Ep. 20 - Organizational Principles for Residency

In this solo episode, MDK reflects on the role of organization in residency; not as perfection, but as a tool for clarity and sustainability, sharing simple strategies to manage tasks, tame the inbox, and create systems that can actually work in real life. Please write to us with your organizational methods that have worked in residency at LongCallPodcast@gmail.com!

Transcript

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Hi everyone, thanks for listening to The Long Call This Week, where we delve into the complexities, lessons, and triumphs of residency. Through candid conversations, we want to explore how meaning and connection can emerge from the challenges, chaos, and unexpected moments along the way. It's about discovering the purpose, and sometimes even magic, woven into the everyday work of being a physician. As always, the views, thoughts, and opinions expressed in this podcast are solely our own and do not reflect the policies or positions of any institution, organization, or employer. This podcast is for informational and reflective purposes only and is not affiliated with, endorsed by, or representative of any official entity. And while we are doctors, we are not your doctors, and we are not providing any medical advice on this podcast. Well, welcome again to today's podcast. This is Mary. It's a very busy season for us here in Philadelphia. Kyla and I have been juggling match day, fellowship letters of rec and interview scheduling, spring break, and some unexpectedly late OR days, leaving us a bit behind our planned recording schedule. So we're trying something a little different today. I'm recording a solo episode, and this was inspired by the encouragement of one of our residents I was on an overnight shift with recently. She's about to graduate, so she had queried me and we were going through some best practices of inbox management together, and we realized in chatting that some of what we were discussing could potentially be helpful for listeners of our podcast. So please bear with me today as I try to share some tips and tricks for organization without the usual fabulous insights of my co-host Kyla. So as a PD, I have honestly developed a somewhat complex web of organizational methods, most of which are totally unnecessary and frankly probably impractical for residents, but I do think my deep dive into this world has left me with some practical ideas to share. I do think first and foremost it's important to address mindset regarding organization. One part being that there isn't a morality to organization, and I strongly believe that someone isn't a better or worse human based on how organized they are. But I do think there is a baseline requirement to be a professional in the workplace, including as a physician. Luckily, organization is a skill, not a personality trait, so it is something that everyone can cultivate and practice to the extent that it's an important skill in their life. And the next overarching point I would emphasize is that while it can be motivating to think of organizational tasks as a game and even score yourself possibly on some parts of it, this is not an all-or-nothing endeavor and perfectionism is not the goal. Your systems need to serve you and work within the realities of your own life. So when I've had some one-on-one conversations with residents on this topic before, sometimes some residents want to hear about the exact systems I use, but it's probably not going to work the same way for them because we're in very different seasons of life. So I think it's important to be intentional, to try out some new things, but also to continue to iterate and be willing to pivot when you realize something isn't working for you. But with that being said, I do have some actual tips and tricks that I think might be useful regardless of stage of career or life season. Most, if not all, of these are things I've picked up from experts along the way and then implemented in ways that work for me. I am a big sucker for organizational books and talks, and I'll just acknowledge quickly some of my biggest influencers here. Probably predictably David Allen makes the list, but otherwise it's an all-female cast, including Maura Neville Thomas, Kendra Adachi, Laura Vanderkam, and Sarah Hartunger. And most of these folks have books or podcasts that you could look into if you want to take a deeper dive yourself. As I already alluded to, residency can, of course, be cognitively overwhelming. So I'm not trying to suggest that residents should have a complex organizational system, but I do think it can actually reduce cognitive load if you have some systems in place that help you to catch things you might otherwise forget. And this can also be really helpful to help you leave work at work. Ideally, you want to preserve your brain space for creative thinking and learning, which means not using brain space for mental lists. This is where a task management system is key. Sarah Harthunger calls this airtight task management, meaning you don't rely on memory for any tasks, but instead keep everything in one reliable place. Now, importantly, this doesn't mean recording everything that is already a part of your routine. Hopefully, brushing your teeth is so ingrained in your daily routine you don't need reminders for this. But anything that could take up brain space is put down somewhere outside of your brain to return to later. Your task management system needs to be one singular space. This is as opposed to what I've heard called the here, there, and everywhere system that could include sticky notes, notebooks, random pieces of paper, email inboxes, and those things you're holding in your brain to remember later. This singular task management system can be any place that works for you to record these things, but in my opinion, it must have two important properties. First, it has to be consistently and easily accessible, and second, you must look at it every day or at least almost every day. It needs to be easy to access because you need to be able to record tasks or ideas as they come to you. Not something that you will have to remember to record down later. There are some hacks around this, of course, like emailing or texting yourself in the moment so you can record it later, but it's really best if you can get it into your system the moment you think of it. And then to actually release these things from your brain, you do have to trust yourself that you will see it wherever you recorded it later. So you have to look at it every day. Or I think probably the goal should be every day, and then in actuality, you don't go more than every other day. I heard recently that the definition of a habit is it's okay to skip a day, but you should never skip two days in a row, which I think is great advice that would be applicable here. Your task management system can be analog or digital, fancy or basic, and I would argue if you aren't already reliably using something, simple is going to be the best way to start. I definitely prefer digital tools as they are more flexible and easier to modify, in my opinion. And as a recovered perfectionist, I still don't love crossing things out on paper, so analog isn't a great choice for me, but some people really do love their planners or bullet journals. You do have to be sure to carry around whatever you are using if it's an analog tool though, and not lose it. For digital tools, simple apps like the notes or reminders apps can work. I used Evernote for many years, including in residency, and I'm currently using Outlooks to do, as many of my tasks come from emails. A quick note here about task management: a basic rule of thumb is that if it's going to take longer to write down the task than to do the task, you should probably just do the task. Depending on your context, you can stretch this a bit too. For me, generally, if I think something will take less than two minutes, I'll just do it then rather than list it out for later. Examples might be quickly replying to an email or bonus points if you can just give it a thumbs up and not actually write anything back, printing and signing a form, calling a patient to review a result, which this actually usually does take less than two minutes, somewhat surprisingly, or skimming the minutes from a recent meeting to check for anything important. But if it's going to take longer than two minutes, I put it in my task management system to try to avoid getting sidetracked or going down unintended rabbit holes. One other point I'll make is that email is not a great task management tool. It's an inbox similar to a physical mailbox or your EMR inbox. I personally embrace the zero inbox philosophy for both my work email and EMR inbox. Importantly, that is a philosophy, not a consistent reality. Again, the goal is not perfection. And it's not actually an achievable goal anyway, because if and when you get to inbox zero, more messages will come in. But the idea is to process your inboxes purposefully. So for my work email, about two to three times per week, I get to inbox zero using my less than two-minute rule and task management system. In residency and still to this day, I try to use any time I'm waiting for something to chip away at my email inbox. So those dedicated inbox processing sessions take less time when they come. If something requires no action but I don't want to delete it, I'll archive it. A few other folders that I made in my email inbox that I use regularly are a waiting reply, optional reading, and quick reference folders. Awaiting reply is for those emails that I'm not taking action on, but that I am waiting for someone else to take action on. And if they don't, I'll need to follow up with them. Sometimes I'll actually BCC myself on emails I write and then place them in that folder. And then I review that folder each week for anything I need to follow up on. Optional reading is for all of the journal table of contents that I receive via email that I might want to read or refer back to in the future. And quick reference is for those important updated practice guidelines or new workflows that I know I'll want to refer back to soon so that I can easily find them without using the search function. Although, importantly, if your email has a good search function, you really shouldn't need many, if any, folders at all. Speaking of inbox management, a couple other random tips. As I'm about to go out of town on a family trip for my kids' spring break, I can't emphasize enough the importance of away messages for your email as well as your EMR when you're away. Not only is this important for your wellness and actually stepping away from work when you have scheduled vacations, it demonstrates professionalism and letting folks know that you are not available. In our work email, if someone has an automatic reply away message up, we can actually see this before sending an email. So I've recently added to mine a suggestion that folks could schedule send emails for once I return. And I think this also helps with reducing the inbox bloat that I face when I get back. Also, I definitely recommend unsubscribing aggressively. If you haven't utilized a subscription type email within the last couple of months, you should probably just unsubscribe. It's easy enough to get back on these email lists if you decide you want them later. As far as the EMR inbox goes, I'm definitely a proponent of finishing all the work while physically at work. So before leaving clinic or the hospital for the day, you try to close out your charts and get to inbox zero in the EMR. Now obviously there are exceptions to this. Sometimes you have to leave to pick up a pet or a child or make it to an appointment on time. But nine times out of ten, when I know I have a time-based deadline like this, I can get the work done within the time allotted. And if I can't, then I'll put it in my task management system. For example, I'll write finish op notes and put it as a task for the next day. Okay, so the last major idea I'll leave you with today is the concept of planning time to plan. It potentially seems counterintuitive and maybe even impossible in a residency, but I think it's so important to keep your system running smoothly. As already mentioned, you need time to look at your task management system almost every day. This can really be accomplished, for example, by waking up five to ten minutes earlier than normal to look at it as you make your morning coffee, or if you take public transportation to work, you could review it then. And then ideally, about once per week, you have 15 to 30 minutes as an administrative check-in with yourself. And this is much more likely to happen if you put it in your calendar. I try, I do pick a standing time for this weekly, but then I move it around as needed based on my call schedule and OR time for that week. And again, some weeks or days or even months, this doesn't happen, and that's okay. Some rotations you are in survival mode and you won't have the bandwidth for purposeful organization. But if you have the structure in place, it's easier to pick back up when things calm a bit. And one other quick point I'll make organization isn't just for mundane or work-related tasks. I think one of the most important things to plan is time for fun. As part of my weekly check-in with myself, I scan my calendar to identify at least one fun thing I'm looking forward to in the upcoming week, and if I don't find anything there, I'll purposefully add something in. Alright, so I think that is enough from me for today. The ideas I shared are maybe more on the philosophical side and less tips and tricks focused. Maybe that's a part two I could do with Kyla in the future because I have some of those as well. We'd love to hear actually what has and hasn't worked for our listeners on a practical level, and then we'd be happy to share that on a future episode. In the meantime, I would encourage you to pick one thing you heard in this episode that you aren't doing already that maybe resonated with you, and try to implement it in a way that might work for you this week. And then if it doesn't work or doesn't work as well as you are hoping, try to take a few minutes to reflect on why, and then iterate it to something that is more likely to work for you in this season of life. Thanks for listening and thanks for bearing with me in this different format for an episode. As usual, if you have comments, questions, or ideas for a future episode, please reach out to us via email at longcallpodcast at gmail.com. And I'll hopefully be back with Kyla for our next episode in a couple of weeks. We'll catch you on call next time.