Let’s start with a technical message: Last week’s newsletter was not emailed on time due to technical difficulties with the service I use to send it (Revue). I tried to work it out myself and even considered manually sending it to each subscriber. However, I didn’t want my email address flagged as spam, so I waited for the matter to be resolved, and eventually, I sent it the next day. For future reference, if you don’t see the newsletter in your email, you can access it online at newsletter.shaysharon.com, and if everything else fails, it is also available on my website at www.shaysharon.com/weekly-newsletter.

Writing this newsletter started during my last day in New York. I completed my microvascular course, connecting blood vessels 0.5 millimeters in diameter using 0.02-millimeter sutures. It was an extremely challenging course with a great instructor who pushed us to our limits and beyond (thanks, Yelena!).

So I’m waiting for my train back to Boston in a local bar (as promised, the ride is reviewed in the appendix below). This bar doesn’t have a menu or any display of prices, so I just observed the cash register for a minute and figured out the pricing. The beer selection is okay, and it’s close to my train station, but like many other bars around the city, nothing to write home about (literally). You can check out last week’s newsletter for the full description of my New York experience.

Last observation of the city: Weed (marijuana) is fully legal in many states of the USA, and from what I’ve seen in New York (and to a lesser extent, in Boston and Portland, Oregon), some populations are negatively affected. People of lower socioeconomic levels spend their hard-earned money on that, and bystanders are exposed to second-hand marijuana smoke. On three occasions, passengers smoked weed inside the subway, and nobody did anything about it. I wonder what I will tell my kids if this happens when we tour the city. Previously, I was on the fence about fully legalizing marijuana (I have always endorsed marijuana for medical reasons such as cancer). However, after my observations here, my opinion on fully legalizing marijuana is a huge fat NO. 

“The story of the golden calf also reminds us that without rules we quickly become slaves to our passions - and there’s nothing freeing about that.” - Jordan B. Peterson, 12 Rules for Life

Enough rambling. Today we are celebrating issue number 10! Happy birthday! Let’s do this.

Table of contents

1. Main Article - How I study

2. OMFS World

3. Stuff (Book, Gear)

Main Article - How I study

👨🏻‍🎓 Studying, oh, studying. Such a huge subject with so much to talk about. Every single thing about studying I learned the hard way, building on my mistakes as I moved forward. Aside from my 12 childhood years in school, I spent 12 more in university, and on top of that, I’m now in my 7th year of advanced training. Even after all these years, I can’t declare that I know everything about studying, but it is safe to say that I have finally established my foolproof studying system. A system that allows me to achieve high scores 💯 and knowledge retention 🧠 as long as I stick to the plan. As a strong believer in the 80/20 rule, I think that if you adhere to a couple of rules, you’ll achieve 80% of the results. Most often, 80% of the results equal acing a test. So what are the rules? Drumroll, please! 🥁 Our two high-yield rules are active recall and spaced repetitions.

📔 Rule number 1 - Active recall. When you study, there’s no point in reading, highlighting, and summarizing. These are passive methods and a complete waste of your time! Yeah, I know, some of you will get angry and say: “What is he talking about? I’ve been doing it for years, and I’m an A student!”. So what if I told you that you could achieve the same results in half the time? 🕰️ And more importantly, if I asked you to repeat your test after a month, or a year, what would be your score? This is where active recall shines. Have you ever needed to refresh your memory before driving your car, so you wouldn’t forget what the signs mean? Of course not. It has become second nature since you do it frequently. To achieve the same level in studying, you need your brain to WORK HARDER 💪 by asking questions. Active recall is the process your mind undergoes when trying to remember the answer. It means that your brain works (active) to remember (recall). Whenever you do that, you are inducing neurons in your brain to work simultaneously, and the more they work together, the stronger the connection between them will become. 

🫀 Example: I want to remember that an S3 sound (murmur) may signify a hypertrophic ventricle. I can read this sentence over and over, but come test day, am I certain that I will circle S3 and not S4? What about hypertrophic vs. hyperplastic? Or atrium vs. ventricle? So my first step would be to write down the question: What does S3 signify? Or better yet, and this is exactly how I do it, close the sentence:

S[…] sound may signify a hypertrophic ventricle. 

Or: 

S3 sound signifies a […]. 

If I really want to challenge myself (and I usually do):

S[…] sound may signify a […].

Once you master this closed sentence, there is no chance you will get it wrong on your test, and more importantly, you will remember what you’ve learned long after your test day. Stay tuned for the Gear section - where I discuss Anki, an app that will make it easy for you to prepare closed sentences and study them.

Intermission - a myriad of touching stories by authentic, hard-working singers, reciprocated by authentic reactions of the judges:

✍️Rule number 2 - Spaced repetitions. So you mastered the active recall rule and created a neural pathway - a connection between two neurons in your brain. But you want to make this connection permanent, right? To that end, you must make these two neurons work together OVER AND OVER again. The beautiful thing about it is that every time you successfully remember a piece of information, you can extend the interval between two repetitions. For example: on the first day, you answered a question, then waited 10 minutes until answering it again, then waited 30 minutes until answering it for the last time. The next day you had to answer it just once, so the next time you see the question will be after an interval of 3 days. After that: 7 days, 2 weeks, a month, 3 months, 6 months, a year, and so on. And what happens if you don’t remember it after 1 month? Then you will see it the next day, 1 week, 3 weeks, 5 weeks, and so on. It may be difficult in the beginning to know how long you should wait before revisiting a subject, but you can let the Anki app do that for you. Check out the gear section for further details.

🙇🏻‍♂️So these are the most important 80% of my study routine. I’ve been using it for two years, and undoubtedly, this system is responsible for remembering everything I learned, even years later. And I’ve done it all with hardly having time for anything.

“When you enter a mindset, you enter a new world. In one world - the world of fixed traits - success is about proving you’re smart or talented, validating yourself. In the other - the world of changing qualities - it’s about stretching yourself to learn something new, developing yourself.” - Carol S. Dweck, Mindset

OMFS World

👩‍🎓For the student - One great opportunity that students have during their school years is the chance to participate in an exchange program. These programs provide many benefits and can help you learn more about yourself and the world around you. Many students who participate in exchange programs say that it was one of the best experiences of their lives. As someone who hasn’t taken on the opportunity to be an exchange student during his school years but now enjoys his second stint in the US, I highly recommend you check the programs your school offers.

🥼For the OMFS resident - Even when times are tough, it’s important to maintain your nutrition. When you’re feeling stressed, it can be tempting to turn to unhealthy comfort foods, which happens A LOT during residency. So cut back on foods low in nutritional quality whenever you can: Give up the fries and just eat the hamburger, go for a chicken salad instead of fried chicken, and avoid soft drinks with sugar (don’t drink your calories!).

🩺For the non-MD medical professionals - People on a vegan diet abstain from animal-derived food. This diet usually leads to lower cholesterol levels and reduced risk of developing diabetes, heart disease, and stroke. However, it also leads to deficiencies in calcium, vitamin D, and vitamin B12. So if your patient is vegan, monitor their calcium and vitamins D and B12, and prescribe the appropriate supplements if needed. 

The best part starts at 2:10 in this video: Larry Bird is missing A LOT of shots, but he ends up winning. How he deals with almost failing is the part that I love.

Stuff

📚Book I read - Lone survivor by Marcus Luttrell is the story of a navy SEAL (elite military unit in the US) who was the only one of five to survive a reconnaissance mission on the Afghanistan-Pakistan mountains. SEALs are trained to accomplish any mission by systematically breaking it into parts and finding creative solutions. Other than the story itself, I was fascinated by what goes through the mind of a navy SEAL in these difficult moments, and realize that even horrific scenarios can be broken into manageable parts.

💡Gear I use - Anki - this app is free on desktops (Windows, macOS) and android (AnkiDroid). If you want the iOS app (iPhone / iPad) you will have to pay for it, but in my opinion, it is well worth it. Imagine a card with a question on one side and an answer on the other - this is what an Anki card looks like. I have used this application every day (and I mean EVERY SINGLE day) for two years. It got me through med school 😷and the USMLE: I squeezed in studying at any free moment between being a husband and a father👨‍👩‍👦‍👦, attending surgeon👨‍⚕️, principal investigator👨🏻‍🔬, and establisher of a private practice👨🏻‍🚒. Now you see why I had to be efficient while also aiming to remember this information for life. You can use flashcards prepared by others, but I highly recommend you prepare your own set of cards. The sequence is pretty simple: You copy-paste a sentence into the software (Ctrl c, Ctrl v), highlight a section you want to close (Ctrl+Shift+c), click done, and that’s it! It takes about 5 seconds to prepare a single card, and the app will take care of active recall and spaced repetitions. All you need to do is study! Everything is synced seamlessly between your devices, and the data is saved on all your devices and the Anki cloud (no data limit). So less worrying about losing your data, and you don’t need an internet connection for studying or preparing cards.

Appendix (New York)

🚂 Train ride (Amtrack) back to Boston: Prices are extremely variable, so plan ahead. I purchased my ticket about a month ago and went for a 7:50 pm train on Friday for 31$. I could have gone for a 60$ ride two hours earlier. Closer to the departure date, prices went up considerably, ranging between 250-350$ for the earlier ride that cost 60$ a month ago, and my ride was already sold out. The ride, as expected, was smooth. The boarding of about 250 people took 5 minutes. The seat is much more comfortable than the bus, and 2 electrical outlets 🔌 are near each window seat. It’s a 2-2 seat configuration (with occasional 4 seats facing each other)🪑. If you’re sitting in the aisle seat, reaching the outlet is less comfortable (other passengers really stared at me while I looked meticulously around the aisle seat for another outlet. How’s that for a journalist’s integrity). You get a foldable tray (the same as on airplanes), and the background noise is similar to an airplane (and less than the bus). There’s plenty of room for luggage 🧳 , and you need to be able to lift it up yourself to the overhead storage. So, all in all, the train beats the bus by most factors.

In two weeks, I have another trip, this time to Jacksonville, Florida, for flap-raising course (the surgical part where you take a piece of flesh from the leg / arm / etc. to reconstruct a head a neck cancer resection site). Ground transportation was not a real option, so I had to go for a flight ✈️. it will allow us to discuss domestic US flights, airport experience, and connecting flights vs. direct flights. Stay tuned for that one.

Epilogue

That’s it for this issue.

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Next week we will discuss minimalism. 

Have a great weekend!

Shay