Beyond Check Boxes: Time Management Skills for Fellows

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Medical school was a rigid environment. My daily routine consisted of opening a pre-populated calendar and following the timeline. Set schedules, dense material, and a focus on memorization. Time management was as simple as getting through a list of lectures and memorizing facts. The overarching theme was a lack of control.

Thankfully, I am no longer a medical student, but as a second-year fellow, a budding medical educator, and a mom—with less time and more tasks than ever before—time management skills are as vital now as they were during my medical training.

Medical education tends to focus on mastery of skill and knowledge with little room for trainees to assess individual time allocation or task prioritization. The same is true of graduate medical programs—very few learners receive formal training in time-management skills(1). There is little, if any, guidance on planning large projects, task prioritization, or the use of written goals. There is, however, a focus on multi-tasking, even though we have a limited understanding of the implications of this potentially fast paced and low-yield strategy.

Time management isn’t just about making our day to day easier. After years of relying on high acuity because of the pandemic and limited resources, the risk of physician burnout is rising. When surveyed, physicians noted that the two biggest causes of burnout were “too many bureaucratic tasks” and spending “too many hours at work”(2). Both speak to a lack of control over one’s time and schedule. We must commit to time-management, better described as task and value prioritization, to gain increased satisfaction and longevity in our careers.

Fellows are in a unique position. We are on the verge of completing our medical education, at least in a formal sense, but are still bound by the constraints of a set schedule and a workload that is often chaotic and unpredictable. This blog post explores effective time management skills for Pulmonary and Critical Care Medicine fellows (as well as faculty).

 

1. Prioritize Goal Setting

Take time to set short and long-term goals. Like many working parents, I struggle with this, but it helps avoid the pitfall of allowing short-term goals to predominate at the expense of potentially more rewarding long-term goals. Reflecting on values, identity, and one’s own personal mission statement facilitates this prioritized goal setting.

Covey’s Time Management Matrix Technique (TMMT) is a useful tool to prioritize existing tasks and responsibilities. The TMMT is based on a 2 x 2 table (see below) and asks users to characterize each responsibility as “important” or “non-important” and “urgent or “non-urgent”(3). All of our tasks, especially when related to patient care, are important, but activities like this one allow us to stratify these tasks.

The goal is to dedicate time to both quadrant I and II, acknowledging that quadrant II are likely long-term goals and more often associated with overall career satisfaction(4).

Table


Sample time management matrix for a PCCM fellow. Adapted from Covey S.
The 7 Habits of Highly Effective People, 1989.

 

2. Limit Multi-tasking

The temptation to do it all, and all at once, is real. Fellow physicians pride themselves on their ability to be actively working on as many things as possible simultaneously. I caution you to pause and reflect on whether multitasking increases the speed of your work. From a behavioral science perspective, multitasking does not decrease cognitive load, and in fact, disrupts focus. As a result, we are less efficient and more likely to lose productivity with the unintended consequences of more mistakes and stress.

 

3. Take inventory of your time

Once both short and long-term goals are set, ask yourself: do I have enough time to achieve these goals? Set a baseline by taking a formal inventory of your time. Catalogue the activities you completed, both personal and professional, within the past 24 hours and note the time devoted to them, and how valuable of a task it was.

This allows you to identify areas of potential wasted time that can be redistributed to higher priority goals. Accounting for your time also allows you to be less reactionary and more flexible when unexpected situations arise. Acknowledge when you are most productive. If you are a star in the morning, work on your most important tasks during this time and set emails aside for the afternoon slump.

That said, the reality for trainees is that less important, or less valuable, tasks like writing notes and responding to emails are not always less urgent. I dedicate a set amount of time for these tasks during the day and often utilize the Pomodoro Technique to maintain focus and urgency so I can move on to higher value items.

The Pomodoro technique has users divide the working day into 25-minute increments followed by a 5-minute break with a longer break occurring after four blocks(5). Doing this creates a sense of urgency in a short period of time, but long enough to knock out a few consult notes (for example). Two of these cycles fit nicely into an hour and there is some evidence that for students taking pre-determined and planned breaks can improve mood and efficiency(6).

 

4. Get organized and stay consistent

In addition to limiting multitasking, try to have a consistent method of organizing your workload. I recommend having one place or inbox that collects all the projects, tasks, and to-dos. I use a web-based document that I dump my tasks into; instead of focusing on remembering the task themselves, I can focus on executing. Organization can happen in the form of to-do lists, calendars, etc. Just be consistent and automate as much as possible. Applications such as Todoist and Remember the Milk are tools that allow for not only task lists but a way to flag, categorize and prioritize items.

Once organized, revisit your priorities, and assess the best order to accomplish your “to-dos.” It is important to think beyond a “one day at a time” mentality. Planning for days or a week at a time makes it more likely that you will work towards your long-term goals, especially with a fellow schedule. Plan your projects and goals across the year. Knowing which months are less rigorous lets me focus on completing high value projects when I have more time so I can address discrete tasks throughout the year(7).

The stakes are high. Fellowship moves quickly and demands so much of our time and energy. For me, time management skills are more than a study on organization and efficiency. They are survival skills.

 

References:
  1. Pitre C, Pettit K, Ladd L, Chisholm C, Welch JL. Physician Time Management. MedEdPORTAL. 2018;14:10681.
  2. Peckman C. Medscape Lifestyle Report 2017: race and ethnicity, bias and burnout. https://www.medscape.com/features/slideshow/lifestyle/2017/overview. Published January 11, 2017. Accessed February 15, 2023.
  3. Gordon CE, Borkan SC.  Recapturing time: a practical approach to time management for physicians. Postgraduate Medical Journal 2014;90:267-272.
  4. Covey S. The 7 Habits of Highly Effective People. Simon & Shuster; 1989.
  5. Cirillo, Francesco. The Pomodoro Technique. pomodorotechnique.com. Retrieved 9 April 2023.
  6. Biwer F, Wiradhany W, Oude Egbrink MGA, de Bruin ABH. Understanding effort regulation: Comparing 'Pomodoro' breaks and self-regulated breaks. Br J Educ Psychol. 2023 Mar 1.
  7. Pitre CJ, Pugh CM. Reclaiming the Calendar: Time Management for the Clinician Educator. J Grad Med Educ. 2023 Feb;15(1):117-118.

 

Kashi Goyal, MD is a second year Pulmonary and Critical Care Fellow at The Ohio State University Wexner Medical Center and rising chief fellow. She previously completed her Internal Medicine residency at Beth Israel Deaconess Medical Center. She is interested in advanced lung disease and a focus on symptom management and quality of life. She is currently taking advanced courses for medical educators and developing curriculum surrounding palliative care as well as diversity, equity and inclusion.

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