerPoints? Or, more bluntly, does holding a retractor require the summit of your mental capacity?
By the time you get home, the hourglass is long past empty.
Studying after a long day in the hospital is like trying to run a sprint after a marathon. Not only does everything take longer, but the quality of your work also suffers.
Why a Morning Routine is Great for Med Students
I can hear your objections. “I do my best work at night.” Or, “I know I should wake up early, I’ve just never been able to do it.” Let’s discuss these obstacles, and show why a morning routine may still be better.
Problems with Night Owls in Medical Training
You may do your best work at night. (Or at least think you do). However, there are significant problems with working late for medical trainees.
First of all, if you study late into the night, when do you decide enough is enough? When I started studying at 5 AM, a huge motivator was knowing I only had 3.5 hours before class. I was done with most of my work before I got home. Working in the morning allowed me to get enough sleep to be productive the next day.
If you work at night, there are no natural deadlines. Maybe you finish at midnight one night, and 2 AM the next. Irregular schedules create uneven rest. Ever stayed up late to complete an assignment, only to wake up tired the next day? Saving everything for the evening creates a vicious cycle, as it steals productivity from subsequent days.
Second, how do you KNOW you do your best work at night? Often, people claim to be a night owl only because it’s all they’ve known. You may accomplish everything on an all-nighter. However, that doesn’t prove it was the best course of action.
Finally, night owls are particularly maladapted for work in the hospital. Most doctors have to wake up early, especially trainees. On inpatient clerkships, it’s not uncommon to wake up before 6 AM. On surgical specialties, in particular, 4 AM wake-ups are not uncommon. During my residency, I often had to be in the hospital by 6 AM! Because my subway left at 5:16 AM, I was up well before 5 AM.
Clerkships are a problematic transition by themselves. However, what if you’re transitioning to clerkships AND starting to wake up early at the same time? Starting hospital work will be substantially harder.
How to Wake up at 5 AM: Go to Sleep 8 Hours Before!
Previously, you may have thought waking up early is a good idea. You may have even tried it, but concluded it wasn’t for you. What can you do to make an early morning routine stick?
There are lots of tips and tricks floating around. However, for me, the best solution is to plan for 8 hours of sleep.
Want to wake up at 6 AM? Go to sleep by 10 PM!
During med school, I was always in bed by 9 PM, so I could wake up refreshed and ready at 5 AM. (My nickname at Stanford was “grandpa” for how early I went to sleep). Even in residency, I consistently went to bed at 9 PM, so I could be up 8 hours later. (My tutees are shocked to learn that I was in bed 8+ hours per night during residency.) Even today, to write this article, I went to bed at 8:30 PM last night, and woke up at 5 AM! Notice a pattern?
Today’s decisions seal tomorrow’s fate.
To Accomplish Everything, Prioritize the Essentials
It’s critical to do the most important work when your attention is at its peak. Doing so creates a virtuous cycle of rest and even better concentration. However, it’s equally important to do only the most essential tasks and cut out the fluff. Doing the essentials will make your 9 PM bedtime a reality.
For example, you won’t finish by 9 PM if you try and learn every word on your professors’ slides. Same for trying to memorize every fact in a QBank question’s explanation.
It’s easy to fall into the trap of quantifying hours studied rather than quality. The culture of medicine glorifies sacrifice and long nights. We marvel at people who can “get everything done” and only sleep 4 hours. Heck, it took a tragic death due to medical error to prompt restricting resident work at “only” 80 hours per week. (That error was likely from an exhausted, overworked resident).
That’s not the life that I wanted, however. I needed to realize I only had 3-4 hours of peak study in a day. Once I realized that I began to put the most critical work at my best time of day – the morning.
In the Online Course, we track students’ work. We measure:
- The number of topics they master,
- Anki cards they review, and
- QBank questions they do
We have found that by waking up earlier – and doing the hardest things first – students do more and score higher.
Photo by Nathan Dumlao.