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Time management in a medical career

Borrelli, Mimi R; Farwana, Reem; Gundogan, Buket; Agha, Riaz

doi: 10.4103/ijssr.ijssr_14_17
Review Article

Time management is an essential skill in doctors. Work in the medical profession can be high stress, with multiple conflicting demands, and often involves unsocial hours. Time management is necessary to enhance patient care, management of teams, and delivery of health services. Balancing work and home life is also important for mental health and stress management. This article discusses some considerations and techniques to help individuals manage their time.

The School of Medical Education, King's College London, London, UK

The School of Medical Education, University of Birmingham, Birmingham, UK

The School of Medical Education, University College London, London, UK

Department of Plastic Surgery, Guy's and St Thomas Hospital, London, UK

Address for correspondence:Mimi Borrelli, The School of Medical Education, King's College London, London, UK

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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Time management involves determining needs, setting of goals, prioritizing and planning time for success, and productivity to use available time efficiently and effectively. 1 , 2 Although time itself is an inaccessible factor, habits, attitudes, and behaviors in organizing and allocating events in relation to time can be optimized. 3 Time management is essential to excel in any career. 4 In the hospital environment, junior doctors experience higher levels of pressure than the normal population and comparative occupational samples. 5 The introduction of the European Working Time Directive limits doctors' working weeks to 48 h. 6 Doctors work with multiple conflicting demands, often involving unsocial hours. The associated high “job demands” predict poor mental health and low job dissatisfaction. 5 Time management can buffer the potential stress from time pressure. 7 , 8 Good time management behaviors increase energy levels, increase self-esteem, and reduce stress. 9 , 10 , 11 , 12 These all contribute to improved job satisfaction and improved perceived job control. 10 , 13 , 14 Time management is necessary to enhance patient care, management of teams, and delivery of health services. This article discusses some considerations and techniques to help individuals manage their time.

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The initial step in time management is an exact calculation of time currently spent. 15 , 16 , 17 This can be conducted by keeping a log of work and leisure activities, over several days. Reflection on the log will enable identification of which tasks are being completed effectively and which are not. It allows a realistic insight into time needed for different activities; this will help planning. It will track unintended interruptions and time wasted by unimportant tasks. A time log should note daily variations in energy levels which can highlight periods of productivity or wasted time. It is important to understand “personal prime time” the most productive time of day. 15 Each activity needs to be assessed according to its relationship to personal values. 18 A self-analysis leads to the identification of where change is needed and whether time allocation is appropriate and in line with goals.

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Goal Setting and Prioritizing

A central part to the management of time is the identification and prioritization of goals. 19 Goals dictate what must be accomplished and time management should be aligned with those goals. Goals can be divided between work and personal life. Some goals are imperative, others are desirable, and some are crucial for career aspirations. Larger unattainable goals need to be divided into smaller, specific, achievable, and realistic tasks. Physically writing and expressing goals in “to do” lists is advocated 1 , 19 as it can make them more powerful. Lists help give an overall idea of the entirety of tasks to be completed which assists future planning.

Prioritization is possible after goals have been established and can be achieved in a variety of ways. One effective strategy is to categorize tasks according to two independent variables: urgency and importance. 18 , 20 Tasks can be assigned to one of the four quadrants, as visualized in the time management matrix Figure 1. 21 The highest priority items are those that are both urgent and important. 20 Important, nonurgent tasks have second highest priority. Unimportant tasks, regardless of urgency, should be allocated the least amount of time Figure 1. 21

Figure 1

Figure 1

Other methods for prioritization involve assigning a letter of importance (A, B, or C) to each task: “A” is assigned to activities that are most important or critical; “B” is assigned to activities still important but not as critical as “A” activities; and “C” is assigned to activities of low priority activities or relative unimportance. 15 Prioritization can draw distinctions between immediate tasks and future wish lists. Individuals may have multiple to-do lists or separate ones to cover work and home. Lists should be reviewed and updated continuously.

A skill in prioritization is the identification and subsequent elimination of which tasks that are not in line with personal values, goals, or aspirations. The amount of time spent on each task should be determined by its priorities. This includes the ability to not undertake tasks that are not valued or desirable or have little benefit. Without this ability to prioritize new tasks, all other time management is redundant. Understanding dreams, desires, and aspirations makes discretionary decisions easier. Not being overcommitted to numerous tasks frees up time to be spent on valued meaningful activities; this maximizes performance. It also is important to apply discretion to all time-demanding activities. Presence at meetings or courses, for example, may not be necessary. Furthermore, some tasks can be delegated.

Time will stretch to accommodate what we choose to put into it”

- Vanderkam.

Delegation is the assigning of responsibility for a task to another individual or individuals. It allows for the freeing up of time to focus on the most important and urgent tasks. The first step in delegation can be to use a “traffic light system” whereby tasks are divided into three categories: red – important tasks that need to be conducted by the individual; orange – important tasks that need to be conducted by the individual plus another or others; and green – tasks that must be delegated to others. Once delegated tasks are identified (green), the next important consideration is who has the necessary skills, capability, interest, and tenacity to be assigned these tasks. 3 The ability to delegate underpins true leadership, an important skill for any doctor. Delegation involves imposing deadlines, giving clear concise instructions, allowing sufficient freedom to delegates completing the tasks, and establishing a system for follow-up and feedback is established.

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Planning of time is assigning a time element to each task, alongside the consideration for the value of self, the availability of resources and other individuals' schedules and deliverables. Deadlines and time-limits need to be set for each goal. Accurate planning involves realistic time estimations for given tasks to avoid pressure and minimally disrupt time management of other activities. Planning can be conducted across different time scales, across a day, week, month, or year. Planning the night before each day can make it easier to start tasks in the morning, supporting an efficient start to the day. 15

“Failing to plan is planning to fail”

- Alan Lakein.

Scheduling tasks involves consideration of task priority, difficulty, and enjoyment as well as “personal prime time.” Productivity varies throughout the day and days should be structured to optimize high-energy points. Important and difficult tasks should be conducted when energy is highest as these require the most effort and attention. 15 , 18 Routine and easy tasks can be saved for lower energy periods. Larger and unenjoyable tasks should be accomplished sooner rather than later and can be sandwiched between the enjoyable tasks. Seemingly unachievable tasks should be broken down into smaller chunks. 3 Research shows that tasks reliant on short-term memory are better performed in the morning and those that require long-term memory are better performed in the afternoon when long-term memory is strongest. 22 , 23 , 24 Tasks that are similar in nature or in location should be grouped to maximize efficiency. Tasks that require other individuals should be coordinated with other diaries based on seniority. Planning extends to the preparing for particular activities, including phone calls, presentations, and meetings. Material should be read and agendas organized in advance to maximize productivity in such activities. 2 , 3 , 15

Scheduling should be considered with breaks. Breaks offer a period of recovery 25 which may be restorative and refreshing. 26 “Micro-breaks,” which last 30 s to 5 min, might simply involve a moment of mindlessness on task completion before addressing the next task. 27 Although often overlooked due to fear of wasting time, breaks have been shown to increase productivity, 14 , 28 , 29 lessen fatigue, stress, and boredom 28 , 30 , 31 , 32 and reduce job-related strain and accidents. 33 , 34 , 35 When used for meaningful activities, breaks can maintain energy and positive arousal which increases eagerness and capability for tasks. 36 In a similar way to breaks, scheduling physical activity into the daily routines enhances health and well-being. 37 Positive unwinding experiences during workday evenings to recover from work stress are associated with higher levels of engagement the following workday. 38 , 39

Tools to assist time planning, such as paper or electric diaries and calendars on phones, are useful. The best medium depends on personal preference. Electronic devices can sync between computers and phones, can be used to set reminders on weekly, monthly, or yearly repeats. Planning tools should be portable, readily available, and be constantly reviewed and updated.

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Execution of Plans

The next step is the actual execution of tasks. Execution involves meeting deadlines, being punctual and keeping to scheduled time slots. Punctuality is critical, respectful, and can instill discipline into execution, leading to positive work environments. Being clear at the start of an interaction the time available is helpful, and being able to end transactions in a timely fashion is equally essential. 4 Crossing completed tasks off “to do” lists can lead to a sense of satisfaction that is motivating.

“Never put off till tomorrow what you can do today”

- Thomas Jefferson.

The execution of tasks also involves avoiding distraction and procrastination, particularly from social media. Today's technology means 24-7 availability. Total availability on E-mail and unwanted E-mails can waste time. Consideration can be given to setting up different E-mails for different purposes or removing an E-mail address from E-mail distribution lists. Standing up when on the phone or in short meetings is uncomfortable for long periods and is therefore one strategy used to keep meetings short. Some occupational health nurses advocate standing until visitors leave as this makes it more likely conversations are kept brief. 15 Educational audiotapes can capitalize on time lost through travel. 1 Working alongside high-achieving colleagues can be invigorating. 40 Long-term efficiency can be achieved by completing tasks to one's best ability, irrespective of time.

In daily life, there is a constant influx of new tasks and new information, which need to be handled and sorted efficiently. Chapman and Rupured 3 recommend sorting new information into one of the five categories: (1) deletion or elimination; (2) completion; (3) delegation; (4) short-term storage; and (5) long-term storage Table 1. Categorizing information immediately, or within deadlines, and handling information only once can prevent wasted time. 15 Efficient filing allows development of a system that prevents time wasted on retrieving information. A similar sorting approach can be used to organize and declutter work and living space, both of which are argued to be important aspects in time management. 19 {Table 1}

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Skills to effectively balance commitments, responsibilities, priorities, and preferences under time pressure are essential for every doctor. Planning tasks may demand time in the short term but increases time efficiency and productivity in the long term. Being strategic and having integrity to personal worth and goals will maximize performance. Time management behaviors reduce stress and are important to professional success. Effectiveness does not depend solely on the effort put forth, but whether the effort is in the right direction. 15

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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41. . .;:

    Efficiency; management; planning; prioritizing; productivity; time

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