Touch It Once: The Value of Making Anki Cards Throughout My Day

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I used to get really frustrated that I had to keep tweaking my strategies for time management. “I’m a high school graduate/college student/medical student/wife/successful dog mom,” I would say at each stage of my life. “Surely, I’ve got this figured out by now!”

Of course, that’s just naive. There’s no way the same strategy that worked for me in high school would translate with the same efficacy to my life as an intern. I have to make my own dinner now, for one. All this to say, the guiding principles remain the same, but the execution has to evolve. 

On top of time management for my own life, I now spend most of my days managing my time for others. When you’re working in the hospital as an intern, one of your main responsibilities is making sure that consults, pages, lab orders, imaging studies are all coordinated and addressed in a timely manner. It’s easy to start working and find that you’re suddenly juggling ten things at once. 

Early on, one of our upper levels gave us some good advice for managing inpatient orders that I’ve started incorporating into my study practice. He calls it the Touch It Once method:

For tasks that don’t need high-level approval, it’s best to address it immediately, especially if it takes less than one minute to do. A perfect example would be if you are reading through a patient’s chart in the morning and you notice that a patient should be receiving fluids. Go ahead and order fluids for that patient immediately, instead of completing the chart review, or even opting to jot down a list of things “to order” for the patient. 

While some could argue that this interruption in workflow may be inefficient, touching it only once (instead of assuming you’ll pick it up later) actually prevents important things from slipping through the cracks. In addition, it lightens your mental burden of tasks to be completed.

So how did this translate to a change in my study habits? 

I used to carry a small Moleskine to jot down notes throughout the day, with plans to review my notes at a later time. In theory, this is a great idea--some of the best learning occurs on the job, and medical students should do their best to capture all these learning moments. Also, let’s be honest, the optics of whipping out a small notebook for notes on rounds is much better than typing something down on my phone in front of an attending.

In practice, however, I rarely reached for my little notebook for review. At home, I focused my efforts on high-yield curated content and retrieval practice. I never converted any of my notebook notes into Anki cards to form more durable knowledge, even though I thought them important enough to write down. 

As a resident, I enjoy more responsibilities and also more trust. Practically, that means I can use my phone more freely--to look up information about my patients, put in orders and now, jot down new cards into Anki. Sometimes it’s as little as writing down the topic on the front side of the card, with the understanding that when it’s time to review the card, I’ll take the time to write out the full details of what I want to remember. It’s the learning version of Touch It Once. Instead of trying to manage my time so that I can sit down and convert my notebook notes into Anki, I just touch it once and put it into Anki, no matter how imperfectly. This method works best for me when used to incorporate deeper understanding of old/familiar material, instead of something completely novel. I’m not making that many cards, so if I’m making a card, I know it’s important information.

So far, Touch It Once has worked well for me. Now if I could just figure out how to make dinner a Touch It Once endeavor…

Do you use Anki to take notes on the go? What are your thoughts on Touch It Once?