Janice M. Bonsu, MD, MPH


Published 3/11/2024
Janice M. Bonsu, MD, MPH

Resident Shares Time Management Tips for Orthopaedic Surgery Trainees

Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.

As a third-year resident, I grappled with the intricate act of juggling my constantly changing rotation schedule with academic, research, and family commitments. I was developing bad habits and an ever-growing to-do list. It became clear how easy it was to fall perpetually behind and how quickly your mindset can shift into a mode of merely “getting through the day” instead of strategically seizing the day.

When choosing to specialize in orthopaedics, I received warnings about potential challenges with work–life balance that could negatively impact my life. Although those concerns are complex and multifactorial, I had more examples of the overburdened surgeon struggling to catch up on documentation and frequently missing family events than the orthopaedic surgeon who is home for dinner with an empty inbox.

One morning during grand rounds, Neil Sheth, MD, FAAOS, an adult arthroplasty surgeon at the University of Pennsylvania, delivered an illuminating presentation on effective time, attention, and energy management. Drawing from his experience during his time on Wall Street, where he first put these habits to the test, as well as his orthopaedic surgery residency, he emphasized the transformative impact of deliberate time management. There he was, a busy arthroplasty surgeon with teaching and administrative responsibilities, ending each day with an empty inbox and being consistently home for dinner by 7 p.m. without his laptop. He seemed to have unlocked the secret to balance and was there to share that it is attainable for all.

Master estimation
Dr. Sheth’s talk discussed the top three habits that residents must practice. The first habit is what he identifies as the main issue with a lack of productivity: estimation. It involves an understanding of each task you must complete and how long it might take.

He described that time management is a function of the mental bandwidth to be maximally productive. To estimate the time required for a task, you need to consider three critical elements. For any given task, you need the energy (you cannot be too tired), appropriate attention/focus (you cannot be preoccupied), and the commensurate time available (the time required must be available in your day).

Start scheduling tasks in 30-, 60-, and 90-minute blocks, and tailor your blocks as you learn more about yourself and your capabilities. For example, it takes me 60 minutes to prepare for my weekly pediatrics conference. Using Dr. Sheth’s methodology, it is not advisable to tackle this task at the end of a long day in the OR when I am physically tired and mentally preoccupied. In fact, I’ve come to find that in that setting, the task at hand takes much longer than the intended 60 minutes.

Once you have determined the estimated time to complete a task, the next key is to select a time of week or day when you have the attention and energy available to hyperfocus and increase your likelihood of completion. For example, I have scheduled the hour-long task of preparing for my weekly pediatrics conference to immediately follow my last clinic patient. This way, I can capitalize on a productive environment where I have an ample reserve of time and mental capacity to complete the task at hand.

Design a system to manage your tasks
The next habit is to design a system to manage your to-do list items. Throughout my life, I’ve experimented with many systems, from Post-it® notes to physical and digital planners. The reality of a to-do list is that it quickly gets longer, and unprioritized tasks get shifted to the bottom when there is no dedicated time set aside on your calendar to address those tasks.

Dr. Sheth advises that the best place to manage a to-do list is on your calendar. According to him, “To-do lists are useless unless the items go into your calendar with reserved time blocks.”

He places to-do items in a timeslot directly in his calendar. For residents who have a lot of variability in their days, this practice takes intentional planning, as they will need to find when they have the attention, energy, and appropriate time to complete tasks.

Designing a good system for tasks allows you to handle emergent issues with reduced stress. I set out in residency promising myself to complete at least 30 minutes of dedicated daily academic reading. However, most OR days run longer than anticipated and my post-call days in the past have lacked structure for learning.

Since adopting the system of physically reserving time blocks for to-do items on my calendar, I have been able to reliably complete my readings. In practice, this means that I know that every evening at 9:30 p.m. is academic reading time. There are some evenings when I am on call and this reserved item is interrupted; however, instead of ignoring the calendar notification, I simply move the task to the next day, meaning that I will complete an hour of academic reading.

Because of this thoughtful system, instead of missing out on my reading, I am able to accept the daily uncertainties of residency, knowing that my overall education strategy will still be accomplished. Likewise, when I have windfall days when cases or clinic visits end early, it is easy for me to look forward and pull future calendar items into the present.

Allow yourself to hyperfocus
The final habit is challenging yourself to hyperfocus when a task is at hand. As surgeons, we are practiced in hyperfocusing. As a chronic busybody, one of my draws to an operative specialty was the peace of focusing on a single task at hand while I was scrubbed in. Now, I take this same “scrubbed in” mentality with me when I have to-do items pending.

During your scheduled tasks, you must promise yourself—same as in the OR—“I should get done what I said I would get done in this time frame.” This disciplined way of time management has allowed me to be more productive during my dedicated work times while still preserving time for rest.

The pillars of your life—family, vocation, and community—all demand their rightful attention. The key lies in minimizing the carryover between home and work, ensuring that you can enjoy and savor your downtime without the burden of guilt.

Traditionally, trainees have been advised to master the art of saying “no” for a more balanced life. For those opportunities that you feel inclined to say “yes,” these habits enable a sustainable system to enable your decision.

Janice M. Bonsu, MD, MPH, is an orthopaedic surgery resident at Emory University in Atlanta. She is a member of the AAOS Now Editorial Board.