stop writing manuscripts at 7pm after a full clinic
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[00:00:00] Hello and welcome back to the Academic Medicine Strategy Podcast. Today we are talking about time management deep dives, and this is our sixth week in that series. And we're gonna talk about how you should stop trying to write your manuscripts at 7:00 PM after a full clinic. And if this sounds like I am calling you out, I am, because I used to do this, and it took me forever to try and get that work done late at night until I figured out how to really put my deep work into times.
My brain worked better. Your calendar may look strategic on paper, and yet by Wednesday afternoon you're probably feeling exhausted and by Friday you are running on fumes. So this is the limitation that time management alone can't solve. You can archite your calendar with precision and still fail to get any papers written or any scholarship or abstracts or grants 'cause you're ignoring what research says about cognitive capacity.
This may be shocking, but you are not a machine. You have limitations. You can't keep going all the [00:01:00] time and perform like superhero, and just because you've been doing it for years and seem like you can, doesn't mean you should keep doing it. Your cognitive output fluctuates in predictive, well-documented patterns, and in academic medicine, almost none of us structure that appropriately.
So when we look at our time management throughout the day, it's about energy management. Your biology is being completely ignored by your calendar. For most of us, the evidence here is neuroscience, not self-help. So we all have circadian rhythms. Some of you may not know, but I am also a sleep physician.
Those circadian rhythms affect multiple aspects of our cognitive function, particularly those that are needed for deep work. Those that require top-down executive control, and that might be inhibitory control, working memory, task switching, and psychomotor vigilance. It all sounds fancy, but what we're saying is to do your best work.
These are not peripheral capacities. They are exact functions that are needed to analyze data. To write the paper, to design the [00:02:00] study, to develop the grants. This is what gets you promoted, but it doesn't just happen on autopilot and it is not at its top all the time. So all the components of attention show that these variations, whether it's homeostatic or circadian, reach their lowest level during nighttime and the early morning hours.
So if this is when you're doing your work late at night, there's a reason you're not getting as much done as you might in the late morning. And the best levels, if you look honestly, are around noon and they reach their highest in the afternoon and evening. So this time course can be modulated by lots of things, your chronotype, sleep deprivation, your age, all the other factors.
But the practical inflammation is direct. The manuscript you're writing at 7:00 PM is not just inconvenient. It is biologically mismatched with when your best time is. You are demanding high level function from your brain when it's at its lowest point. Sleep deprivation makes it even worse. So most academic physicians treat insufficient sleep as an [00:03:00] inevitability.
It's part of the job. It happens to all of us, especially earlier in training. But I'm gonna tell you, I still do it sometimes. And this is a career limiting decision. Wakefulness for 24 hours per produces cognitive impairment similar to a blood alcohol level above the legal driving limit, just being awake for too long.
But the more relevant finding for us in academic medicine is not that acute sleep loss. 'cause we all know in those days we feel lousy. We don't think we should be able to write our paper. Then it's that chronic partial restriction. It's never quite getting enough sleep. It's always getting up a little bit early to get the thing done and going to bed to get something else done.
Many of us live like that. I did for years. They did some studies at the university of Pittsburgh where they did sleep restriction of six hours or less per night for two weeks, and it showed significant cumulative dose dependent deficits and cognitive performance on every task equivalent to losing total sleep for one to two nights of total sleep deprivation, meaning what?
[00:04:00] Feels like I'm just losing a little bit every night turns into. Really catastrophic outcomes in terms of our cognitive output. In fact, when they looked at objective sleepiness, they could not differentiate between the six hour a night condition and the four hour a night sleep condition, meaning neither of them are good.
They were unaware too of the cognitive deficits. They all thought they could get more done than they could and that they were better at it than they were. So this chronic sleep deprivation, if this is you, and this has definitely been me. You can't even assess your own impairment. You don't know you're not doing your best work.
You feel functional because you've been living like this, and you believe that writing session is productive until you can see what you can do when all the brain cells are firing on all cylinders, and the surgical literature makes the performance degradation, concrete sleep divide.
Sleep deprived surgeons make about 20% more errors and took 14% longer to complete laparoscopic tasks than when they were arrested. [00:05:00] So there's no reason to believe that if we're writing a paper or doing data analysis, that it's not the same thing. And restricting sleep below your optimal level, whatever that is for you, causes lapse of attention.
It worsens your working memory, it reduces your cognitive throughput, it depresses your mood and it leads to perseveration of thought. All of those neurobehavioral deficits accumulate from partial sleep deprivation and make it from even just one to three nights of sleep deprivation so that we are not doing our best work.
In fact, we're wasting a ton of that waking time when we should be sleeping. So if we wanna match the work to our capacity at Strategic Energy management means you have to get enough sleep. It is not selfish. It is not something that you can just do one more thing because it turns out one more thing before bed means all the things tomorrow are not gonna be done as well.
So be deliberate and match the cognitive end of your work with your current biological capacity. Know your patterns. Know that you need to get to [00:06:00] sleep. Optimize cognitive function when task timing is synchronized with your peak time. Most of us, that's morning types, but there are some people where there's evening types, and so just know what yours are Once you identify that pattern.
The principle is do your high demand work in high capacity hours, writing grants, career development planning, all those things, not in whatever time remains whenever you're done with your reactive work. Collaborative work belongs in medium capacity hours, so not your most upgraded hours, but not your best stuff, something in between, and then that shallow work.
Put that in your low capacity hours. Do the emails and the routine tasks and the things that require a lot of cognitive power. Late afternoon is oftentimes the most appropriate container for this, not your prime morning hours, and make sure you remember that recovery is not optional. This is when your co cognitive capacity builds.
This is when you can make sure that you can write the paper and do your best work and do the data [00:07:00] analysis. And weekends should not be treated as overflow time. They are recovery. They should not turn into extended depletion of your energy. So the weekly prep pattern that sustains high output over years.
Is when you do your highest cognitive work during your highest capacity hours and you make sure there's an alignment between the two, but that there's also real recovery time. So don't spend your weekends and your evenings doing that work unless you say these two hours are dedicated for it. And that's fine, but don't just continually work all the time or else your work isn't gonna be the best.
So what I wanted you to do this week in order to figure out how to put this in into motion is to track your energy, not just your time. For five days, note your cognitive state at three points in a day, morning, midday, and late afternoon, and rated as high, medium, or low. By Friday, you should have enough data to identify your actual peak window.
If you don't already know it, not the one you assume it is. Research confirms that chronotype [00:08:00] significantly moderates when peak executive function occurs, and that most people cannot accurately self-report their own hours without systematic observation. So please do it if you're not entirely sure, and then move one piece of demanding scholarly work, the stuff that's gonna move your career forward into your highest capacity window.
And if that window's not open, make sure that the next point in your calendar where you can protect it. You do now batch all your shallow work into your lowest energy hours. Get it done, but don't waste the time that you could really be using your high cognitive time and then try to go to bed 30 minutes earlier than usual for the next five days.
One of the things I find really useful is setting an alarm to go to bed. It actually is the ping, and maybe you need to set two, but it is very useful for you to make sure you get back past that six hour mark. And if you need eight hours, get to the eight hour mark. But a 30 minute increase in sleep duration sustained consistently begins to reverse that accumulated sleep deficit within days.
Now the career you're [00:09:00] building requires sustained high quality intellectual output over years. That output does not come from willpower. It comes from managing your energy as carefully as you manage your time and building a week that's designed to protect your cognitive conditions so your best work actually occurs.
If this resonates, please rate and review and share this with your colleagues who may benefit from the same conversation. And talk to your chair or faculty development leadership about bringing systematic faculty support to your institution. Individual discipline cannot fix structural time problems.
Please learn more at my [email protected] and look at our ferry program, FERY, which is the Faculty Excellence and Retention Initiative. Thank you so much and I look forward to talking to you next week.
