Time Management Facilitation Guide

Introduction (3 – 5 minutes)

• Facilitator Introduction
• Identify Audience (poll to determine Interns vs Senior Residents, etc.)
• Agenda:
  • Learning Objectives
  • Time Log Exercise
  • Case Scenario
  • Discussion Questions with Teaching Points
  • Case Teaching Points Summary
  • Participant Action Plan
• Learning objectives:

  By the end of this activity, learners will be able to:

  1. Recognize the importance of time management in fostering well-being
  2. Identify an approach to efficient time management with the "GPS system"
  3. Utilize practical strategies to increase everyday efficiencies

Exercise 1 – Time Log (5 or 10 minutes)

• Option A - Distribute Time Log handout and ask audience to complete (inform participants they will have only 5 min to complete)
• Option B – Send handout electronically (https://emory.box.com/s/timelog (opens in a new tab)) prior to session as pre-work and request participants bring completed log to session.
• Quick Discussion – Ask audience for reactions, insights upon identifying where their time goes.

Case Scenario — tbd post planning meeting

Discussion Questions: (10 minutes)

(1) What signs from ____may indicate it's time to adjust his/her time management? (e.g., fatigue, mood swings, forgetfulness, incomplete documentation, rushed patient care, mistakes, relationship conflict).

(2) What challenges may get in the way of _____ managing time effectively? (personal or work)

(3) What scheduling tools could ___ use to improve efficiency?

(4) What other strategies would be useful?

(5) What does ____ need from Emory/SOM to help better manage time?

Teaching Points

Summary of Time Management PowerPoint: Review general highlights of Time Mgt PowerPoint presentation (some residents will not have reviewed it beforehand). (10 minutes)

Key Introductory Points to Summarize if not referenced after prompting residents:

• We have many competing demands we must manage during residency (physiological, emotional, spiritual, relational/social and professional).
• If it's a given that up to 67% a resident's time is devoted to their professional life, plus 25% for sleep, less time is available for self and relational care, which can place at us risk for burnout if unchecked.
• Time management can help us maximize our performance at work, quality time away from it, as well as improve our health and happiness.
• Although eating healthier and other habits may take some planning, the time and energy expended will likely save us both later (e.g., if I eat healthier, I'll probably have better stamina, concentration, mood).

"The key is not in spending time, but investing it." - Stephen Covey

Discussion Questions

(1) The "G" in "GPS" stands for goals. Do you tend to set goals in these areas or try to "squeeze things in" when possible? (a) nutrition (b) exercise, (c) unwinding, or (d) social/family.

(2) The "P" in "GPS" stands for prioritizing. Please see the Time Management Matrix for one system of prioritizing. (Suggest showing slide below for easy reference).

(A) Using your time log, select 1-2 activities that belong in each category/quadrant (1-3 typical days of your life during the current rotation). For example:

1- Urgent/Important (Emergencies) Your patient codes

2- Important/Not-Urgent (Priorities) Social/Family rituals, self-care, patient care

3- Not Important/Urgent (Demands & Reactions) - giving into a request you feel is inappropriate

4- Not Important/Not Urgent (Escapist Distractions) - Games on smart phone, gossip with co-resident

(B) (i) How much time are you investing in priorities relative to other areas?

(ii) In retrospect, would you now categorize any of the activities differently than you did in the moment?

(iii) Where do you have the most influence?

(iv) Other observations?

There are of course external obstacles to our use of time and energy - aspects of the environment or systems within academic healthcare that are demanding, inefficient, inconsistent with our goals/values, or otherwise limiting to us (e.g., long work hours, miscommunication between departments, treatment vs. Cost/insurance coverage issues). We could probably spend hours talking about them, couldn't we? Would THAT be time and energy well-spent?

So, in 3 minutes total, 10 words or less per person, let's quickly identify general "time/energy obstacles". Ask audience to share a few examples.

(3) The "S" in GPS stands for "Strategies". Here are several different tools:

(A) Shift your "talk" to be more accurate and accountable to your use of time. For example, you could say "I don't have any time for myself" OR "I sometimes struggle to devote time to my personal life." Which statement leaves the door open for change? What are some examples of your limiting "time talk" and how can you revise it?

(B) Shift 5 minutes of distractions (category 4) to 5 minutes of monotasking self-care (priorities). During transitions, (between patients, interactions, commute, etc.) practice a version of mindfulness (feel feet against your shoes, notice colors, sounds) versus rehashing difficult interactions, repeatedly venting about your day.

To ease your transition from work to sleep, do physical self-care and mind sweep!

• First, take deep breaths, tense, hold, and relax major muscle groups.
• Next, write down or dictate on your electronic notepad one challenge you experienced, one next step towards addressing it, and one gratitude or success from the day.
• Follow this with sensory decompressing (warm shower, cyclical nature sounds, etc).

While this isn't much time, it is about calming one's limbic system, which allows for managing transition, and closure to one's mind and day/night. This equates to more energy to enjoy and focus on what matters! We often need external cues to redirect our natural tendency to internalize. So, right now, as quickly as possible, I encourage you to pull out your cellphones and set at least one alert/reminder to practice one of these.

(C) Shift unhelpful patterns (Category 1 & 3 when possible) experienced in your life/residency by focusing on aspects you can control/influence, practicing proactive responses to them (vs. Passive or reactivity). For example, asking for help, asserting self, practicing new organizational strategies. This means less time suffering after being willing to keep stepping outside of the comfort zone. Eventually this means greater momentum. What is one way you can be more proactive?

(D) Shift by "Zooming in" to organizational strategies to increasing efficiency during residency. Examples included PowerPoint are: 1. Delegate to medical students; 2. Time your note-writing; 3. Utilize electronic resources, Phone reference cards, Epocrates, MedCalc; 4. Combine tasks and ambulation 5. Know when to ask for help. What is your experience with these strategies? Other practices that have worked for you?

(E) Shift by Zooming out when you are sidetracked by frustrations or discouragement, questioning where you are. These will help you refocus on what is most important. Rewind to recall the big picture. What drove you to become a physician? What & who energizes and supports you outside of your career?

Then, fast forward to visualize the end of your residency. What hurdles did you overcome? What does that say about your strength and others who helped you along the way? Capture your answers creatively (in writing, pictures, or physical forms, symbols that you can easily access and review them regularly and when needing a boost! What "Zoom out" questions ground you?

(If time during the discussion), turn to someone sitting near you and tell them one of your responses, if not tell someone by the end of the day.

(4) When is it time to ask for more help/assistance? (2 minutes) Answer: anytime you're stuck, concerned about yourself personally or professionally, need more support, or a different perspective. Or your co-resident, chief, attending, or family member encourages you to do so in a subtle or not so subtle way.

Resources: Who can help, if/when that time comes?

(a) Emory FSAP or Faculty Staff Assistance Program (404-727-4328, 727-WELL, efsap@emory.edu)

Free, confidential, coaching, short-term counseling, short-term psychiatric consultations, and referrals, for medical house staff and insurance eligible dependents. Early morning, late afternoon/early evening meeting times available by appointment. On-call emergency phone access 24/7.

(b) Healthy Emory: (Phone: 404-712-3775 healthyemory@emory.edu)

Healthy Emory – one-stop shop to health promotion, well-being, recreation, fitness, and healthy living across Emory. Our goal is to create easy access to programs and services for employees, their families, students, and the community that Emory serves. You may download a brochure and learn about discounts for discount gym memberships, for example.

(5) Recap Teaching Points and Ask Residents to Share Discussion Take-Aways (3 minutes)

Mention, if not shared by residents:

• GPS (Goals, Priorities, Strategies)
• Shift your thinking/talking about time to help you refocus on how your choices matter, even when you may lack control over aspects of your schedule/environment.
• Rather than large goals or amounts of time, shift small moments to create smoother transitions and self-care momentum.
• Use external cues that will help you energize and shift gears when stuck.
• Build skills to help you respond more efficiently and effectively to demands.
• Zoom-out to reinvigorate yourself and reassess your priorities regularly.
• Utilize your support and reach out for more when needed.
• Look for ways to be proactive vs. Reactive. Invest rather than just spending time.

Action Plan

Given your time log, and what you've identified for your GPS, what opportunities can you identify in improving your time management skills?

Ask participants to complete Action Plan and identify accountability buddy and follow up date.

Draft References

"Recapturing Time: A Practical Approach to Time Management for Physicians" (Link: http://www.bumc.bu.edu/facdev-medicine/files/2013/07/Borkan_Gordon_Time-Managment-Postgrad-Med-J_2014.pdf (opens in a new tab)).

Training for Efficiency: Work, Time and Systems-based Practice in Medical Residency https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886114/ (opens in a new tab)