Seven Strategies of Time Management for Surgical Trainees: The Mindful Surgeon

Time management: the age-old struggle to try to fit everything in life. There are work stuffs like surgery, ward rounds, and clinic along with the admin stuff doing letters, answering emails, checking investigations having work meetings. Then there are other stuff, such as working on your portfolio, revising for your exams, writing that paper or audits, and teaching juniors. On top of all of that, you also need to be updated on your knowledge, by attending workshops, webinars, and courses. Oh! And you are supposed to have a family, social and personal life also! So where do you fit all that?

Now if you are reading this and you are not a surgeon. I will briefly elaborate by giving an example of my typical day. The day of a surgical registrar in the UK typically starts before 7.30 a.m. in the hospital ( although we are paid from 8 a.m.). If we have theatre, we will go and see our patients, consent, and check investigations. We usually are allocated to do ward rounds every day, so depending on how nice your boss is, you have to do the ward round, brief for theatre, go back to ward round, and come back for theatre. In between theatre, doing the op-notes, and seeing the patient in recovery; we pop back into wards to check on the juniors, follow – up on investigations,  talk to patients and their families, and try to squeeze in some food! We usually don’t leave at 5 p.m. on the dot. Often theatre will overrun and you as the surgeon can not just abandon the surgery, ( no we usually do not get paid for this). After we finish the theatre and ward jobs, we will usually try to see the patient's scan and investigations for the next day! This is the typical day for any surgical registrar and consultants. Unlike consultants or my friends in other specialties, we don’t get admin days! So we work on our portfolio and do admin in between or stay after hours to do it.

So how to manage time? Now, I confess I am not always good at it in fact I am very much a serial procrastinator! I’ve always used the looming deadline to get things done! But it is not something I will recommend as not only does it cause unnecessary stress, but you don’t get to your best!  I’ve tried various time productivity hacks and not always worked. Now the common ones that I find do not work in my line of work, doing tasks matching your productivity level. Now I feel more productive at night, but that means compromising my sleep, and also no one else is awake to get anything done!  I can’t afford to wait for my productivity spark to get things done (which is why I procrastinate)!

So here are seven strategies that I and my more productive surgical colleagues have found useful. I will be focusing on work stuff as mentioned above, which is universal to us all.

1.      Use One Online calendar:  You can use your phone, google, or work mail calendar. But do invest in an online one where your personal and professional plans are noted. Now, you may also use a paper diary/ calendar, so do I but I use one in addition to that.  The reason I would suggest online is because you can carry, update, and check it anywhere and everywhere. Now, put these things in chronological order.

·        On-call days ( as you need to see which holidays you are working),  

·        important family stuff (like your partners on call and  important occasions for family ),

·        Annual leaves ( plan as early as possible),

·        Important meetings ( like ARCP, revalidations, conferences) so that you can book study/professional leaves.

·        If you are planning to sit for any exams, also google the potential dates and times.

·        Last of all, also put deadlines, like sending MSF or portfolio sorted weeks before so that it can remind you to start working on them or renewing insurance, submit an abstract. Then you can also put regular stuff like going to the grocery, and insurance renewal.

2.      Portfolio Organization:

·        You are not alone if you start doing this the day before the deadline. This includes updating our logbooks, sending assessments, and updating our resumes. The thing that really works for me is updating each theatre list on the day of the procedure. Now it is more difficult in on-call times as you are always on your toes. But remembering to prioritize this is very important. Use an e-logbook or website on your mobile phone as bookmarks to help that. My biggest hurdle is keeping my colonoscopy logbook as it is a very cumbersome website.

·        Whatever assessment I did, I try to fill it up in the hospital, when the reflection is fresh on my mind. I write much shorter reflections than the ones I do because the purpose of doing this assessment is to reflect. If the consultant is there with you then you can also have signed off ( saves you from chasing them to get signed off). This improved my portfolio numbers dramatically.

·        If I do any course, and get the qualification, the first thing I do is put it on my resume. My resume is saved on an Online drive so that I can access it anywhere. You can also have it in your email. This will save you so much time and you will always have a CV ready for any opportunity.

3.      Tackling Admin: Now there are three segments of admin. The biggest time sucker of all is Emails. Then there is admin such as clinic letters,  operation notes, and managerial roles.

·        The clinic and operation letters can be tackled by templates. In all operations we do there are some same steps that we always do, as we are trained in a certain way. No surgeon does an operation purposefully in a different way every time unless the situation demands it. So have templates ready for most common operations that you and then modify as per the operation. You can save them on your work drive or work email and just copy and paste.

·        Clinic letters also need a template. The discussion has to be written in detail, but some parts of the discussion like discussed operations and risks of complications which is your standard that you can put in every letter where you discussed with patients. Templates can also be there to inform patients about the investigation. Like your endoscopy showed benign pathology and follow-up is required or not required. Informing the patient about their follow-up regimens. If there is anything that you have to a letter regularly, see if you can make a template. Copy and pasting will be your biggest time saver.

·        Some countries don’t use clinic letters. Prescription pads with a brief summary are usually used there, where the doctor writes symptoms, investigations, and treatment with medication. You can preprint your prescription pad with pertinent points like a bullet point for diabetes, heart disease, and anticoagulants so that you can put a tick mark or something around them and also have proforma which you will fill up at the same time, every time. Remember, our brain likes structures and routines. This helps to automate some functions and divert energy to other cognitive tasks.

·        E-mails. The biggest time-sucking vacuum. You can do the time block, like only checking and answering your mail on a particular set of times. But that is not always possible. So, the system I use is similar To a do list. First of all, I will try to delete as many as emails possible just by reading the subject. Like promotional offers, I am not interested, in unimportant organizational mail. Then I prioritize them in Respond Now ( urgent or mails that require a line response).  Respond today and then Respond this week. I also save the mail in a special category box, like, car, home, deanery, Appraisal, receipts, etc. If any mail requires a time-sensitive response but not at the immediate moment, then I pin it at the top of my mailbox. Set up a template for your email. This can be universal greetings, introductions, signatures, and invitations.

·        Send all important forms like study leave, annual leave, and templates in an accessible place.

·        Make a folder for all approved study leaves and all important emails and correspondence.

4.      Building a Knowledge base: The easiest way to do that is by listening to a podcast. Especially if you have a long commute and you are preparing for a presentation or examination. If you have signed up for a webinar, don’t forget to set a reminder. Otherwise, you will forget. An easy way to make it more productive is to watch it while on the move. Watch a webinar or YouTube while you are on the treadmill. Don’t have space for a treadmill, you can buy a stepper from Amazon like me, and use it to multiply your productivity and squeeze some exercise in.

5.      Writing: Now I hate deskwork. I am fine on a couch, but making myself to actually sit down to do a task is very difficult.  I also sometimes get writer's block or feel unable to express my ideas in words. One way to tackle this is dictation apps like Live Transcribe. It has its glitches, but it starts by putting my ideas to paper and just dumping those thoughts on paper. I can then review, edit, or rewrite them. But I have started the process. I can also couple this by doing something else like walking or folding laundry. This way I am coupling a cerebral process with an automated process and multiplying productivity.

6.      Organizing workweek: If you know what days you are in theatre, check all your patient’s investigations for all the operations that week in one go and save them in a work drive. This will give you an idea about what operations you need to study or prepare, what cases can you discuss and prepare, and read relevant papers. This will add to your knowledge, and portfolio and impress your boss. You can also roughly estimate which days you will be late so prepare and organize adequately. On your non-theatre days, you can allocate for admin, teaching, or other meetings.

7.      Social Media: If you are using social media for work, also consider making some common templates with links that you need to use to save time. Actively try to network using LinkedIn and other social media to look for opportunities. The only thing I will add about social media, is whether you use it for work or for recreation, time yourself so that you are in control.

So, these are my seven strategies for time management for surgeons. I would love to hear whether you have any other strategies for time management and productivity, that I can incorporate.