#13: What if I Fall Behind?

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A plan of action for if you fall behind during medical school.  As a bonus, get the PDF of a catch up guide that you can print out and keep as a reference, by entering your info below.

I want to start by saying that falling behind is inevitable.  The pace of medical school is such that a small stumble can turn into a huge gap in your knowledge and performance, so you want to make sure to have a plan for when you fall behind.  Now, I can remember during my first year of medical school.  My plan for when I fell behind was pretty much to not sleep, feel miserable, and think I was a huge failure until the next exam.  Not a great plan.

Now I’m a dermatology resident, PGY-2.  The amount of material I have to memorize in preparation for derm boards at the end of residency is overwhelming, just like at the beginning of medical school.  Last month I went to Costa Rica with my family and…I fell behind!  So I have to practice what I preach.  I’ll tell you what I’m doing about it.

Very briefly I will touch on the obvious: prevention.  Not falling behind in the first place is the best approach, everyone knows that.  Keep your study habits organized and efficient.  Go to lecture if you are the kind of person who needs external forces to keep you on schedule.   Here’s a tip that I wish I had known at the beginning of medical school: When you make your overall study strategy or schedule at the beginning of a block, schedule “black days” so that you have a cushion for the unexpected.

And if you do fall behind, you’ll need to troubleshoot.  Falling behind because of an acute problem is much different than falling behind because of a chronic flaw in your study methods.   If you fell behind because you always handwrite notes, the solution is not to handwrite notes faster.  You need to change your study strategy.  Now might not be the time to try something new if you have an upcoming deadline and you are already behind, but you’ll need to do it after the next exam, and you may need to chalk the current exam score up to growing pains.

1. Assess

But if you have fallen behind, how do you start to catch up?  First, assess the defect and make a schedule.  Write out exactly what you are behind on and estimate how long it will take to complete.  Be conservative, and estimate the perfect world scenario.  If you had all the time in the world, how long would it take you to make up what you need.  So for illustration let’s say you calculate you are 12 hours behind.  Maybe you usually study 12 hours in a day and you had to go to a wedding or you got sick.  Break that down in your assessment.  4 hours of reading, written out as 1 hour for each of 4 lectures.  4 hour-long lectures, itemized.  4 hours of memorization and practice questions or flash cards.  As part of your assessment, define when you need to catch up by (likely the next exam).

2. Prioritize

Next, take that list and start to prioritize.  Decide what order you are going to attack the material in.  You may only have time for the high-yield.  You may not have the luxury of being able to digest every piece of material.  Something has to give when you are in a time crunch situation.  You’ll have to let go of the minutiae.   You can keep making Anki cards if that doesn’t bog you down, but tag some of them “HighPriority” so you make sure to at least get through these before test day.  If you are using Anki, you may also want to change your Anki deck intervals so that you aren’t seeing reviews as closely spaced, since this will reduce your overall review time.  If nothing else, look at your list and identify 1 or 2 items that you could live without.  This is always the hardest thing.  It feels like you need to do everything or you might miss something critical.  Just remember you are behind and you need to catch up, so something has to give.  Tell yourself that if you catch up and have extra time, you can always come back to those things that you glossed over.

3. Re-assign

Realistically decide when you are going to have time to complete the unfinished work.  This is so important.  I made this mistake so many times.  A realistic plan for catching up does not include you magically studying faster.  For example, if you study for 3 hours every night after lecture, and you miss a night, don’t think that you can just squeeze your normal studying into 2 hours and be caught up in a few days.  Your plan for catching up has to include time that you otherwise would not have been studying.  This is so important I’m going to say it again, because it’s not obvious.  You need to map out when you will have time to catch up, and it has to be during time that you otherwise would not have been studying.  Because if you start impinging on the study time you already needed, you’ll end up on a treadmill where you can never catch up.  So identify non-study time that you can borrow from.  Some ideas:

  • Unplug.  Eliminate social networks and other distractors, temporarily.  
  • Let your family and friends know that you will be out of touch for the next two weeks.  The hour that you normally Skype with your parents will need to be reassigned this week.
  • Reschedule social plans for after the next exam.  Plan for a social reward when you catch up.
  • Skip a meeting.  Your interest group will survive if you miss a month.
  • Notice that sleep is not in these suggestions.  Keep sleeping.  You don’t do yourself any favors trying to study harder on less sleep.  This is hard to do, but don’t sacrifice your mental health.  I would always tell myself, “if I just sleep an hour less, I can get everything done.”  It never really worked out that way.
  • Also, all of these things are terrible, terrifying really, if they become a habit.  You need social time, you need to Skype with your parents, you need distractions.  Remember what I said about troubleshooting!

4. Rejoin

I think this is the hardest thing, and it’s what I’m doing now after my Costa Rica vacation.  Fall in step with your classmates.  Don’t try to catch up at the sacrifice of the current classwork.  You’ll feel really uncomfortable, because there’s this huge hole in your knowledge.  Reassure yourself that you’ll fill it in, and that even though you may be learning things in the wrong order, it will all come together.  Whatever you do, don’t perpetuate the problem by studying old stuff at the expense of the current material.  That is one way to guarantee that you will never catch up and that you will learn all of the material less well.  Think about it – if you are completely off-cycle, you’re learning the old stuff at the wrong time and the new stuff at the wrong time too!  If you let the old stuff go, at least you are learning the new stuff at the right time so that it will stick better.  By right time, I mean when you are seeing it in lecture, lab practicals, when everyone is talking about it between classes…

5. Maximize

Maximize efficiency.  Watch videos at double speed if you can.  Skim lecture notes instead of reading slowly and carefully.  Set a timer for your flash cards in Anki to force yourself to move more quickly.  You’ll find that you naturally start glossing over the minutiae and focusing on the more important facts.  But be cautious – you don’t get that much juice from this lemon.  If you could be 50% more efficient, chances are you’d already be doing that.  So, in our example, don’t think that you can catch up 12 hours in 3 days if you just squeeze your current 12 hours into 8 hours of studying.  That just doesn’t work.

Okay, so to summarize, the key points are prevent, do a written assessment, prioritize, re-assign your tasks to non-study time, keep up with current material, maximize efficiency, and troubleshoot your study strategy.   If you have a friend who is stressed about being behind, please share this with them too.  

I wanted to illustrate the gestalt of falling behind and hopefully this episode showed you how to think about falling behind and catching up.  Stay positive – you can do this!  

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