A typical greyhound spends between 16 and 22 hours sleeping. But when they come off the leash, they can hit speeds of 70 kilometres per hour.

Elephants in the wild sleep only two to four hours per night. When awake, they don’t move nearly so fast as their lazy four-legged counterparts.

Most people study like an elephant. You should study like a greyhound instead.

There’s a lot to do outside the hospital as a medical student or junior doctor – exams, research, courses. These sap hours from every day. But they need not sap so many.

Your productivity is proportional to two things: time spent on a task, and the intensity you bring to the task.

Medical professionals and students often think about “for how long” we are studying, but not about “how intensely”.

Why? It’s easier to spend more time doing less. We feel like we are doing more; we’re less likely to worry we’re not doing “enough”.

But increasing time and intensity spent learning are both subject to the law of diminishing returns. There’s a big difference between doing no study and doing an hour a day; much less of a difference between doing four and five hours of study a day. There are far greater improvements to be had by turning attention towards improving the intensity with which we study, instead of aiming to find extra hours in the day to sit in front of our textbooks.

Optimising learning

How do we learn?

The psychologist Anders Ericsson coined the term “deliberate practise” as the means to developing expertise in an area – from chess to music to business to the military and to sport. It involves focused, undivided attention on a task combined with regular feedback on one’s performance. More recently, author and computer scientist Cal Newport has explored the term “deep work”: the ability to focus without distraction on a cognitively demanding task. Deep work is central to deliberate practise, which is key to learning.

What’s the problem?

You sit down to study. You are multitasking, with Facebook messenger up on your computer.

You’re not multitasking. Multitasking is a myth. When people are multitasking, they are actually rapidly switching attention between different stimuli. This is not the focused, undivided attention required for learning.

Sighing, you turn off your computer, focusing on your textbook and flashcards instead. Your phone’s screen lights up with a text. You respond to your group chat, then put your phone back down and get settled back into studying. Five minutes later, your phone lights up again. Again, you respond, and get back to study.

Unfortunately, you haven’t quite got back to study. Whenever we switch from one task to another, our attention doesn’t completely follow. It keeps flicking back to the previous task, preventing you bringing the full force of your attention to the task at hand. This stickiness in our brain is called attention residue. It’s particularly insidious when the task we are leaving is unfinished (or indefinite, as with a group chat) and low-effort.

Sighing, you turn your phone off, put it out of sight, and get back to studying. But after five or ten minutes, the cravings begin. “Just a quick check of Instagram”, you tell yourself. “Then I’ll get back to studying”.

Why is this focused, undivided attention just so hard?

Phones and social media are designed to hijack our attention. The intermittent, unpredictable dopamine hit you get from that like or that text message is all the more addictive than a predictable one might be. Our brains are more sensitised than ever to dopamine, and so we need more and more and more. Hard work often just doesn’t provide enough.

And so without clear feedback from our behaviour – feedback that provides dopamine – we are likely to do whatever is easiest in the moment. This means, more often than not, low intensity study. Even if we have to spend more time doing it, it’s easier to overcome the inertia and begin and keep studying when the study is low effort.

Undivided focus produces neurological adaptations

When an action potential travels down a neuron, oligodendrocytes produce more myelin. This speeds up transmission down the neuron. We get better at a skill, understand more etc. by thickening the myelin around the neural circuit. To do this, we need to force the specific circuit to fire again and again, in isolation. And to increase or further our skill or knowledge, we need to cause neurons associated with pushing our limits to fire in isolation, so they too develop more myelin.

Meditation is an act of training attention. Studies of experienced meditators demonstrate neurological adaptations in regions of the prefrontal cortex, and the middle and superior frontal cortices, areas associated with improved attention processing and enhanced cognitive function. Actively training working memory improves our ability to undertake complex tasks including reasoning, by modifying the activation of neurons in our frontoparietal network.

Our brains are magical. They are constantly rewiring themselves in response to new stimuli. Unfortunately, the distractions of the modern world have left out brains unprepared to stay on task for extended periods of time.

Why deep work?

Beyond improving your ability to learn, deep work and deliberate work can be more rewarding and enjoyable than shallow work. Structured correctly, you can enter a flow state, when your full concentration is on a “limited stimulus field”. The built-in goals, feedback rules and balance between challenges and skills offer greater joy than unstructured free time; one’s sense of time distorts so it passes quicker. 

Working deeply also increases the importance of relaxation. Beyond the benefit of doing more in less time - enabling more time spent relaxing or pursuing other passions - it’s important to remember that willpower is finite. A 1998 study found that an initial task requiring self-regulation (imagine seeing a notification on your phone and not checking it) led to subjects quitting faster on unsolvable puzzles; and less persistence on making a meaningful personal choice or complex mental tasks such as solving anagrams. Subsequent meta-analyses have found that self-regulation increases the effort required to complete tasks, and increases their perceived difficulty and your subjective fatigue. Our focus and willpower are limited. Don’t waste them.

Practical tips for incorporating deep work into your routine

Increasing the amount of time spent doing deep work

We’ve talked about rewiring your brain. You can make that work for you. The more you build a routine of deep work, the easier it can and will become to do. Some basic steps include:

-          Having a set time and place where you will do your focused work

-          Plan exactly what you are going to work on and for how long

-          Have a routine or ritual before you begin. I say to myself out loud exactly what I will work on and for how long, then sit down and do it. This routine could involve literally anything; the important thing is to prime your brain to know it’s about to work hard

-          Minimise distractions – avoid depleting your willpower.

-          Set a timer and increase the time you spend in focused work. At first, 15 minutes two or three times in a day might be enough. Then increase it over time

-          To keep yourself accountable, particularly when preparing for a big exam, keep a scoreboard. Track the hours spent in deep work per week, and try and do more each week.

-          Finally, prioritise relaxation

Incorporating deliberate practise into your study

It’s worth spending time considering how to specifically apply deliberate practise to your learning. Remember, the two key characteristics are that they are at or close to your limits; and that there is structured feedback.

In medicine, this could involve examining a patient in hospital under exam conditions, overseen by a colleague or senior doctor, and receiving feedback. It could entail doing challenging practise questions, and when making a mistake or identifying a knowledge gap, following that up with study from a textbook. It could involve explaining the pathophysiology or management of a condition/presentation from memory – to friends, family, your dog – then checking to see if it was correct. The possibilities are endless.