HyGuru was started by 2 doctors, Rahul Damania and David Shafran, who found common ground in their approach to learning and teaching. Learning, and preparing to learn, involve more than just sitting down in front of a book. Equally intensive attention must be paid to preparing the mind and body for optimally effective study. In other words, you’re leaving Step 1 points on the table if you don’t master yourself.
And HyGuru buzzwords like ‘integration’ and ‘question-based’ as well as catchy slogans like ‘think-like-the-test-maker’ symbolize our deliberate, carefully considered teaching strategy. Diseases don’t happen in a vacuum. They happen to a patient- an integrated organism with dynamic pieces and parts affected by ever-changing variables. Our teaching reflects the integrated complexity of our remarkable patients, the same level of integration Step 1 expects you to know.
We felt it only appropriate to introduce the HyGuru Blog by taking you through our playbook, an inside look at our personal routines and general approach to medicine, the luminaries who guide us, as well as the evidence-based learning strategies that underpin the HyGuru teaching methodology. Enjoy.
🙇♂️ Study Fundamentals
We wouldn’t dedicate this entire section to Mindset and Lifestyle considerations if we didn’t feel they were as, if not more critical than the Study Routine and Study Strategies themselves. Medical training is a slog- a long, arduous slog, at times utterly uninspiring. Getting your mind and body right (and keeping them that way) is both essential for this marathon and crucial for continued growth long after training is over. Everything you see in the following pages is something that Rahul and I completely subscribe to and practice in our own lives.
‘Whether you think you can or think you can, you’re right.’ -Henry Ford
⁍ ENVISION THE MOUNTAIN PEAK
- Be crystal clear on your ultimate goal because it’s a laudable one- to become a physician and beyond. ‘Beyond’ means that becoming a doctor is only step one in a professional life committed to service, relationships, and personal growth. Trust us, there is no better job! This is your North Star guiding you always, maybe hidden behind the clouds from time to time but ever-present nonetheless.
- Appreciate the significance of this goal, internalize it, and then commit to the incremental, often uncomfortable, steps it takes to get there. As David Goggins, retired Navy SEAL, ultramarathoner, and author of Can’t Hurt Me says, decouple the goal from the calendar and just work the process.
⁍ BE A WORLD-CHAMPION ATHLETE
- Approach studying as a champion athlete would- disciplined, focused, and unrelenting with 100% commitment. Not 99%. 100%, like you don’t have a choice. What you accomplish is entirely determined by your attitude and approach.
- World chess champion Josh Waitzkin, author of The Art of Learning, offers personal coaching very selectively with the following disclaimer, ‘please do not apply unless you are willing to live qualitatively, as if within a world championship training camp.’ Have the mindset of a world class champion athlete in training. Do you want to be adequate at what you do, or the best?
⁍ HAVE A ‘GROWTH MINDSET’
- Get rid of the ‘fixed mindset’ → the belief that your capabilities are predetermined and limited so that every failure/setback signifies an unchangeable inadequacy (Carol Dweck’s Mindset.)
- Instead, ‘Win or Learn’ → your potential is limitless, every setback is merely prelude to and necessary for growth
- Attack the source of limitation (Jim Kwik’s Limitless.)
- Limited mindset→ low confidence and belief in your capabilities
- Limited motivation→ lack of drive, purpose, or energy
- Limited process→ ineffective process to create results
🍽 Eat, Move, Sleep, Breath
To be at your best cognitively, you need to be at your best physically. It’s that simple. You can’t learn, retain, integrate, and apply optimally if you’re not adequately caring for your body. Make the concrete connection between our recommended lifestyle practices and the benefits they confer. In other words, don’t alter your diet or exercise for some vague goal of getting healthy. Make your ‘Why’ more immediate, because you feel good here and now, everyday, and because they improve your studying! Motivate yourself by being mindful of this connection. See Michelle Segar’s No Sweat.
- Because you feel and perform better, period!
- The brain-gut connection is real→ 90% of serotonin receptors and 70% of immune cells are located in the gut.
- Turn back the clock to a less processed time prior to factory farmed animals. Our diets have changed more in the last 100 years than they have in the last 1000 thanks to efficiencies and mass production brought about by industrialization.
- Eliminate temptation and conserve willpower by clearing out your pantry and simply not buying it.
- Dietary Recommendations
- Reduce or eliminate the bad such as trans-fats, partially hydrogenated anything, white sugars, vegetable oils and processed flours.
- Choose whole foods and fats over carbs. Fat doesn’t turn on insulin!
- Healthy fats→ olives, olive oil, avocado, algae oil, coconut oil, nuts, seeds
- Fermented foods such as cheese, sauerkraut, and kimchi calm anxiety. See Clean Gut by Alejandor Junger and Brainmaker by David Perlmutter
- Exercise and movement enhance mood, reduce stress, fight depression, lengthen life, enhance sleep, and improve brain function. That’s not hearsay. That’s science.
- We are built to move. The average caveman moved 3000 minutes per week whereas we move 300. Cells thrive with movement. It has a positive epigenetic effect on our DNA. Move your DNA, biochemist, researcher, and author Katy Bowman tells us.
- Not exercising is like taking a depressant (Tal Ben-Shahar’s Happier)
- Fitness improves academic performance→ Check out the students of Naperville, Illinois and Jon Ratey’s Spark.
- Consistency over intensity says Tony Horton, creator of P90X. Tony describes 3 voices in his head who weigh in on working out on any given day- devil (33%), angel (22%) & consistent (45%) Tony. You won’t always be psyched up. Just listen to the predominant ‘consistent + angel’ voice.
- OTMs (Opportunities To Move) → Movement over the course of a day is as good or better than concentrated bursts of exercise. It’s the aggregate that matters. That’s an epigenetic fact.
- Exercise in nature advises Daniel Goleman author of Focus. It restores attention and reduces techo-stress
- The 1:10:50:100:10000 day→ one 20min walk, 10 pull ups, 50 burpees, 100 pushups, 10000 steps. Create streaks on a calendar, measure your success, and celebrate it. Just having a pedometer increases the number of steps you take.
- ‘Fatigue makes cowards of all of us’ -Vince Lombardi
- Because you feel and perform better the following day
- Sleep is a necessity, not a luxury.
- ‘You snooze, you win’ → Sleep consolidates and improves learning (Benedict Carey’s How We Learn)
- Follow your circadian rhythm→ we’re programmed to sleep from sunset to sunrise, 10p-6a.
- AM Purpose > PM Entertainment→ Your morning starts the night before. Choose sleep deliberately in order to optimize your purpose on the following day.
- Consistent sleep schedule 7 days/week that aligns with your sleep-wake cycle. See Power Sleep by James Maas.
- Evening ‘buffer zone’ → create space between your go-go, work brain and your sleep brain with a evening/nighttime routine
- Develop your off switch→ train your mind to shut off on-demand by practicing meditating. Slowing down your breath slows down your brain.
- Take a nap → we evolved to be multiphasic meaning we’re meant to nap (Sara Mednick’s Take a Nap, Change Your Life). Naps as short as 6 minutes can restore energy, willpower, and creativity. Matthew Edlund’s The Power of Rest
- Do’s and Don’ts: Sleep 101
- Don’ts→ No caffeine after 2p, no alcohol 3hrs prior to bed, no late exercise, no phone in the room, (digital sunset→ screens off when the sun goes down), no late exercise
- Do’s→ Exercise early, keep a gratitude journal (count blessings and you’ll be counting sheep), light sleeping attire in a cool, dark room.
- ‘Suppose you read about a pill that you could take once a day to reduce anxiety and increase your contentment. Would you take it? Suppose further that the pill has a great variety of side effects, all of them good: increased self-esteem, empathy, and trust; it even improves memory. Suppose, finally, that the pill is all natural and costs nothing. Now would you take it? The pill exists. It is meditation.’ – Jonathan Haidt The Happiness Hypothesis
- Deep breathing and meditation literally, structurally alter your limbic system→ 2012 study- UCLA Laboratory of Neuromodulation and Neuroimaging
- Shift from stress to self-control anytime→ slow your breathing to 4-6 breaths per minutes to activate the prefrontal cortex and increase heart rate variability, says Kelly McGonigal in The Willpower Instinct.
- Separate stimulus & response→ learning to observe your thoughts and feelings during breathing sessions translates into less impulsive, reflexive behavior in the real world. It makes room for you to show up with your best self in every moment.
- Start small, maybe a minute per day, repeat the same routine, and be consistent. Just sit and do it. It’s ok to suck. It’s not ok to skip! (Herbert Benson’s Relaxation Revolution)
- Breathing Mechanics
- Lie flat on the floor or consider ‘sitting with dignity’ with a straight spine to reflect a positive, powerful mental state
- Choose an anchor such as your breath or a mantra to be your focal point when your mind inevitably wanders. Always bring your focus back to that anchor.
- Breath deeply into your bellow to a count of 7, hold for 2, and exhale for 8. Do it for 5 minutes and do it every day!
- Don’t judge your meditation!
‘It’s not that we work too hard, it’s that we don’t recover enough.’ – Tal Ben Shahar
‘Rest more, accomplish more.’ – Matthew Edlund
- The importance of solitude→ Your brain needs to be free from the input of others to process information, experiences, and to recover. The absence of solitude makes us listless, anxious, and leaves you impoverished. (Cal Newports’s Digital Minimalism)
- Workout = Stress + Recovery → The stress of a workout is catabolic and the recovery phase is anabolic. It’s during anabolic recovery that ‘the body gets stronger, faster, and builds more endurance.’ Your brain is the same. It needs recovery to sublimate your learning.
- Leisure energizes you. It’s not the rest your brain needs, just the change in pace and scenery. – Arnold Bennett How to Live on 24 hours a Day
- Calm your oscillating mind→ Technology, email, phone all keep cortisol pumping through you
- True leisure is non-instrumental→ done for its own sake bringing sheer satisfaction and joy
- Leisure achieves ‘active rest’ per Matthew Edlund, author of The Power of Rest
- Social Rest→ Connecting to others boosts serotonin and oxytocin boosting ‘positivity resonance’ and cultivating a sense of well being (Barbara Fredrickson’s Love 2.0) in addition to preventing heart attacks, strokes and cancer.
- Use your recovery time to connect to others: your coworkers, your spouse, your friends, etc.
- Physical Rest→ focusing on basic physical processes takes you out of your mind provokes calm, relaxation & alertness
- We learn to think by using our hands and not the other way around. Gary Rogowski Handmade
- Craftsmanship boosts self worth→ ‘Craftsmanship must reckon with the infallible judgment of reality, where one’s failures or shortcomings cannot be interpreted away.’ – Matthew Crawford Shop Class as Soulcraft
- Go for a walk or play an instrument
- Spiritual Rest→ Connect to something larger and greater than ourselves fostering fellowship and meaning
- Praying, expressing gratitude and articulating your hopes, even for a minute and even if those hopes don’t come to fruition, is a form of giving and is, therefore, self-nourishing.
- Mental Rest→ practice the art of ‘selective attention’ to learn how to tune out stimulus bombardment. Add self-hypnosis to your tool-kit.
- Anchor your mind to your breath or something in your environment. Practicing this regularly actually enlarges your frontal lobe, the seat of executive function.
- See Dan Siegel’s Mindsight and Andrew Newberg’s How God Changes Your Brain
📚 Study Routine
💤 Don’t Procrastinate
⁍ Start with a recognition→ procrastination is an irrational delay, we voluntarily put off tasks knowing we’ll be worse off by doing so and that we’re acting against our own best interests. (Pier’s Steel’s The Procrastination Equation)
⁍ Follow the 5-minute takeoff rule! Action precedes inspiration! In other words, don’t wait for inspiration to strike. If you know an activity is important, sit down, start, and more often than not within 5 minutes inspiration will take hold.
⁍ Declare war on procrastination by
- Keeping a work journal, track progress, and maintain accountability
- Break large goals into small daily ones. Success creates success.
- Train recovery to maintain willpower→ eat, sleep, move, breath
- Create habits and run on autopilot
🧘♂️ Deep Focus
⁍ Devices make you dumber, literally→ They diminish your deductive abilities, your ability to think, your ability to remember and your ability to focus. Check out Nicholas Carr’s The Shallows.
⁍ Practice! Focusing is a myelin workout! The more you do it, the better you become.
⏲ Study Bursts
⁍ Work accomplished = time spent x intensity of focus→ maximize intensity to minimize time. Be at a 10 focus-wise for shorter bursts rather than a 3 for longer ones. Check out Deep Work by Cal Newport.
⁍ Create time blocks of intense focus starting first thing in the morning. Set your desk up the night before to remove any decision making.
⁍ When/Where/How→ early, in isolation, device free, in one hour blocks with 5-10 minute recoveries. Recover by moving, not by emailing!
☕️ Study Routine
⁍ Be creative before reactive→ don’t touch your phone or email until you’ve studied
⁍ Match your energy to the task→ do the stuff that requires the most concentration early in the day
⁍ Automate your day with if-then ‘implementation intentions.’ Building habits decreases decision making and conserves willpower. For example:
- If/When I wake up, Then I make a cup of coffee and knock out a 60min study block
- If/When I finish my first study block, Then I do 10 minutes of breathing/meditation.
- If/When the sun sets, Then my phone goes off
- If/When I take a study break, Then I do 20 pushups and 10 burpees
- If/When I go grocery shopping, Then I stay away from the cookie aisle
⁍ ‘Shut down complete!’ → Pick a time at the end of the day when you close your books, your computer, and begin recovery to be ready for the next day.
🤔 Study Strategy
So here’s the HyGuru secret sauce. Every one of our lectures employs some or all of the following techniques to optimize your learning in the most efficient manner possible. It might feel like we jump around but be assured, it’s deliberate:
(1) Integration of content is by definition non-linear
(2) We map our content to ensure we’re comprehensive in our coverage
(3) We deliberately create dysfluency in order to help you achieve mastery. Get comfortable being uncomfortable. It means you’re learning!
🥋 Mastery > Fluency
⁍ Avoid the ‘fluency illusion’ → Understanding is NOT mastering. Rereading and highlighting might feel good but gets you very little. Instead, get comfortable being uncomfortable! (How To Become a Straight-A Student by Cal Newport)
⁍ Lean into discomfort and embrace disfluency when studying. The confusion you feel is the step just before real understanding and mastery.
⁍ Learning is more durable when its effortful→ take notes with a pen rather than a keyboard
📝 Active Recall & Elaboration
⁍ Test yourself→ close the book and recreate what you’ve learned to identify gaps. Active retrieval strengthens memory, period. (Make it Stick by Peter Brown)
⁍ The strain and hurt of retrieving information creates deeper memory traces
⁍ Elaborate→ put ideas into your own words and actively connect to other ideas building a knowledge and concept map
⚾️ Spaced Repetition & Varied Practice
⁍ Start early and spread out material over time to let your brain chew, digest, and imprint. Don’t try to tackle an entire subject at once. Water your brain like you water a lawn, little by little. Forgetting and retrieving causes a stronger memory trace.
⁍ Zeigarnik Effect→ We have stronger memories for uncompleted tasks. The earlier you ‘open up’ a task, the longer your mind will work on it, and the more you’ll remember.
⁍ Practice ‘Interleaving’ → Choose ‘varied’ over ‘block’ practice. Rather than doing a block of the same question types, mix it up with different subjects. This random assortment and unpredictability results in a deeper memory trace and better mastery…even if it doesn’t feel as good initially (see Robert Bjork’s desirable difficulty→ slow down short term performance for long term retention).
⁍ Teach to Master→ It’s the fastest way to identify conceptual gaps. You should be able to explain your subject to a 5 year old. Read Barbara Oakley’s Learning How to Learn or Peter Brown’s Make it Stick.
🖼 The Hyguru Day
A HyGuru day is your masterpiece, perfect day…within the constraints of reality with the inevitable distractions baked in. It might go something like this.
⁍ AM purpose > PM entertainment
- Get a good night sleep
- Decide not to decide→ pick your work the night before, whatever requires your clearest attention, set your goal(s) for the following day, set up your desk and even your coffee
⁍ Be creative before reactive
- Wake up and do not touch your phone
- Morning breathing and values/gratitude journaling
- Early morning 60-90 minute study burst in ‘monk mode,’ NO DISTRACTIONS (avoid ‘attention residue’)
- Recover by exercising→ boost your mood, concentration, and sleep
- Eat a good breakfast
⁍ Ultradian rhythms & blocks
- 90 minutes on/20 minutes off→ Set blocks for study, for recovery, and for email
- Serotonin/oxytocin rather than dopaminergic recovery→ recover with a walk or a conversation rather than email
⁍ Shutdown Complete!
- Close your books at a certain time and train your recovery
- Debrief→ chart progress, reflect on accomplishment & evaluate for improvement, iterate (get curious not furious→ growth mindset)
- Train your recovery with leisure and solitude
- Recharge with nighttime/bedtime routine
⁍ AM purpose > PM entertainment→ do it all again!