Fowl's Blog

Formulation Diary #1

March 12, 2021

Today I was doing some soul searching to find the issues within my collection - as it stands, it was actually SM searching.

I was doing my daily repetitions without enthusiasm when I thought “let’s write down my mental process in an article”.

My collection has gone through A LOT of shit. There has never been a problem in consuming new material, but mostly repping the items. As I am writing this article, I am repping some items, so that the feelings are still fresh.

Five items went by nicely, then one of my medicine items came by…

Boom. Badly formulated, the answer was not immediate, and it was painful to rep it. It was REALLY badly formulated, I suspended it. Forgot it. This is SuperMemo’s terminology, forgive me.

Later on, I would be deleting that item.

Now, let’s change it a bit. Let’s switch up the rate of topics to items to 1:1.

Why would you do that?

It gives fresh air to your brain.

Some people might think “well, I want to be done with my reps before doing anything else” - and sure, good luck with that. Not all of my reps are enjoyable and going through topics gives me a nice trip into my collection. My topic queue in around 1800 topics, to be clear.

First topic, my brain is screaming: I DO NOT CARE.

Re-prioritized. Pushed it into the future.

Item now, an interesting one.

Without the direction of a regular practitioner who admonishes patients about what to do next, and without regular habits of seeking preventive care, […] seems to block potential patients from timely action (Lauver & Ho, 1993).


The thing is: this item is not useful.

It frustrates me. There is nothing about it that tickles my learn drive.

How do I make this item useful?!


Why is anxiety bad in the contest of healthcare when there is not guidance from a figure?

It blocks people from timely action.

Now, is this any better?

What do we want to accomplish?

Learning how to create real-world value.

Where is the real-world value here?

Learning that guidance is important because otherwise anxiety will block people. But how will we face this problem while walking a hospital’s hallways?

Well, whenever you are in front of someone with a problem, you want to remind yourself that you should guide them, that you should be there and point the right route. Anxiety can be fatal in healthcare. People who do not seek preventive care risk dying. Dying.

So, the previous question is still useless, isn’t it?

Now, let’s try again.

How do you bring people with anxiety to the hospital if they do not have any habit of regularly seeking preventive care?

With direction of a regular practitioner who will admonish them.

Now, now. This looks WAY better than the last one. It’s not even comparable to the cloze.

A question always has to be semantically linked to the answer.

Going forward.

Use Done on the topic, now moving onto the item.

The question is which are the precipitating factors of ketoacidosis.

There is no semantics from the question that will lead to an answer. There is no link. It is a decoupled pair. They will drift apart more and more as time passes.

How would you reformulate that? Isn’t that how your professor would ask the question in the real world? Sure. But what semantic thread will your mind use to go back on that? How do you avoid massive interference every time you hear “precipitating factors”?

When you are taking one exam and you have that three or four times, it’s fine.

But imagine being in the clinical practice, how do you know what to expect without confusing it with another 400 maladies “precipitating factors”?

You need a context. Your items need clear labels and application.

How do you apply the precipitating factors for ketoacidosis?

You create fictional scenarios. I am still not entirely sure on how to tackle very long lists without resorting to mnemonics - which are fine by the way, don’t be scared of using them.

One item could be:

A patient with ketoacidosis is now under your care, the hospital hygiene conditions are not the best and staff that brings food is lacking. What should you be checking first? (aggravating factors)

Infections and dehydration.

Another one:

A patient comes from a shoddy countryside hospital and shows signs of ketoacidosis, what drugs should you be worried about?

Drugs that affect carbohydrate metabolism.

You could always go deeper and ask yourself why. In this case, I have enough clinical knowledge that the why is pretty much self-evident. But if you were to be an complete newbie to medicine, you would surely need to build a framework around this knowledge.

The thing is:

Is it sustainable for one person to do this work all by himself?

It is more sustainable than clozes, in my opinion, but less than Massive Multiplayer Flashcards, MMF. You could teach a group of two hundred people how to formulate flashcards properly by following some principles. By now, I do believe few people have the experience I gathered in the last ten days.

Another Item

Behaviors need to remain novel in order for them to stay attractive and satisfying. Without […], we get bored. And boredom is perhaps the greatest villain on the quest for self-improvement.


Look at this piece of shit here.

That dot between bored and And it is killing the whole semantic structure. I don’t know if the lack of rest is progressively making me hallucinate more and more, but I am getting this sixth sense for semantic links. A semantic link is a thread that brings the question to the answer.

In some cases it’s a small twig or barely existent, in others it’s a massive fucking log.

In this case, it’s not much.

The aim of this flashcard is telling you to have variety in stuff. It does not matter what you are doing, if you want to keep it attractive and satisfying, you need to keep it varied.


When we find working on something and trying to create an habit, what should be our priority number one?

Keep it attractive and satisfying.

OH. SHIT. Look at that. One flashcard and we are not even at the core meat.

We need another one now to nail down the concept.

Suppose we are working at something trying to create and habit and we are feeling bored (e.g. exercising, writing), now we feel the urge to make it attractive and satisfying, what should we aim for?


At the end of this session I deleted my entire diabetes branch, made up of 300 items. The reason for this drastic choice is a breakthrough I experienced in relation to formulating the best items for medicine.

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