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Note-taking vs Note-making: Do You Know the Difference? And Which Will Make You a Better Doctor?

Bernardo Schubsky, MD, MSc

Disclosures

September 27, 2021

Have you ever felt overwhelmed with the amount of information thrown at you during any moment in your academic pathway? And for our entire lives, what did we learn to do during a class or study session? Take notes, of course.

You probably reviewed your notes before a test, but after you got your grade, chances are you never got back to them again. Doesn't that seem like a waste of good knowledge? And as each one of us advances in our academic or professional lives, the amount of information that we need to access only increases.

According to a classic paper about short-term memory, we can only store seven plus/minus two items at a given time. So, our brains are constantly removing and adding new items to our working memory. The removed items are either discarded or stored in our long-term memory. Writing is one of the strategies we use to make sure we are keeping the "signal" and discarding the "noise."

But not all writing is the same. Note-taking and note-making may seem similar, but they are different processes:

Note-taking is akin to content consumption, while note-making correlates to content creation.

The Note-taking Process

Note-taking is a top-down and linear process, where we reproduce or highlight the information we are reading or listening to with some level of filtering. But because our brains do not always work linearly, ideas and connections can emerge at any moment, in any given context. So, it would make sense to booster that innate capability.

When we are in the note-taking mode, we are not processing the inputs. We are reproducing other people's ideas instead of writing about what the content means for us. Re-reading transcripts also produces a confirmation bias effect, as we are not confronting previous knowledge with the new ones. A good note-taker needs to be a fast writer or typist.

The Note-making Process

Note-making, on the other hand, is an active learning process. A good note-maker needs to be open to connecting thoughts.

While in note-making mode, we should constantly be asking:

  • What does this content mean to me?

  • How does it connect with other information I already have?

  • How does it contradict other information I have already acquired?

The Zettelkasten Method

Note-making is not a new concept. A German sociologist, Nicklas Luhmann, developed a workflow for note-making in 1968. In 30 years, he had filled over 90,000 notes, which resulted in the fantastic production of 500 articles and 70 books. His process is still used today and has gained more adepts as digital tools evolved, making it easier to index and find the connections between the notes. Luhmann's approach is called the Zettelkasten Method, or "slip-box."

Luhmann composed his notes in small paper cards and indexed them for later review. When he was writing his articles and books, he was never starting from scratch but instead following different lines of thoughts that occurred over years of accumulated knowledge. Luhmann's workflow is approximately like this:

  • Fleeting notes: The first step is to capture a thought at any time it occurs. After processing, Luhmann would throw away that note.

  • Literature notes: These are produced while reading books or articles. Luhmann would write the bibliographical references and the date on one side of the card, and on the other side he wrote what he understood from that particular text.

  • Permanent notes: These are the final and indexed thoughts. They were short and understandable for the future "self." As they were indexed, Luhmann could tackle different projects simultaneously, switching from subjects and groups of notes.

Courtesy of Bernardo Schubsky Download PDF

The slip-box is an "external brain" where we can contemplate both opposing and connecting ideas. By using the external brain, we can create something new that is more complex than the sum of the parts.

We don't think all the time linearly, and our focus is restricted. The ability to get into different flows of ideas and projects is a powerful tool that can increase our scope and breadth.

Slip-Box Tips

It would be best if you never used full quotes on your notes. Your notes are personal thoughts about a subject at a given time and context. Because you will review them in the future, having the possibility to confront diverging ideas based on new knowledge is part of the creative and learning process of note-making.

One common pitfall of implementing a slip-box method is not changing the writing mindset and using the system just as storage. Note-making aims to improve the learning process by allowing bottom-up ideas to emerge.

And to answer the question posed in the title: If you are looking at it over the long run, note-making would probably compound more gains over the traditional note-taking process, but changes always require some effort.

Some healthcare professionals may already have a system in place, either deliberately or by habit, that works for them. By shining a light over a different viewpoint, some healthcare students and professionals will be curious to explore an alternative learning workflow.

Now, some practical tips: Yes, you can have an analog slip-box system. But it is easier to index and connect your notes and come up with ideas using digital tools.

Digital Tools and Apps

  • Zotero: personal research assistant

  • Mendeley: free reference manager

  • Evernote: All platforms, syncs over mobile. Easiest one to begin your journey. There is a free version.

  • Obsidian.md: All platforms, syncs over mobile. Has a bit of a learning curve but is more powerful. There is a free version.

  • Roam Research: All platforms. One of the apps of choice for academic researchers.

  • Drafts: For Apple platforms only. Syncs over mobile. Great for capturing fleeting notes, as it has a very simple interface.

  • Notion: All platforms, syncs over mobile. Highly customizable. There is a free version.

The goal of this post is not to compare applications; I recommend that you conduct your own research and play around with some of the tools until you find one that will best fit your needs.

Please share in the comments if you are already using any type of note-taking system and how that experience has been so far.

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About Dr Bernardo Schubsky
Bernardo Schubsky graduated as a physician, with a master's in healthcare education. He is currently pursuing a PhD in the same field. Connect with him on LinkedIn

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