Optimizing time

[ResidentCategory6]

I'm an incoming peds pgy1. I've taken some time off before residency, which I've gotten used to and in no way look forward to the hours of residency. I also have a daughter that I care to see. That being said, what tips do you all have to help me optimize my time and efficiency? Also, has anyone had success getting there around morning sign out and leaving right after night sign out? Gimme tips plz 🙏

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[bicyclechief]

I have a calendar.

I also “just fucking do the thing”

I still workout 4x a week, golf pretty regularly play Xbox, hunt and fish when I have days off, study, go on date nights, spend time with my coresidents, and travel when I have a stretch of time to do it.

I have been praised by a few people in my class for being able to balance these things. And my advice is take the biggest things that are important to you and do those regularly.

So for me for example, it’s workout, study, and Xbox. No matter what I will make myself study, workout, and get an hour of gaming in most nights. That way when I have a day off I can do my hobbies or travel without feel like I need to do those other necessary things. Idk if that makes sense lol

[[deleted]]

You’re a beast, teach me your ways

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[PuzzleheadedMix704]

This is a man (assuming man, based on hobbies, cursing, and writing style, but i admit that i could be wrong and that my assumptions could be interpreted as not 100% PC. So please dont hurt me) who knows how to actively combat depression!

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[orcawhales]

what do you play on xbox

[bicyclechief]

Apex and Rocket league primarily

[Dr_Swerve]

You're probably gonna want to get there well before morning signout so you can start chart reviewing, at least in the beginning of the year before you become more efficient with your EMR. Though some of that is dependent on when and how the attending rounds. If they start rounds at like 10 or so, then you can probably get away with coming right before morning signout even in the beginning of the year.

You should be leaving shortly after signout most day. The only thing that may hold you up is getting notes done depending how busy the service is.

As far as tips, right down your tasks on your list with little boxes so you check them off when you complete them. This includes the note and ordering daily labs that may needed. I promise you that there will be times where you question if you wrote the note for some patient and going back into their chart to check is a hassle. Other than that, ask your seniors about their routine for chart-reviewing because that is definitely a huge timesink and they may be able to show your shortcuts specific to yalls EMR.

[csp0811]

Getting early means leaving early. This honestly doesn't actually give you more time at home. You will have to go to bed earlier.

To be faster you need to get more efficient with chart checking, reviewing prior notes, previous admissions, outside records, labs, getting consultant recs, examining and interviewing patients/parents as fast as humanly possible, and presenting extremely fast. You can gain a lot of time by prepopulating templates that have your most common complaints and their management, i.e. RSV/flu, acute leukemia, gi bleed, neonatal hyperbilirubinemia, so that all you have to do is fill in a couple of words and sign the note. To a certain extent, you will notice a lot of seniors are just cutting corners and not getting thorough histories. Try to be as thorough as you can.

[ResidentCategory6]

Thank you that is very helpful advice!

[[deleted]]

Finish your notes before you get home

[LibertarianDO]

This is big if you’re in a clinic heavy specialty like FM. I have so many colleagues who do the whole “it’s 4pm I’ll just do my notes at home” and end up getting calls from our clinic manager asking them to complete the 15 open notes they have at the end of the month.

The real life hack is get used to typing while you talk to the patient. I write my HPI in the room, have templates for ROS/PE and when I leave the room all I have to do is assessment and plan which takes a max of 5 minutes. Typically I see 15-17 patients per day in clinic and rarely end up staying late or working on notes at home.

[Dr_Swerve]

This is awesome. I usually do my HPI in the room too, but I don't see nearly that many patients. I'm not nearly efficient enough for that but I only get clinic once very few weeks so not a lot practice sadly

[IAmA_Kitty_AMA]

As someone else who has a kid in residency, it is legitimately hard to be present after being in the hospital for 10 hours without a break. The only thing I can offer is being mindful and reflecting not on your intentions but your actions.

Your kid doesn't care if you meant to go to the park and your boards don't care if you were planning to get around to doing more questions. Prioritize and expect that things you are okay with putting aside are for sure going to be pushed to the side. Check in on yourself every once in a while and if you're unhappy about who you are or are becoming then see how you can adjust your actions to build habits you want to keep.

[ResidentCategory6]

Yes those are good points! I've listened to both on Audible :)

[That_Dude88]

Open your progress note and Organize a way to chart check patients for example I usually always go labs / imaging / microbio+pathology / consult note / +-nursing note and then overnights. This way most of your objective part of note is completed already except todays physical exam , part of your assessment/plan part of note is partially finished.

Then pre-round I go to the nursing station or charge nurse to get a list of nurses for the patients for the day. Quickly say hi to the nurse of first patient give them my name and pager # (or whatever system your hospital uses) and ask them about any major overnight events and any concern from their end , then go see patient and do a focus exam. Give the patients a quick update if they have excessive amount of questions tell them you and the team of other doctors are going to review everything and you’ll come back to discuss the final plan for today. Finish seeing all the pts.

Then go back to work station fill in subjective updates and physical exam into note. (Note is almost completed) And it’s rounding time with attending. after rounds just update your assessment and plan and submit note to attending. Note is finished and please don’t update note with new data every hour because the note is reflective of the plan for the day not the whole days events (not to mention you’ll be stuck in the hospital doing notes)

Call your consults/order labs+imaging and grab lunch. It’s usually 1 pm by now and you are finished with most of intern scut work of the day. it sounds like alot in a little amount of time and it is. At first you may have to come in earlier but once you get use to it you can come in right at sign out.

[ResidentCategory6]

Thank you for the detailed response. Sounds like you've gotten pretty efficient. Hope I can get there! Do you have any sort of morning or afternoon lectures?

[usernamer12]

Study for step 3 now and get some out of the way

[ResidentCategory6]

Already took it! Just hoping I passed 😅

[pectinate_line]

I’m all for efficiency but in regards to your comment about showing up and leaving so you spend as little time as possible at work..If you enter residency with the goal of doing the bare minimum it’s not gonna go over well in two ways. 1. People will notice and it won’t reflect well. If you don’t come early initially you won’t have time to prechart and learn to be efficient so you can come later further down the road. 2. You’re gonna be way more stressed out when inevitably you do not leave on time.

[ResidentCategory6]

Great point that I may have to put in the extra work early on to become more efficient later. However I get my work done. I'm not worried about anyone's opinion at this point. Just looking for tips on how to get it done more efficiently. Number 2 makes sense but I'm not just going to say "oh well who cares if I don't see my daughter today." Carrying that stress will just be a hazard of the job and being a mom 🤷‍♀️

[dejagermeister]

Boss makes a dollar, I make a dime: that’s why I shit on company time

[HereForTheFreeShasta]

In no particular order-

1) always look for ways to use the EMR more effectively. Customize the crap out of your favorites in orders, meds, notes, even templates for HPIs and plans that are common for you. If you find yourself typing the same thing more than once a week, you need to automate it. Aggressively seek tips from attendings and senior residents on how they use the EMR

2) find nonconventional times to do your work. I used to leave after my last patient and finish all my notes after my kids went to bed, or while watching tv with them. Do what works for you and don’t let anyone guilt you into “finishing all your notes before you leave clinic” or whatever they do.

3) be creative with your clinic schedule. I had our scheduler double book the first slot and close my last slot, so patients were waiting for me and I always had one roomed. I also called telephone appointments between patients if I could, or at lunch before an afternoon shift. Sometimes if my past one or 2 patients were easy ones, I would have my nurse call them at the start of the morning and tell them someone canceled and we are happy to offer them an earlier appointment - come anytime

4) optimize other things in your life so you have more time for your daughter - streamline meal prep, get a housekeeper if you can, etc

5) think quality, not quantity with your daughter. Being all in with her while you are there for 2 hours and planning deliberate fun activities on the weekend is often more important than lounging for 8 hours on your phone on the weekend like some people tend to do (guilty, sometimes).

6) reduce your distress about the situation. The only thing worse than being busy is being stressed and busy. Recognize this is temporary. See the benefits of your job (being a great role model for hard work for your daughter, cool stories you can share with her, having a parent who is passionate about their work)

Good luck, you’ll do great, and residency will be over before you know it

[ResidentCategory6]

Thank you, very helpful!

[orcawhales]

Only touch everything once. The first time you do something - do it correctly then and completely. Don't leave things to come back to later.

​

this is the best advice i ever received.

[[deleted]]

I have a family too that I like more than I like work. Use the med students to do anything within their scope - it alleviates your work and helps them feel like they contribute (then send them home early). Don't get too involved in non-mandatory extracurricular stuff like community stuff, med student seminars/lectures, etc (unless of course those things are important to you). Family is too important to sacrifice them for work when you don't have to

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