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Sir William Osler’s Advice to Students: Practice Concentrating on Hard Things

Sir William Osler is one of the most important figures in the founding of modern medicine. In 1910, he published a book titled Aequanimitas: With Other Addresses to Medical Students, Nurses and Practitioners of Medicine. It builds on a farewell address he gave at the Pennsylvania School of Medicine in 1889, and details his thoughts on what it takes to thrive in an intellectually demanding medical field.

As one of my readers helpfully pointed out recently, chapter 18 of this book contains the following prescriptive gem about how to succeed in an endeavor that requires you to create value with your mind:

“Let each hour of the day have its allotted duty, and cultivate that power of concentration which grows with its exercise, so that the attention neither flags nor wavers, but settles with bull-dog tenacity on the subject before you. Constant repetition makes a good habit fit easily in your mind, and by the end of the session you may have gained that most precious of all knowledge—the power of work.”

What struck me about this quote, in addition to it being a nice endorsement of the deep life, is that it comes from an educator. To Olser, it was clear that training a new generation of thinkers required teaching students how to actually put their mind to productive use, which is hard, and requires “bull-dog tenacity” before it becomes a “good habit.”

We don’t teach this any more.

Modern educational institutions care a lot about content: what theories we teach, what ideas students are exposed to, what skills they come away knowing. But we rarely address the more general question of how one transforms their mind into a tool well-honed for elite-level cognitive work.

We have, in other words, largely given up talking explicitly about this element of the intellectual life. This might be in part because it seems too pragmatic and not sufficiently lofty. I suspect it’s also due in part to the fact that educators themselves, drowning in a sea of email and unchecked administrative obligations, don’t feel comfortable pushing a lifestyle they don’t themselves lead any more.

But regardless of the reason, this omission is almost certainly made to our culture’s detriment. I suspect (though can’t yet prove), that an educational institution that unapologetically made deep work a core principle, would not scare off a generation used to staring at screens, but instead find itself deluged with applicants hungry to taste a more meaningful mode of existence.

42 thoughts on “Sir William Osler’s Advice to Students: Practice Concentrating on Hard Things”

  1. But Cal, I cant stop using Facebook as its one of the factors for my visa approval. Yes they check our social media contents too. And by uploading our photos/ events I show them I’m a real person with genuine intentions. (Okay I admit this comment is unrelated to your post).
    I’m also using Instagram lately because I need to find inspirations from people I kinda like. Its like my way of getting to know myself. It’s just hard to focus on things that really matter like personal peace or global peace- does this even exist?!

    • Use them 30 minutes a week. On a laptop/desktop (not your phone). Plenty of time to receive some inspiration and/or prove that you’re a real person (though I’m not sure that I believe that the visa office would be offended if you didn’t use social media). The rest of time can then be dedicated to other meaningful activities. The nice thing about knowing what you need social media for is that it makes it much easier to ruthlessly cut out everything else.

  2. Hi Cal! I’ve purchased your books and have been following the digital minimalist lifestyle. It has helped me tremendously! Not just getting more done but I feel less mentally fatigued. Now I understand, the less I see, the less I process. The less tired I am.

    I do have a question about digital minimalism. Now that I find myself being able to work in silence, I came across this website.
    It pairs you with someone else to work within a 50-minute session while one’s webcam is turned on. Each person says what they are going to work at the beginning of the session and then they update each other on the progress at the end of the session.

    What implications do you see this in the long term? Perhaps I am creating a “crutch” into deep work? Perhaps I will only be able to spend 50 minutes of work if I only initiate a session within ?

    Thank you again for your deep insight into how we work.

    • It’s not a crutch but instead a training aid. After a while, as you hone your ability to concentrate and become more comfortable with the effort, you’ll find you don’t need the service anymore. People often report similar things about internet blockers: they are great training tools, but once they’re in cognitive shape, they don’t need them any more.

      • I need to spend more time practicing on concentrating. As a very involved college student, I have a lot of work I need to get done in not a lot of time. I like the ideas that this blog gives. I want to work harder on working harder. I want to take some of these suggestions and implicate them into my daily life during my work and study hours. Also to remember, the more rest you get the easier it is to concentrate. Also, remembering to eat every meal, because sometimes I get too busy and skip them.

  3. Educational institutions that unapologetically make deep work a core principle certainly still exist: medical schools. Osler’s ideas are embodied in the structure of modern medical education, and he is required reading in many such institutions. However, judging from the composition of my daughter’s graduating class of new M.D.s, this “meaningful mode of existence” is disproportionately attractive to women and children of immigrants. Seemingly, if a job involves more than tapping on a keyboard while sipping a latte, young American men aren’t up to the challenge.

    • I work in a Health Science center, and none of our programs (Medicine, Nursing, Health Professions, etc) put an emphasis on this for faculty or academic staff. We have faculty that are literally in the building for 3-5 hours per week while they also work in a private practice, are members of multiple organizations, and typically are part of faculty councils multiple times per month.

      • Joe, I was referring specifically to the training of physicians, which begins, as it has for at least the past 200 years, with the methodical dissection of a human cadaver over the course of four months, one body for every three or four students. Each blood vessel, nerve, muscle, ligament, muscle, bone, and organ is located and identified. Organs, in turn, are dissected into their component tissues, down to the microscopic level. Phones and other devices are strictly prohibited, regarded as disrespectful intrusions. Photographing a cadaver is considered equivalent to theft of a body part.

        Physician training in the United States consists of four years of medical school, followed by at least three years as a resident physician on the staff of a teaching hospital — a sequence established by Osler. During medical school, students spend 60-70 hours per week doing a combination of academic learning (books, lectures, screens) and hands-on clinical training alongside physicians treating patients. The proportion of those hours devoted to treating patients gradually increases during the four years of medical school.

        After receiving an M.D., the new doctor moves on to residency, which requires 80-90 hours per week of increasingly independent patient care in his or her chosen specialty, over the course of three years.

        I find it hard to imagine a more rigorous and focused course of education.

        • As an instructional designer who handles working with faculty to set up courses, among other things, I can tell you without hesitation that 60-70 hours per week isn’t happening. We’re a tier 1 research university, with excellent facilities and two teaching hospitals in the city, and until residency it’s no more difficult than the other programs here. I know what it was, but the reality of the current situation is very different.

        • Jeff, current medical student here, nearing the end. One must fight for any scrap of focused time in medical education, especially in the clinical years. The residents in training have it the worst. Torn between constant charting responsibilities and instant messaging within electronic health systems on top of already constant pages, unless they are in surgical field and in the operating room, their days are a case study in just how much extraneous stimuli the human brain can handle.
          When it comes to learning the content of medicine before the clinical years, this is largely a solo endeavor, and it is very obvious the difficulty many have with good focus and study habits. My own prioritization of deep work and proper learning principles has led to 100th percentile scores on medical boards and success within the course work, which I absolutely do not attribute to being “smarter” than anyone.
          Medical education is in flux. Board scores were just switched to pass/fail. A recent publication in JAMA predicted fully online lecture content for all medical schools over the next decade. Several schools have gone exclusively to a flipped classroom model, where for 4-6 hours a day they must work through problems in groups. This puts significant constraints on the time allowed for solo and deep exploration of the content. I avoided these schools when applying. After medical school, things diverge widely depending on what specialty one does residency in.

    • I agree that medical schools represent a small percentage of a university’s overall student population who require deep work skills in order to succeed. However I question your assumption that the lack of young American men in American medical schools is due to their preference for ‘tapping a keyboard while sipping a latte’ (which, by the way, often also requires deep work in order to excel, although most ‘keyboard tappers’ are not permitted this luxury in their work environments). I suspect there are other factors at play in the admissions process of present day North American institutions.

      • Judy, According to the medical school faculty with whom I have spoken, admission applications from 2nd, 3rd, etc. generation American men are significantly lower than those from women and 1st generation American men, as compared with their representation in the general population. It’s not an admissions issue, but rather an interest — or ability — issue. One explanation for this differential is the sorting of our population into two broad groups: those who have learned the skills, values and rewards of deep work, and those who have not.

        My daughter attended a STEM charter high school where many of the students were children of immigrants. Virtually all of those parents placed strict limits on time allotted to social media and video games, giving their children the opportunity to develop the habits of deep work. This population of young people constitute the pool from which many of our new doctors are emerging. Though not a child of immigrants, my daughter seldom uses social media because she’s always considered it both pointless and susceptible to manipulative misuse. She’d rather spend the few free hours she has a a first-year resident with actual embodied friends!

  4. Hi Cal,

    I’m a theoretical chemist who found your blog by searching about deep practice in music. Since then, I’ve enjoyed a lot reading your thoughts and advices about deep life, learning and work.

    However, I wonder if you ever would be interested in writting about “management” of external factors (work enviroment, students and colleagues) as it gets extremly difficult to maintain the deep mindset in a toxic workplace with poor interpersonal culture (overall when leave isn’t always an option). Unfourtunately, I talk from observation and experience, as I dropped my PhD just before the viva (DProcastination: “if that’s being researcher, why would I like to become one?”).

    I’m looking forward to read your opinion!

  5. Hi Cal,

    I’ve read almost all of your books and I participated in your and Scott’s “top performer” course. I’m currently in my last Ph.D. year and for a couple of years I’ve tried to implement the “deep work” and the “ultra-learning” concepts as much and as intense as possible.

    The only problem I’ve encountered is that I haven’t been able to make out of both concepts an habit. Why? Because it’s quite hard to work one way, when almost all your co-workers don’t. I’m sure it would be a completely different story, if the whole institution would adopt a “deep work”-culture. And once I lost my inertia, it gets me a lot of energy and effort to begin again.

    As a regular worker (in my case Ph.D. student) you can hardly say to your boss or to your colleagues, “hey, please get out of my office, because I’m in my deep work hours”. You may negotiate with them so they can respect your “deep work” hours, but almost every day something “urgent” will happen. How did you manage this issue when you were a Ph.D. student or in you post-doc phase?

    In any way, I think this is a point where Ray Dalio has succeeded. He has been able to implement a working culture (“idea meritocracy” and further concepts – see his Principles book or youtube videos) in a company with several hundred workers for almost 40 years. You either adapt to the company’s culture, or you’re out. Imagine yourself a company or a research institution with a similar logic regarding “deep work”!

    Best regards,

    • I second both what you and EPSUD, above, have said.

      I work in a cubicle environment, so there’s no “close the door for a while” option. My cubicle mate (far more senior than me) across from me talks to me a lot as well: he seems to think I listen in on his phone conversations (I tune it out since I’m doing my own work in my cubicle), so when he hangs up he exclaims, “So, I’m sure you heard! blah blah blah” (no, I did not hear); he’ll dive into life stories which I’m obliged to stop what I’m doing to listen to to be polite; he flits in and out of his cubicle, and makes verbal exclamations as he does so (“My gosh, I forgot my notepad” as he walks away again), so he flies in, interrupts my focus, and immediately leaves again.

      People are always dropping by with the next “urgent” matter. Loud conversations are held in the cubicles adjacent to mine. Meetings that are scheduled for 30 minutes turn into 2 hour meetings.

      Headphones don’t drown out loud, nearby conversations without turning up the volume too loud and hurting my ears. But wearing them is pointless anyway: people still wave their hands to get my attention, even for matters that are not at all urgent.

      Sitting somewhere else (hiding in a conference room) can be an option…but it is not fitted up with my ergonomic chair, keyboard, etc. So it is highly uncomfortable to squat in hiding places.

      Working from home where I can control my environment is NOT an option. I must work at the office.

      I used to use my off-Fridays (my office is on a 9/80 schedule) as a “get focused work done” day…but my new cubicle neighbor also, unfortunately for me, comes in on off-Fridays. I need my Saturdays and Sundays for personal obligations and plans.

      Deep work is something I have successfully applied in my personal life, with personal projects/hobbies, as well as life admin. But at work? No way.

    • I also agree with this. I’m a junior software engineer and when I need to write a piece of code that does significant business logic, I usually use a headphone but also get frequently interrupted. Recently I needed to study a NoSQL database for the first time in my life because we are going to use it in production and I was assigned the task. I found it extremely difficult to do the required deep work to understand the new storage paradigm due to interruptions and loud conversations in the open office that I asked my team leader to work from home for two days and explicitly stated that the reason is to be able to focus on this challenging task because I can’t in the office. I was able to finally grasp the concept in these two days.

  6. As much as I love your thoughts and insights, this one as well, one thing did not sit well with me. You referred to an article in a paid magazine. I cannot access that without paying, and the magazine itself does not hold enough relevance for me to actually pay for a subscription.

  7. Great post. Further to Jeff’s comment I would add that engineering schools (at least so far) implicitly require deep work to succeed (I figured that out half way through my second year). In the public school system, we were fortunate to have the International Baccalaureate program available for our two daughters. They are now in university and doing extremely well thanks to the work ethic required to succeed in that program.

  8. cal,
    In this line I would like to share a quote from an Indian mystic “swami vivekananda” from 19th century. The Quote is
    “The very essence of education is the concentration of mind, not the collecting of facts. We should develop the power of concentration and detachment, and then with a perfect instrument, we can collect facts at will”

  9. Cal,

    >>an educational institution that unapologetically made deep work a core principle, would not scare off a generation used to staring at screens, but instead find itself deluged with applicants hungry to taste a more meaningful mode of existence.<<

    In the spirit of "if it's to be, it's up to me" and all that, when are you seeking funding to make this institution happen?

  10. Hey Cal! I love your post and 100% agree with you. When we take the time to plan out every hour of our day with good and productive things, we not only get more things done, but we FEEL better. I was apart of a church mission for 2 years where we did this every day. we had a daily planner and we would plan out every hour with a productive activity. The change in my life was monumental. I realized just how much time I spent watching TV all-day, how much time I was wasting and how much I could really accomplish when I engaged in every second of every day. It’s just hard to build that habit and keep it for the rest of your life haha

  11. Education seems like, on the one hand, an obvious context for cultivating deep focus, and on the other hand, surprisingly undervalued in our current climate.

    A fairly recent colloquialism about education today is that, in the internet age, students are (and according to conventional wisdom, should be) learning how to ‘find’ information, rather than learn how to remember it.

    Supposedly the instantaneous access to unlimited information suggests that students who can find it the fastest will thrive over those who prioritize consolidation.

    The problem is that research skills have always been important, even before the internet, and no matter how quickly you can find information, it’s irrelevant if you don’t hone your ability to make sense of the information and extract value from it.

    Without the ability to focus on the information your taking in, extracting value from it becomes substantially more difficult, if not impossible.

  12. For over thirty years, I have cherished a little book called A Book of Hours by Elizabeth Yates.
    8 am begins:

    “A loved and wise physician, Sir William Osler, had a long life of service and accomplishment. His days were full, the demands on his time were many, but he had a secret which enabled him to keep his time in balance. It was a secret which he gladly shared. As a young medical student with worries about his future, he had come upon Carlyle’s words, ‘Our main business is not to see what lies dimply at a distance, but to do what lies clearly at hand.’ The words became for him a practical approach which he later described as “life in daytight compartments.” Living for and in each day as it came along, doing the work he was trained to do as it presented itself, finishing one task before going on to the next, he gained his mastery of time. Hurry was unknown to him as was boredom.”

    Cal, I have found these words compelling since I was in my 20s. They are not easy words to follow, just as your message to quit social media is not easy. Thank you for putting out there–over and over again– we can practice and become more productive. Many of us will never achieve what you have and Sir William Osler did, but we all can lead meaningful lives. I am very grateful for Deep Work and all your books. I share them enthusiastically as part of our Study Skills program at a small university in the Netherlands. I know many educators who are not afraid of letting students know that they need to work hard, but it helps a lot when we can show them how.

  13. I teach BSN nursing students…yes they are quite distracted by phones, computers, etc…and hell bent in getting the “A”. The deep work I promote with them is to develop a practice of sitting with another being human and be with…vs doing to. It’s a tough assignment for some…I set the example by being with my students in class, 1:1 and whenever the opportunity presents.

  14. I like this post. I have a couple of unrelated questions, though. I remember the first time I saw your YouTube video titled, “Why You Should Quit Social Media.” What struck me was your statement that social media is not essential to career success. What do you think of LinkedIn? I ask because I created a LinkedIn profile several years back, yet none of my paid work since then has come through LinkedIn. In fact, it seems that since Microsoft acquired it, they have been trying to turn it into a sort of Facebook for cubicle rats.

    My second question is this: you have a series of posts on the “Zen Valedictorian.” Do you plan to write any posts on the “Zen Entrepreneur”? Thanks!

    • CGTII, LinkedIn is the last social media account that I keep. I thought it was different than Facebook or even snapchat or what have you, but I realize it is not that different except for one feature in that it makes it easy to apply to a job. Even the profile that it let’s you build is somewhat useful for that. Just because it is useful doesn’t mean I should necessarily have the account. I’m currently a grad student and visiting the web site is just a time sink so I try to check it on a weekly sort of basis, but I’ll probably delete it after I graduate.

  15. Personally, I’ve seen tremendous changes when I’ve applied deep life principals in my daily routine. I no longer chase after meaningless youtube videos, I get to live each moment more. Get my batteries charged when socializing with my friends.
    It took me days to apply this routine in my life (Currently doing PhD). However, I’m getting comfortable with the boredom and really enjoy my work.
    I will post a comment about a year from now, to see if the changes are related to deep life principals or not.

  16. 46-year-old Du Bois writes to Yolande on October 29, 1914:

    “Be honest, frank and fearless and get some grasp of the real values of life… Read some good, heavy, serious books just for discipline: Take yourself in hand and master yourself.”
    W.E.B. Du Bois’s superb letter of advice to his daughter

  17. Hey Cal.

    In “So Good They Can’t Ignore You,” you cite the 10,000 hour rule, as described by Malcolm Gladwell. Have you read, “Range,” by David Epstein? Do you see value in giving significant amounts of time to diversifying instead of just doubling down on one skillset, as Epstein suggests?

  18. Thanks Cal I read Sir William Osler book in 2008–Osler: Inspirations from a Great Physician
    by Charles S. Bryan | Mar 20, 1997– which I think every physician should read. Being a physician and educator myself I can vouch with your statement “drowning in a sea of email and unchecked administrative obligations ” not only emails but a sea of non actionable FYI messages in our EMR. EMRs have become a source of cognitive overload, distraction and takes us away from critical matters related to patient care (though designed to help us). We need to refocus more but our admin tasks are creating a sense of discord and dissatisfaction. Do you have any suggestions how to deal with this ? Sometimes I think I should ignore and follow 80/20 rule but maybe I am fearful on uncompleted tasks.

  19. Having a daily schedule or routine is something that Franklin also practiced. I find that having a set schedule can enhance not just your concentration, but also your productivity. Indeed, we are creatures of habit.


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