A practical system for building, connecting, and maintaining understanding
By now, you understand what Smart Notes are and how they mature. This section shows you how to build that system inside Obsidian in a way that is stable, low-friction, and usable during busy weeks.
We are not building a productivity dashboard. We are building a thinking environment.
If you follow this setup closely, you can start using it immediately.
1. Install and Create a Vault
Step 1: Install
Download Obsidian from obsidian.md and install the desktop version for your operating system.
Do not install plugins yet. Do not customize themes. Keep it plain.
Step 2: Create a Vault
When you open Obsidian:
- Click “Create new vault.”
- Name it something stable, such as Paramedicine Notes or VitalNotes.
- Choose a permanent location on your computer.
- Avoid renaming or moving it later.
A vault is simply a folder. Every note you create will be a markdown file stored inside it.
2. Create the Minimal Folder Structure
In the left sidebar, right-click and create three folders:
Inbox
Notes
Reference
That is enough.
You do not need folders for every subject or semester. Links will organize your knowledge. Folders only separate workflow stages.
3. Creating a Smart Note (Exact Workflow)
Step 1: Create the Note
Click the Notes folder.
Click “New note” or press Ctrl+N (Cmd+N on Mac).
You now have a blank page.
Step 2: Title the Note Correctly
The title should state a claim, not a topic.
For example:
Compensated shock preserves blood pressure temporarily
Avoid vague titles such as:
Shock
Trauma
Sepsis
A strong title communicates meaning and future usefulness.
Step 3: Write the Body
Write in full sentences. Keep it short but complete.
For example:
Compensated shock maintains blood pressure early through vasoconstriction and tachycardia. Mental status changes and peripheral perfusion changes may appear before hypotension develops.
Clinical implication: Do not wait for hypotension before escalating transport or reassessment.
That is enough. No formatting is required.
4. How to Link Notes (Core Skill)
Linking is what turns Obsidian into a thinking system.
To create a link, type two square brackets and begin typing the title of another note. Obsidian will show suggestions.
For example, inside your shock note, you might write:
See also: [[Vital signs lag behind physiology]]
Related to: [[Early transport in high-risk patients]]
Common error: [[Equating normal BP with stability]]
If the note already exists, select it.
If it does not exist yet, press Enter and Obsidian will create it automatically.
You do not need to pre-build your system. It grows as you think.
Only link ideas that genuinely influence each other. If removing the link would not change your reasoning, it probably does not need to be there.
5. Backlinks (Why They Matter)
Open any note and look at the Backlinks panel on the right side.
This shows every note that links to the current note.
If five different notes link to “Compensated shock preserves blood pressure temporarily,” that tells you this concept is central to your reasoning network.
You do not need to decide which topics are important. The system reveals importance through connection density.
6. Splitting a Note Properly
As your understanding deepens, a note may grow too large.
Split a note when:
- It contains two distinct claims.
- It explains two separate mechanisms.
- You want to link to one idea without linking to all of it.
To split:
- Highlight one idea.
- Cut it.
- Create a new note.
- Paste it.
- Give it a clear, claim-based title.
- Return to the original note and replace the removed section with a link to the new note.
This keeps notes clean and improves linking precision.
7. Renaming Without Breaking Links
Right-click a note and select Rename.
Obsidian automatically updates every link pointing to that note.
This allows notes to mature safely. You can refine titles as your understanding sharpens.
8. Using Search Effectively
Press Ctrl+Shift+F (Cmd+Shift+F on Mac) to search across your vault.
Search when:
- You remember part of a phrase.
- You want to see every note mentioning “reassessment.”
- You want to track how often a concept appears.
Search often replaces the need for excessive tagging.
9. Tags (Minimal Use)
If you use tags, keep them broad and few.
Examples might include:
#cardiology
#respiratory
#trauma
#errors
Avoid tagging every idea. Links build thinking. Tags build filters.
If you have more than 10–15 tags, you are probably overusing them.
10. From Scenario Moment to Smart Note
Scenario: A patient with shortness of breath becomes increasingly confused before oxygen saturation changes significantly.
Inbox capture might look like:
Patient more confused than expected
Vitals didn’t look dramatic
Instructor emphasized reassessment
During processing, you ask:
Why does cognition change early?
What does this prevent me from missing?
How would this show up in a real call?
You create a Smart Note titled:
Mental status changes may precede measurable hypoxia
The body might read:
Cerebral oxygen delivery can decline before pulse oximetry reflects significant change. Agitation and confusion may be early warning signs even when saturation appears acceptable.
Clinical implication: Do not rely solely on numeric saturation to judge stability.
You then link it to:
[[Vital signs lag behind physiology]]
[[Reassessment in respiratory patients]]
[[Early escalation under uncertainty]]
Now the idea lives inside a reasoning network.
11. Weekly Operational Plan
During the week:
- Capture 5 to 10 short notes in Inbox.
- Do not organize.
- Do not polish.
Twice per week, for 30–45 minutes:
- Open Inbox.
- Process 3 to 5 items.
- Create 2 to 4 Smart Notes.
- Add 2 to 4 meaningful links per note.
Stop when time ends.
The goal is consistency, not completion.
12. Common Mistakes to Avoid
Avoid:
- Installing plugins in Week 1.
- Building dashboards before writing notes.
- Rewriting lecture slides verbatim.
- Creating elaborate folder hierarchies.
- Linking everything to everything.
If your system feels heavy, simplify.
13. What a Healthy Vault Looks Like After Two Months
- 40 to 80 Smart Notes.
- Claim-based titles.
- Dense but meaningful internal links.
- Minimal folders.
- Few tags.
- Little aesthetic customization.
The graph view should show clusters forming naturally around decision themes.
14. How This Supports Scenarios and OSCEs
Before a scenario:
Open one relevant Smart Note.
Follow links for five minutes.
Think through distinctions.
Close Obsidian.
You are activating reasoning, not reviewing slides.
The system should feel like a thinking warm-up, not homework.
Moving Forward
You now have:
- A working Smart Note structure.
- A clean Obsidian environment.
- A linking method.
- A weekly rhythm.
- A sustainable maintenance approach.
The next step is strengthening access to high-risk, time-sensitive material without turning learning into trivia rehearsal.
Next: Section 21: Anki for Clinical Recall
VitalNotes 