How to Learn

Learning how to learn is the ultimate meta-skill. A trait that all of us need to master in our lifetime. Over the course of my life as a student, I’ve had periods where I’ve achieved ridiculously low grades ( My teachers in primary school were concerned that I had learning difficulties with mathematics) to times when I flipped that (100% in statistics and other subsequent maths exams). This turnaround was not consciously of my own doing, but rather instead of a string of wonderful teachers in my later years. They had used specific techniques and tactics in order to allow their students to absorb material more effectively. Over the past few weeks I’ve delved into books on meta-learning and the art of self-teaching to uncover the exact techniques that top students, effective teachers and memory champions use to learn. In this article I want to outline 9 key concepts.

All of the below are extensively backed up with research and in the interest of getting across a message, I’ve omitted referencing. This information is taken from a couple brilliant books I’ve read called ‘Make it Stick’ and ‘A Mind for Numbers’.

1) Retrieval

Re-reading is not learning. Re-making notes on a topic is not learning. Re-making mind maps by referring to your notes is not learning. Highlighting your passages and reading them is not learning.

Don’t do the above. They are quite literally a waste of time.

You learn by quizzing. By answering questions. Forcing yourself to actively engage your mind in trying to answer a solution. This feels hard. Learning is meant to feel hard. Rereading is easy. Rereading is a waste of time.

2) Spacing

Spacing is the opposite of ‘massed practice’ which is cramming. Spacing instead involves doing questions, every day over a long period of time. This is called ‘spaced repetition’. Ignore your intuition- it tells you to keep going over an answer again and again till you are ‘fluent’. But that is a false sense of fluency. That information has gone into your short term memory only, and has not been consolidated into your long term memory. To get information into your long term memory, you need to revisit it in spaced intervals.

Anki is a great tool for this.

3) Interleaving

Interleaving is the concept of ‘mixing up your quizzing’. This means answering questions not in an obvious structured order. For example :

A baseball player practices by hitting 15 straight balls and then hitting 15 curve balls. He will do better at practice. But in the long run, he will not develop competency to hit a curve ball.

Another baseball player practices by setting the machine to randomly fire curve balls. He will do worse at practice. It will be more frustrating. But over the long run, he will learn more.

Mix up your questions sets. Don’t do them in a logical order. This is hard. It forces you to think, to strain. It will feel slow compared to ‘massed practice’. But this is the proven way to learn.

4) Elaboration

Elaboration is the concept of explaining concepts in your own words. See the ‘Feynman technique’.

This involves relating a concept to your own life outside of class, creating your own examples and metaphors.

For example, to explain angular momentum:  an ice skater speeds up her rotation as she brings her arms closer to her body.

5) Generation

Generation is the concept of trying to answer a question or solving a problem beforehand, instead of just reading the solution. Have a go at a question/problem, even if you get it wrong, as long as you get the solution you will remember it a lot better than just reading the solution. Studies even show that if you delay getting the solution (waiting for the answers till the end of a quiz) it will ingrain itself deeper into your mind.

6)  Reflection

This involves ‘journalling’ on what you have learnt. Asking yourself questions such as :

  • What did I do wrong?’
  • What did I do right?
  • How can I improve next time?

For example : you might see a patient on ward rounds as a medical student. If working on your communication skills, write down your process. How could you frame a question in a simpler way? Are you speaking too fast or too slow?

I am huge advocate of journalling daily. It is a way to organise your thoughts and experiences. As Socrates said “the unexamined life is not worth living”.

7) Calibration

Calibration is aligning your view with objective reality. It is too easy to lie to yourself. You might read over some text, and say ‘yeh, I know this’. Or you might just skip a question saying ‘I definitely know this’. This is called the ‘Illusion of knowing’- where re-reading text gives you a false sense that you know some material.

To get rid of this bias, test yourself. Do quizzes, answer questions. Exams and test results are concrete measures. This keeps you tethered to reality.

If your grades are bad, this is another indication that you are doing something wrong. Don’t take it personally. Look at it objectively. Exams are there to be a compass; something you periodically check to see if you are moving in the right direction.

8) Mnemonic devices

This is obvious. We’ve all been taught this. But use it, it is powerful. One caveat is, these are used only for recall. Mnemonic devices are not a substitute for understanding a concept. They are simply a tool to help recall information and organise it in your mind. A mental filing cabinet.

Examples :

ROYGBIV to remember the colours of the rainbow.

Mnemonic devices can also be visual. If you want to read more about this, see the loci method. This is visual mnemonic device that has been used for thousands of years to organise large amounts of information. It is a technique used by memory champions. I’ve used it to memorise a deck of cards. It works.

9) Focused vs Diffuse Thinking

This concept is more pertinent to solving problems and creativity rather than memorisation. There are two modes of thinking.

Focused thinking is where you are deeply concentrated on a problem. You’ve got the blinders on and are closed to other possibilities. You need this mode to get work done.

Diffuse thinking is thinking that happens subconsciously in the background. Where your mind is still working on a problem in the background. This often leads to those ‘aha’ moments either in the shower, or when taking a walk or exercising. It allows you to step back and find a new way of looking at a problem.

To optimise problem solving, you want to switch between the two modes. This means – work intensely on trying to solve a problem… then walk away. Literally go take a walk. Your subconscious will work on the problem.

Food for thought


Over this past year, I’ve experimented with a vegan diet. In the name of science!

I actually started out knowing little about the ethical aspect of it. In fact I hopped on the bus for the purported health benefits. It was a useful experiment. I stuck to eating mainly vegetables, grains and beans for next 6 months (essentially a Mahastastran diet without dairy) and learnt how to cook decent vegetarian food. But after a year, I’ve reassessed and am back to eating an omnivorous diet. Few reasons why. 

1. Easy to lose weight. I want to try and gain muscle mass. 

2. Certain micronutrients are missed out on a vegan diet.

3. The evidence behind some of the nutrition claims of the 21st century are hugely flawed. They are observational studies (very poor quality). The whole state of nutrition science is in fact terrible. Strange how we can send people into space, but still not know exactly what the best diet is to give them. 

4. Nutrition exhibits genetic variation. How you respond to certain macronutrient splits is dependent on your genetic profile e.g. insulin sensitivity, tendency to put on weight (FTO gene +ve in my case). Some people may respond poorly to high carbohydrate diets which veganism tends to fall under. 

5. Subjectively felt a lot better going back to eating fish and certain meats. (I pretty much mainly eat fish though)

I’m still not 100% decided on the issue and will try to read new information, studies etc as we grow our understanding. 

However one aspect, I cannot argue against is the ethical argument of veganism/vegetarianism. It’s created a schism in the mind, and currently the cognitive dissonance of the ideas actually is making me think a lot about the issue (hence why I’m writing this).


Ethical Case for Veganism

It’s inevitable that half a century into the future, mankind will look back with reproach at how animals were treated for consumption; factory farming en masse. If you deny that this is happening, I’m sorry, you are simply misinformed. Fortunately, it’s likely in the future we will transition to GMO and organically grown meat rather than factory farmed methods. The fact is : that massive suffering and oppression of sentient beings is occurring in most first world countries in order to feed those who are already overfed. This is ludicrous.

Now diet is a sensitive issue for most. People often take a dogmatic approach siding with certain ‘camps’. “I’m vegan, all meat eaters are terrible people” or “vegans are just malnourished hipsters ” or “humans were meant to eat meat, you need the protein” etc. This sort of binary thinking is the wrong approach. “Only a Sith deals in absolutes” as Yoda would say.

However : I don’t think that the only way to be ‘ethical’ is to become a vegetarian or vegan.

  1. It’s way too hard for the majority of the population.
  2. On a macro scale it probably won’t have the intended consequences

Hypothetically if we cut meat consumption in half and sourced it from ethical methods, that is 10x better than even doubling or tripling the number of current vegetarians. Reduction rather than replacement. We can’t expect the 1.5 billion people in China entering the middle class to become vegans. They will eat meat. 

Would you rather have 10,000 people opt for 50% of their current meat consumption and eat more vegetables- or 100 people switch to vegetarianism. The latter just doesn’t have enough of an impact.

Even if you do become vegetarian, you simply switch to eating eggs and it’s arguable that egg laying chickens are the worst treated of all animals. In terms of animal suffering, the solution isn’t always so clear. It’s true we can never have perfect knowledge about the consequences of our decisions. But in this scenario, its clear what the ‘right’ thing to do is. Pretty much no one says that ‘factory farming is ok’. Yet we continue to support it.

How do we change? Most people are following a processed meat, dairy, egg heavy diet rather than a strict paleo or a vegan diet. It’s not feasible that they will go from 0 – 100 and end up sticking with it. What instead needs to happen is that the needle needs to moved slowly in the right direction with our consumer purchases. ‘Vote with your wallet’. Buy ethically sourced goods.

‘But what effect can I have?

You would be surprised by the first order effects of your consumer decisions. Companies are incentivised to provide for the consumer. ‘The consumer is always right’. It’s why you have more Walmart and fast food restaurants in economically deprived areas of the US instead of Whole foods. If instead those people went out and drove 20 minutes to buy ethically sourced products, companies will build stores closer to them. Its pure economics.

‘Its too expensive’

Yes. Expensive your environment. Expensive your moral compass. Expensive on your health. Sure, it might be expensive (arguably) on your wallet. You decide where your priorities lie. No snowflake in an avalanche ever feels responsible. But yes, I agree its expensive, but if you can afford it currently, you have no excuse. 


Health Benefits

On the individual level, switching to mostly plant based foods is the rational thing to do for your health. The general public is inundated with media stories about fad diets, ‘eggs are good’ ‘eggs are bad’ ‘veganism is good’ ‘drink more red wine’. This is all often backed up with pseudoscience and poorly conducted studies. Even with well conducted studies. Do I need a double blind RCT with a placebo group that getting an oversized Russian olympic weightlifter to roundhouse kick me in the groin is going to cause damage. No. * 

Information overload is a problem especially in this day and age (it’s why I quit Facebook) . We know what is good : non factory farmed, ethically sourced products and plant based nutrition. Both morally and biologically. Diet is really the topic where the gap between ‘information’ and ‘action’ becomes so visible. We know but we don’t act. Instead the solution is to simplify. Replace ‘diet’ which implies weight loss for many with just ‘food’. Advise patients to eat food that they enjoy and is actually food. I love Michael Pollans’ (author of the Omnivore’s dilemma) advice on this :

Eat food. Not too much. Mostly plants

Don’t eat anything your great grandmother wouldn’t recognise as food

Don’t eat anything incapable of rotting.

Rather than adopting a certain diet, what we need to aim for is making the correct moral decision. Buy the responsibly sourced meat or eggs, eat mainly vegetables, eat meat only sometimes. Learn to cook with fresh ingredients rather than buying packaged goods. The change happens at the individual level with your wallet. As Agent K said in Men in Black ’A person is smart, people are dumb’.

What we eat will always be an issue close to my heart. In this age of overmedication (insert cholesterol lowering drug here) instead of addressing the root cause, doctors simply end up adding more fuel to the fire. As Hippocrates said ‘Let food be thy medicine’. Ultimately eating well has not only physical benefits, but also considerable moral, ethical and ecological (didn’t even cover) impacts. It all starts with the food on your plate.

Rereading in 2019

*Reading this in 2019. Wow. I quoted Agent K from Men in Black?! Nice past me. Also what is the analogy about a Russian Olympic weightlifter kicking you in the groin?!*

2019: Haven’t changed opinion on this much. Still agree with what I’ve said before. Eat food, not too much, mostly plants. Don’t eat processed food, eat fish/meat in small quantities, and obviously exercise, move etc.

Do exams = understanding?

Approaching half way through third year of medical school, I’ve had a decent exposure to examinations to say the least. Medical school is a strange place in that you see people on a wide spectrum- those who are absolutely dependent on external validation from exams, and those that say that exams are completely worthless. Both are a cause for concern, and believing in extremes is never a good starting point. In one way both tend to sacrifice understanding. The overly obsessed, anxious student aiming only for a good ranking can sacrifice understanding preferring to ‘rote learn’ topics. In fact this was the approach my parents had to undertake in the Indian medical school system in the late 1900’s – and they both unequivocally agree that the approach is flawed. On the other end of the spectrum, the student can become so dejected by the notion of exams that they fail to put in any effort. So what is the solution?

I recently came across the ‘Feynman technique’ for learning which I wholeheartedly espouse.  The premise is that

  • You choose a concept/topic you want to understand – write it on a sheet of paper as the heading
  • Proceed to explain the idea to yourself as you write- as if explaining to a new student / layman/ toddler / 5 year old- or whoever you want. The crucial part is that you vocalise the process and use easy to understand terminology.

That’s it!

The age of epitaph of ‘if you can explain it simply then you understand it deeply’ lies at the heart of this technique.

Now is it perfect? Depends on your yardstick of measurement. If your measure is exams, then no, it isn’t perfect. You will miss marks on those inane questions that demand you to memorise pointless facts. But … will you gain an understanding of a topic for years and years to come that? Yes

Learning in medical school does of course involve memorising certain facts – for example drugs. But even then, I think that due to technology and storage of information, this shouldn’t be the highest priority. In fact modern day hospitals are run mainly bureaucratically though guidelines on exactly ‘what’ drug to prescribe and how much, so the whether or not the doctor knows a certain drug doesn’t matter- what does matter is that he understands the reasoning behind it. Things have changed a lot since my parents were in medical school.

Merely to acquire information or knowledge is not to learn. Learning implies the love of understanding and the love of doing a thing for itself. Learning is possible only when there is no coercion of any kind”

Jiddu Kirshnamurti.

Ultimately exams are a necessary evil- but should you put your mental wellbeing on the line to achieve the highest grade possible? I guess that is a personal question that I can’t answer for individuals but atleast I can shed some light on my own experience. What is more important I feel is not to become dejected by the learning process through examinations. I’ve had periods where I (feeling both internally and externally inadequate) worked intensely hard for exams with idea of ‘do or die’ and I’ve had periods where I was so demoralised by the process that I stopped. It is crucial to remember that learning is life long, knowledge is not an end, but a process. Always ask questions. Always be open to learning. In our 20’s, ego tends to flair up for many where with growing knowledge and pressure of performing and success we pretend we understand more than we do (‘scientia infla: knowledge puffs up). Instead as Bruce Lee advocates- ’empty your mind’. Be receptive and admit when you don’t understand topics.

To conclude, take it step by step: iteration is crucial in any form of long term endeavour. Only by understanding simple concepts can you build on those to grasp more complex ones. Enjoy the process and don’t become fixated on outcomes, (especially those as trivial as examinations).



20 and a half- What I’ve learnt

It’s strange that people only talk about ‘half’ years when they are either really young or really old. “I’m 4 and a half” or “I’m 91 and a half”. I think the rest of us are missing out. Six months is a long period of time and one that perhaps deserves recognition. In an attempt to ‘celebrate’ that fact, and partly due to procrastination, I’ve decided to undertake a deep introspection of what I feel to be most important in life. I would love to look back at this and see how my views have evolved or changed, maybe even write a followup when I hit 30 and a half…


1. “You know nothing Jon Snow”

The fact is that I know nothing. Nothing beyond my initial surroundings, interactions and schoolings. With that comes only a deep respect for everyone I encounter, since they have a unique experience of life and a perspective that can offer a view on the world. I try to listen to everyone.


2. A life not shared is a life not lived

I identify as an introvert. That doesn’t mean I prefer to sulk away in the corner and keep to myself. It just means most of the time I prefer to do that. Yet I have an incredible gratefulness for family and friends. They are the people you can share your happiness with, or troubles when the time comes. That said, I could definitely work on trying to be more sociable though. A close friend who loves to initiate deep philosophical chats that I am never prepared for once told me – “We avoid risks in life in order to arrive safely at death”. I’m sure he stole that one from somewhere.


3. Health is one of the best gifts you can give yourself

A tangible sense of dread would wash over me when I had to do any form of physical exercise in my early teens. The bleep test was the stuff of nightmares. My diet was reasonable, mostly due to the blessing of a health conscious mother, but needless to say, cardio was a word I was not aware of. I would love to say how I was inspired to change, but in fact it was just the underestimated power of establishing a routine. I started going to the gym and lifting weights. I force myself to go and the process becomes mechanical. Heeding the wisdom of the modern philosopher Shia LeBoeuf, “Just do it”.


4. Travel

I am incredibly fortunate to have had the opportunity to travel and experience living life in a different culture. I was  born and raised in India till the age of six and that was when I moved to England, with a basic understanding of the language. I remember running to my Father in blockbuster because I had no idea how to speak to the staff about renting a DVD. The fact is that humanity is incredibly diverse. There are different cultures, systems, environments, climates and most importantly, people. It would be extremely limiting not to experience the countless ways that humans around the globe live their lives.


5. Culminate a deep passion for whatever you want

I didn’t get into medical school in my first year. I try and rationalise that by saying that “I didn’t work hard enough”, which is partly true. Looking back however, it was because I lacked a passion in what I wanted to pursue. I imagine that apathy came through in my interviews.  What has become more clear, is that having a grounded sense of ambition and passion and throwing yourself into what interests you the most, seems to ‘feel good’.  Currently that seems to be picking away at my guitar, reading and ‘being a medical student’… I’m loving it.


6. Be Open and Honest

It’s a simple concept that I prefer referring to as  being ‘chill’. Language is undermined with gossip, exaggeration or deceit and I find that by coming from a place of honesty, much the deadly sins of language seem to vanish. I’m probably one of the worst people to gossip with. By being open and honest, you tend to polarise people who harbour animosity or ulterior motives and attract those who like your company. Although its a cliche topic and I cringe writing it, a fantastic quote by Dr Seuss encompasses the idea perfectly.

“Be who you are and say what you feel, because those who mind don’t matter and those who matter don’t mind.”


7. Reading is food for the soul

Reading offers perspective. One author I strongly recommend is Atul Gawande. He is an incredibly relatable author who talks about a range of topics from mortality, to the use of checklists in surgery to inevitable complications in medicine. His most recent book called ‘Being Mortal’ explorers how medicine is not coping with balancing technological advances with the needs of the ageing population. He delves deeply into what really matters in the final moments of life, essential insight that I think every healthcare professional should have. It had me in tears at points and has changed my perspective on end of life. That is the boon of literature.


7 1/2. Sweet Potato is a gift from God

A brief point. Cooking has been an incredibly frustrating yet endlessly rewarding task. I have found solace in sweet potato. Following the timeless advice of Samwell Gamgee- “Boil em, mash em, stick em in a stew”.


8. Gratitude

“True happiness is to enjoy the present, without anxious dependence upon the future, not to amuse ourselves with either hopes or fears but to rest satisfied with what we have, which is sufficient, for he that is so wants nothing. The greatest blessings of mankind are within us and within our reach. A wise man is content with his lot, whatever it may be, without wishing for what he has not.”

I’ve been reading about stoicism lately and have found it endlessly enlightening. I love this quote but also really don’t want to sound like the philosophy student spouting garbage from that scene in ‘Good Will Hunting’ so rather than analyse it, I just take it at face value- to be grateful for what you have.

Grateful for family and friends, for an education, for shelter and food and of course for good coffee. Even gratefulness in the smallest of things has resulted in feeling incredibly satisfied.




Side note:

If I am reading this in ten years time, keep writing. No matter how convoluted and nonsensical it may be.


My experience of dissection

I was one of those people. On the first day of dissection, I inadvertently fainted, falling back rather unromantically into the arms of the person behind me. It was strange as I’d had a preconceived notion to how the process was going to be. I thought there would be a body, perhaps vaguely resembling a human being in front of me. We would then get busy to work learning the intricacies of human anatomy and dissecting various systems of her body. I expected this on the first day. There was also the fact that ever since doing work experience in the field, I was determined to become a surgeon. So fainting in that sense, felt like a failure, albeit a humorous one. Looking back on the moment, I remember our group unzipping the off white plastic body bag, the smell of formaldehyde (one that was completely new to me) and feeling a form of nervous excitement. It was still excitement though. However when the body was completely out of the bag and lain on the cold metallic table, I couldn’t help but feel unsteady. It was the face. Looking at the face, I realised that this was a person in front of me. A person who had once been a child, sister, mother, daughter, who had once had a job, friends and family. A person who had experienced joy, sadness, grief, anger, jealously and countless other emotions. I imagined a family or friend in that same position and simultaneously felt the blood rush out of my brain. The rest was a blur, but I tried to engage in that first week as best as I could.

Oddly enough, in the following weeks, it just seemed so routine. I had absolutely no difficulty cutting and exploring this person in front of me. Something had changed. Looking back, I feel as I suppressed the idea that this was a person. It may seem daft, but at least it helped me.  Another reason is the sheer volume of anatomy we had to learn. The human body started to seem less and less mysterious and more and more like a compendium of names for various parts. It was like a  piece of machinery but with complexity beyond that of any machine made by man. One that humans were nowhere close to fully understanding. Someone told me that on average, medical students learn a total of 7000 new words by the end of the first year. I assume that number only climbs as we progress. The vast amount of knowledge in a way helped process my misconceptions about the body. I for one, expected everything to be neatly arranged much like in a textbook. In reality it was a mess of fat and fascia, with loops looped around other loops, blood vessels and nerves navigating through muscle and bone. It felt like an incredibly large and precariously packed suitcase. It is of course a three dimensional concept rather than a two dimensional one. I absolutely loved the entire process and threw myself into trying to learn anatomy. Fortunately what seemed like a mystery at the start, now seems slightly more manageable.

Nonetheless, the time sped by and as I come to the end of the process this week, having spent a total of a year learning about the body, I can’t help but feel grateful. Grateful for the opportunity and especially grateful to our cadaver. As the amount of anatomy has dwindled, I’ve started to think of our cadaver as more than  piece of machinery, but instead as a human being again. However now I feel a sense of pride and deep respect. It takes a special kind of human being to donate their body to medical education. One that would want her body to be put to a good use by others after she had no use for it herself. Although I know almost nothing about her as a person, I know for a fact that the virtues of courage and stoutheartedness were not lacking. In the end, all I can say is thank you.

Why Write?

Clear writing is clear thinking

Writing is often glamourised. To be a writer is to be artistic, soulful and cool

For most of my life, I’ve wanted to be a writer. However every time I conjure the urge to write, the question of what to write about comes up.

I have nothing to say most of the time because I don’t real confident enough to say I know something for certain. To write you need something valuable to say.

Or do you?

Is it possible to simply write for yourself without a need for an audience.

Can I simply write to form opinions? To inform myself. To become more articulate, thoughtful and precise when thinking. To convey my opinions, beliefs and ideas. More importantly to expose them to critical and rational analysis. I want to change my mind on the basis of good arguments. On rationality.

This is what I hope to explore. Let me pretend to be a writer on the internet. To virtually shout into my pillow. If you happen to hear it, I hope you don’t think me a madman.