Sahil Bloom shared this image in a recent newsletter, along with an explanation of how Ohtani used the “Harada system” to become the superstar he is.
The chart Ohtani created as a freshman in high school to meet his goal of being drafted 1st in the Nippon Professional Baseball League.
The story of the Harada system is delightful. It was developed by Takashi Harada, an junior high track and field coach in Osaka, Japan who realized that his young athletes needed more than just drills and strength training to succeed (in all ways). He developed a system for them to define their own goals and actions, and then used it to take his last place team (out of 380 schools!) to 1st place – a position they held for 6 years.
Our ability to pay attention is how we accomplish the things that are important to us, whether it’s being one of the best (if not the best) baseball players in the world like Shohei Ihtani, or finishing a book that has been lying fallow on a computer for too long (Mea culpa).
Thinking about how to better pay attention led me to this post, which summarizes and shares a 4 minute video from Daniel Pink with his 5 step plan to improve our ability to pay attention👇
Set a baseline
See how long can you read a book until you are distracted
As you add steps 2-5 (below), repeat to monitor your improvement
Eliminate distractions
Make where you work a “no phone zone”
Close tabs and anything else on your computer that might distract you
No notifications on any device!
Create a focus ritual
It doesn’t matter what it is, but it matters that it exists
“It’s like hitting play on a playlist your brain already knows.”
Take breaks and move
“Think of your brain like a toddler… It melts down if you don’t give it snacks and naps.”
Reconnect attention to meaning
Take the time to articulate the “why” of what you doing
And how do we promote elevation, which sounds like just what we need in our society right now? According to Nancy Davis Kho, it’s by developing an ongoing practice of gratitude.
“Research published in 2015 in Frontiers in Psychology found that an ongoing practice of gratitude basically rewires our brains to reward us for the positive perceptions we have of the people around us. That begets more gratitude and “elevation,” a lovely scientific term defined in a 2000 article by social psychologist Jonathan Haidt as “a warm or glowing feeling in the chest [that] makes people want to become morally better themselves.” Pour me some elevation, barkeep, and make it a double!”
This week I told three separate friends about using their phones to create usable text from notes … and all three were astonished and then grateful. I’m sharing this in case this is something you need, too!
Hold the camera (like you are getting ready to take a photo) above any printed or handwritten text (notebook, article, book, screen etc) until you see yellow “corners” appear. In this example I’m using my phone’s camera to look at this CNBC post: Apple’s latest iPhone update lets you copy and paste text from photos — here’s how on my computer screen… which is a little meta.
Next step (after the corners appear) is to touch the icon in the lower right screen (the one with four corners and three lines), which starts the process of choosing your text.
Screenshot
You can use “copy all” or highlight the text you want to save.
You can do this “live” (like in my example) or from a photo you’ve taken and saved.
You’ve copied it to a clipboard on your phone. Open Notes, Google drive, Word… whatever you use on your phone and paste!
I often stumble onto ideas related to a project I’m working on (intentionally or by serendipity)… Other times I’m reading something and a really new idea pops into my head which could be a seed for a future project. You know as well as I that if we don’t jot down at least a couple of words those ideas are usually lost. To keep those notes from being lost in piles on our desks (or in our computers) it’s helpful to have a system.
Today I discovered a blog post called “On Rooted Productivity” and, since I’m working on a presentation on how to use a specific note taking system to increase productivity for a group of philosophers and ethicists, I knew this source might be helpful.
So, I decided to write this post on how I take a new idea and put it into a Zettelkasten AKA “slip card” system AKA “smart note” system for current and/or future projects.
Because I know a) I’m interested in this idea and b) therefore, I may use it in the future, I know I’ll need to be able to find the reference easily.
The first thing I do is create a reference in Zotero (which is an amazing, free reference manager. For articles and chapters that are in digital form, I make sure they are attached to the reference as a PDF (this is automatic most of the time in Zotero, but do it manually if Zotero doesn’t do it for you)
Step 2. Create the note.
There is a lot written about the Zettelkasten system, and I encourage you to read more about it from the many sources available (There’s a list of references at the end of the embedded presentation at the bottom of this post)
Here are a few core concepts about this system that are important:
You are making a “card” (if you have a physical system) or a Google doc (in my system) that is an “atomic” idea. It’s a single idea, one intellectual “lego brick”… that can be combined with or used to reflect on other ideas.
It is NOT just a bullet list or quotes from what you read. You need to take the idea and then describe – in your own words – why it’s important to you and where it led you in your thinking. The goal here is that you are creating the rough draft of a sentence or paragraph that can be copied and pasted into a future manuscript.
As a technical note… I start by putting a horizontal line in the document. Everything above it is my writing, everything below it is directly from the source or sources I’m using.
Step 3. Put it next to the card/Google document that is most like it.
This is the heart of this system. Unlike a filing system, the idea here is to find the single idea already in your system most “related” to your new idea. Which leads to some important questions…
What if there isn’t an obvious choice for the note “most like it” or, because you are just starting out, there are only a few (unrelated) notes in your file?
I have a really broad interests and I love how they often are connected in ways I don’t expect. When I started this process I realized I’d have to create a system for later notes.
There are many different ways to approach how to number your cards so they will be next to the card most like them. For more info, check out this post by Chris Aldrich)
I came up with a system that works for me by using Wikipedia’s Outline of Academic Disciplines. I created a spreadsheet to organize a 4 digit numbering system for those “first” notes.
Importantly, though, I only use this system if I’m not able to easily find a related note already in my file. Which leads to the next obvious question…
How do you find the note “most like” the note you are working on?
I start by using a set of keywords to search my notes, looking for the one that is most related.
If that fails, I find the topic that is closest to the note in my spreadsheet and create that “first” note.
For example, I used “productivity” and “meaningful work” as keywords to search for the note most like my note on “rooted productivity”.
After this search, the note I thought was most like it was this one…
To make sure these two notes end up next to each other, I changed the name of the note on Rooted Productivity to 2754/1a Rooted Productivity so it would be “filed” next to 2754/1 Meaningful work vs. productivity
Step 4. Create links between your new note and other notes in your drive.
This is not about “related” like the first connection you made. This step is about creative thinking and links that will lead you to connections that are not obvious.
(BTW… Make sure when you put the link in your new note that you make it a two way link. In other words, put links in both notes.)
Step 5. This is where it matters… using this system as a thinking and writing partner
I suspect you can see how this process helps with creative thinking, but this this quote from Soren Ahrens will help if you are confused: “Go through the notes you made …(ideally once a day and before you forget what you meant) and think about how they relate to what is relevant for your own research, thinking or interests. This can soon be done by looking into the slip-box – it only contains what interests you anyway. The idea is not to collect, but to develop ideas, arguments and discussions. Does the new information contradict, correct, support or add to what you already have (in the slip-box or on your mind)? Can you combine ideas to generate something new? What questions are triggered by them?” (Ahrens, 2017)
As for writing… I suspect you have a good idea how this system could help, but start by using it to link ideas and explore things that are important to you. When you get ready to write, I recommend one of these two books to help!
When I first started this blog, I really wanted to title it “Everything I wish someone had taught me about learning and practicing medicine when I was in training (and beyond)” … but that was a little wordy for the name of a website… hence “Wellness Rounds”.
Ten years is a long time for a blog. Teaching and thinking about how we live and move in the world (particularly as healers) is still a passion for me, but I have new tools and more time now that I have retired from the physical work of surgery (one never really stops being a surgeon, though… more on that later). I found myself agreeing with Neil Gaiman, as quoted recently on Cal Newport’s website – “I love blogging. I blog less now in the era of microblogging… I miss the days of just sort of feeling like you could create a community by talking in a sane and cheerful way to the world.”
He goes on to point out what all of us are experiencing – that more and more of us are leaving the world of microblogging on social media (Twitter, Bluesky, Facebook, etc) but feel a loss for the ways we have been connected by these platforms.
He then predicts the start of a new era of finding community online: “But it’s interesting because people are leaving (social media). You know, Twitter is over, yeah Twitter is done, Twitter’s… you stick a fork in, it’s definitely overdone. The new Twitters, like Threads and Blue sky… nothing is going to do what that thing once did. Facebook works but it doesn’t really work. So I think probably the era of blogging may return and maybe people will come and find you and find me again.”
Enter the idea of a commonplace book, POSSE, and reinventing how I communicate with my readers…
What is a commonplace book?
Wikipedia describes a commonplace book as “a way to compile knowledge, usually by writing information into books.” In physical form, it’s a notebook you use to write down quotes, ideas, often organized into subjects (which is what makes it different from a journal). It can also be a collection of index cards or other notes. One of the best examples of a modern approach to a commonplace book is the Bullet Journal (which is a simple approach to organizing information and tasks that so many people find helpful)
I knew in general about commonplace books, but hadn’t really thought about a website as an online commonplace book, until I read this post from Chris Aldrich: “Hello! I’m Chris. I use this website as my primary hub for online identity and communication. It’s also my online commonplace book.”
First and second year medical students often are anxious about the “need” to publish but have trouble finding details about the process and goals of writing. Yes, it’s true. If you are going to be applying in a competitive specialty, you need to have at least one (but maybe a few more) publications. BUT (and this is really important, so please pay attention) there are two important things for you to know:
It’s called academic medicine because we are part of the academy! That means that we are trying to teach and change outcomes for the future. Don’t look on these papers as a “check box”. Find a meaningful question and learn from a mentor how to answer it. You will make a difference!
Secondly, you do NOT have to publish in the field you will ultimately choose. Publications are really a surrogate for being able to think, work in a team, and write. It’s showing that you can take a complex task and actually complete it. No one expects a first or second year student to know they want to be an expert in the pathology of Hodgkin’s disease! The key is to find a mentor who will teach you the process and show you how meaningful and fun it is to study something in depth and then share what you learned with others.
So how do you do this? It starts with a blank form:
So let’s break down the five steps from starting to publishing a clinical research project…. The times in parentheses are my estimates for how long this takes for a student who is on clinical rotations. If you are doing this full time as an month long research elective, it will take less time for each step. (But – note to self – you need to get the IRB request in 2 months before your research elective starts!)
Store your PDFs in Zotero – you can attach it as a file if it doesn’t automatically download. Don’t forget to add the Zotero plugin to Word if it doesn’t automatically install.
This last step is the key step (my opinion, others may have other strategies). My goal is to read each article ONCE. Therefore, I put EVERYTHING I think might be of interest from each article as I create my outline. It’s a lot easier to edit things out than add things in…
I start with an outline in Word that has headings something like this….
Introduction
Epidemiology
Pathophysiology
Natural history of the disease
Presentation
Treatment
Outcomes
Complications
So, I might read this paragraph in an article written by Smith et al in 2015 (I’m making this up – don’t quote anything written below!)
Pyloric stenosis was first described in 1886. Prior to the introduction of surgical treatment, the death rate was 50%. Surgery, which started in 1923 has now led to an almost 100% success rate with no mortality. The typical patient is male, and 4-6 weeks of age. They present with projectile, non-bilious vomiting and do not appear ill between episodes of vomiting.
So – using the outline in Word and Zotero I would do this…..
You then go on to subsequent articles and – even if they mention the same detail – you put it into the outline. For example, if you found 4 articles that said the typical age was 4-6 weeks, it would look like this: Typically 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)
Next, use your outline to start actually writing about the information you have gathered. As an example, switch to the “text” setting to change your note about age at presentation from “Typically 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)” to text that says “The average age at presentation is 4-6 weeks (Smith, 2015) (Brown, 2011), (Jones, 2000) (Who, 1014)”
The Institutional Review Board is responsible for protecting patients participating in research. Even if you are “only” reviewing charts, they must be protected with respect to confidentiality, etc. This is not usually true for case reports, but since many journals require IRB approval, you may have to submit it anyway and have the IRB letter that says it’s exempt.
It takes approximately 6-8 weeks to get the IRB approval after it is submitted. If they require modifications, it can take longer. You can’t (and shouldn’t) look at charts until you get this approval.
You must have IRB approval before you can submit the list of patients from the hospital with the disease you are studying. If they are treated by doctors other than the faculty you are working with, the IRB may ask you to send a letter via the hospital medical staff office to the other doctors giving them the option to exclude their patients if they want to. (They virtually never do, but this is a required step)
The “term paper” is just what is sounds like. Depending on the topic, it will be ~6-15 pages long with ~20-60 references. Here is where the outline and Zotero are so important.
Change the “view” in your outline to “draft”. The outline levels will be in Blue and will now be section headings. Everything that you wrote as text will be just that – text. You can write in this view or go back and forth between the draft and the outline if you want to rearrange sections.
All of the links to the references you put into Zotero using “Add/Edit Citation” will be in your draft. At this point, you click on “Add/Edit Bibliography”. It will prompt you to choose which journal you want (Yes! It knows the format of all the major journals!) and then will automatically create the bibliography. If you add new references in at the top of the manuscript, or change the order of the sections, you click this again, and it recreates the bibliography in the correct order.
As you are creating the outline, you are also designing the “data sheet” to retrieve from the charts the details you need to prove your hypothesis.
Writing a term paper is a great way to become an expert in the topic you are researching, but it also helps you later. The hardest part of any final paper to write is the introduction and conclusion – which you mostly do by writing the term paper!
Once you’ve got to this stage, you want to skim through the articles again to see if there are any “big picture” points you might have missed and then write the summary – i.e. the abstract.
It is ALWAYS better to write the abstract after the manuscript if you can. But – many times the deadline for the abstract will be used as the motivation/pressure to write the manuscript. Each attending will do this a little differently.
Use this section as a “journal” for your submission and for notes during meetings.
Sir William Osler was probably one of the most prolific, most loved and most respected physicians in American history. Osler is credited with the concept of journal clubs, with being responsible for bringing medical students onto the wards for “clinical clerkships” and for the structure of the modern medical residency. Osler is also famous for quotes about medicine and teaching medicine. But, for this post, I want to focus on something that recently caught my eye … his desk. Osler wrote the first definitive textbook of Internal Medicine in the United States, The Principles and Practice of Medicine. I can only assume that a lot of his writing took place at this desk:
Which made me look at my desk and think about desks in general. There are many of us, particularly in the era of the laptop computer, who use our desks as storage space. But maybe we are missing an opportunity. What if, instead of stacking things on our desks, we actually created a space that made it easy to study, read, think and be creative? Organizing your desk will unquestionably lead to being more productive. But being productive isn’t the only goal. It’s also important to create a space that makes you look forward to spending “non-productive” time thinking, dreaming and being creative.
Organizing a desk.
Keep pens, highlighters, etc that you use in a holder – but only the ones you use. Get rid of the pens that don’t really work, and the ones you don’t like.
Declutter the surface of the desk by hiding electronic wires, filing stacks of papers, etc
Keep a scratch notebook on the desk to replace scraps of paper. Use it for phone messages, ideas, etc.
Keep the surface clear of everything except what you are working on (and put it away when you are done)
Position your computer screen so it’s ergonomic
Personalizing a desk (and the space it lives in)
Make sure you have a great (and very comfortable) chair.
Get a really good light.
Make sure the area is quiet
Keep the area decluttered to decrease visual “stress”
If you listen to music when you work, get good speakers for your computer (or a good sound system)
Put things in the space that motivate you – art, photos, quotes, etc
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