We’re back! The USMLE step 3 test is done! I’m writing this on my first free night for the last two-plus years. This is an excellent opportunity to reflect on what I have learned while preparing for these tests and to write on self-discipline, which will be our main topic for this issue.

On the Boston side of things - my dear wife found a great volleyball team to play in, so she’s running, jumping, and serving tonight, and I had an opportunity for a father-kids evening after the test. We will have our official family celebration of my relative freedom this weekend (beer and steak, of course 🥩🍺).

My firstborn got accepted to the school we aimed for, so another box checked. Second-born is brushing up his English skills in preschool (by “brushing-up,” I mean learning English from scratch), so we’ll see how fast a 4-year-old-soak-it-all-brain will pick up a second language.

It is safe to say that we are pretty much settled in. We still don’t have a car, and we haven’t even scratched the surface of what Boston has to offer. We will definitely work on that in the following weeks because, as Bostonians have warned me, “Winter is coming, sweetheart.”

Self-discipline, let’s go!

Table of contents

1. Main Article - Self-Discipline

2. OMFS World

3. Stuff (Book, Gear)

Main Article - Self-Discipline

🏃🏻‍♂️Self-discipline is key to success in any endeavor. Whether you are trying to lose weight, quit smoking, or be more organized, self-discipline is the key to success. Self-discipline means making choices that align with your goals and following through on those choices. But when it comes to self-discipline, we tend to perceive it as an external force that we can’t control: “I should have more self-discipline,” or, “If I just had a bit more self-discipline, I could have taken this project / get up early / started working out again / etc.”.

💪However, I believe self-discipline should not be seen as an external force we must control or accomplish. Let’s take my studying for the USMLE as an example: The USMLE is a bunch of tests (or “3 steps”) you must pass to become eligible for an MD license in the United States. I began studying for it more than two years ago, and besides a close circle of family and friends, no one knew about me taking these exams. It was different from my medical school exams in Israel because other medical students also took the same exams. So if someone saw me having a night out when I should have been studying, they would hold me accountable for it. No one would do that for my USMLE studying routine. So if I failed or passed the USMLE, no one would care… In other words, no one would hold me accountable for my actions.

👨🏻‍💻This is all well and good, but some of you may think: “Yeah, but you HAD to pass the USMLE exams for your fellowship, right? So you DID HAVE someone to hold you accountable for your actions”.

⏰So, what if I told you that it might have been true for the first two USMLE exams I took but not for the third? What if I told you that I was eligible for an MD license in the US after passing the second test, and that I went on to take the third step of the USMLE without needing it soon or perhaps ever? And on top of that, what if I told you that I got up almost EVERY SINGLE DAY from December 2021 until September 2022 before 5 am to squeeze in studying for this exam before the rest of my day started? I’m talking about weekdays, weekends, snow days, holidays, vacations - you name it. So how did I do it? We’ll get to that in a minute.

But first, a rock legend on a piano and another legend on the guitar:

Back to self-discipline. How did I do it? Let’s break it into three parts:

🏹First, internal motivation is my driver. There are two main types of motivation for self-discipline: internal and external. Internal motivation comes from within oneself, such as a desire to improve one’s skills or abilities. External motivation, on the other hand, comes from outside sources, such as rewards or punishments. Both internal and external motivation can be effective in helping someone develop self-discipline.

However, I believe that internal motivation is more successful in the long run. This is because internally motivated people are more likely to stick with their goals even when things get tough. My drive for taking the last test was not external: I don’t care what people think about me taking the exam (or failing it), I don’t get paid for it, and my only “reward” for it is a different kind of MD license. My internal motivation, however, was to keep my opportunities open for further international training so I could become a better doctor. This allowed me to get out of bed at 4:30 am to the cold dark morning. So what is your internal motivation? What makes you happy? Find it, and that is your driving force.

🏂Second, I got accustomed to challenging myself. We all know we are bettering ourselves by challenging ourselves and setting high standards. However, we sometimes find some challenges difficult and lower the bar for ourselves. I believe that we should always do the opposite: Aim for the (so-called) impossible. Surely you have that one thing you always wanted to do: Take that dream vacation, ask someone on a date, apply for a lower-paying but gratifying job. What if, right now, and I mean RIGHT NOW, you would start working on that “impossible”? The starting point is usually fairly simple - go online and submit a form, text your future wife/husband, write an email to a high-rank individual, or sign up for something you always wanted.

“Walking into the very things that scare you is how you reclaim your forgotten power. And how you get back the innocence and awe you lost after childhood.” - Robin Sharma, The 5 AM Club

🏋️‍♀️For me, two years ago, I signed up, paid, and scheduled my USMLE step 1 without even knowing what it meant. Considering the 15 years that have passed since I learned these topics and my limited time, it was impossible for me to pass it. You probably think that now I will tell you how I ended up passing it and how the impossible has turned into a possible, right? Then no. I FAILED it. It was pretty expected, but what I did not expect was how close I came to pass it. I was only short of 3-4 correct answers out of 280 questions! In retrospect, if I had known this during the exam, I might have been able to find the strength to stay a bit more concentrated. Or perhaps not. But turning the impossible into a challenging task and what I learned along the way, well, it’s priceless. Regardless of the outcome, every challenge you take will make it easier for you to take the next one. So what is your "impossible” challenge? And what if you just took the first step towards achieving it, RIGHT NOW?

“Success is not final, failure is not fatal: it is the courage to continue that counts.” - Winston S. Churchill

👩‍🚒Lastly, I have a calling. Yes, it will sound corny, but bear with me here. We all have a role on this planet, and I believe our role always involves making a difference in other people’s lives. Circling back to my first point of internal vs. external motivation, helping others is an enormous internal motivation driving force. As for my USMLE example - my studying over the last two years has made me a better doctor for my patients, regardless of my passing or failing. It enabled me to share my experience with others and advise them towards achieving their goals. “Calling” also brought me to start writing this newsletter, so I can share my experience and hopefully improve the lives of others.

So what is your calling? Perhaps donating your time or money to others? Gain skills to change the way people live? Or maybe sharing your experience with the world? Remember, a motivation to help others will always be more substantial than a motivation to do something for yourself.

Another piano bit, love the third hand at the end of the video:

On to the OMFS world section; feel free to skip it if it’s not up your alley.

OMFS World

👩‍🎓For the student - Warning: This tip is not intended for chronic procrastinators!

Suppose it’s 5 pm and you have until 8 pm to study a specific subject. However, you find yourself nodding off and not motivated enough to continue. Your mind is just not permissive right now. In these cases, I like to implement the “permissive procrastination method.” I stop studying altogether and reassess the net time I need to complete it. Then I cut that time in half and procrastinate it. Let’s practice it on our example - Suppose I assessed the net time needed for studying to be 2 hours, so after cutting it in half, it will leave me with 1 hour. So I will take a break from 5 to 7 pm, during which I will become more and more stressed about procrastinating, which will turn on the “fight-or-flight” response and make my mind extremely permissive to studying. This way, I will have no problem staying focused (and a bit stressed) from 7 to 8 pm, and completing all the studying. The chronic procrastinators among you will probably scoff and say, “I do that all the time!” Well, you’re right, but this tip is not meant for you. It’s intended for all the non-chronic procrastinators out there who can utilize it from time to time.

🥼For the OMFS resident - Don’t use copy-pasted texts from manuscripts or the internet in your presentations! It will look bad, and your audience will have difficulty following you. Do you know these residents who just copy from Wikipedia and leave all the blue links in the text? This is the worst! The best practice is to put a few words on each slide to provide context and explain them. Your audience will appreciate it! And if you do see that some are falling asleep or scrolling through their phones, skip a slide or two, summarize them (or not), and say, “for the sake of time, I will skip this.” This will wake up your audience. Guaranteed!

🩺For the non-MD OMFS - Know how to mask-ventilate! You will probably witness CPR more during training and CPR courses during your career than in the wards. Our internal medicine, emergency medicine, and anesthesia colleagues do it far more often. Training may involve practicing intubation, but I believe it is far more essential to know how to mask-ventilate: How to achieve a good bag seal, how much and how often to squeeze the bag, how to watch the chest rises, and how to observe the color of the lips. You can mask-ventilate for a very long time without needing to intubate, so you can easily keep your patient well-oxygenated until the code team arrives. So take advantage of your CPR courses and anesthesia rotation to perfect your mask-ventilating technique!

Stuff

📚Book I read - Can’t Hurt Me by David Goggins. THE book on self-discipline and defying the odds. It will give you a great perspective on what goes on in the mind of a fighter and the long journey before you can finally say, “nothing is impossible.” I highly recommend the audio version of the book that includes commentary by David Goggins himself.

💡Gear I use - Garmin Fenix 7x Sapphire Solar - My favorite sport watch, by far. After spending four years with the 5th edition, I finally upgraded. Durability is essential for me, so the sapphire glass makes the difference between an enjoyable watch and a shattered watch. I wanted a watch with a touch screen, solar charging, and sapphire glass, and Garmin finally made it happen. My watch had literally seen heavy metal objects slamming upon it, and there was not even a single scratch on it. The sports functionality is excellent; it is highly customizable and functions without relying on a link to your phone. You can pair it to your Bluetooth headphones, and don’t worry about the battery at all. Highly recommended for sports enthusiasts. For those of you who consider the brand new Apple Watch Ultra - please assess your needs for durability and battery life because the Apple Watch Ultra doesn’t come near the Gramin.

Epilogue

That’s it for this issue.

Now it’s a good time to reflect on the one thing you always wanted to do but thought was impossible. What can you lose by making the first step? The worst thing that can happen is that you will learn something new on the way to failing it. Enjoy the journey, not the destination…

In the next issue, we will discuss how I read books (without having the time to read books) and my method for retaining the information I read.

If you enjoyed this issue and think of someone who may enjoy it as well, please forward it the way you would with any email. They can click subscribe at the bottom of that email if they want.

Have a great self-disciplined weekend!

Shay