Clinician–trialist rounds: 2. Time-management of your clinical practice and teaching

Abstract

In the previous Clinician–Trialist Round [1], I presented approaches to finding, protecting, and using time for generating first-authored publications, the ‘key criterion used to evaluate a person’s scientific achievement’ [2]. This round begins with the second important element of time-management: how clinician–trialists schedule their clinical activities. On the one hand, you want to maximize the delivery of high-quality care and high-quality clinical teaching. On the other hand, you want to avoid, or at least minimize, conflicts with the other elements of your academic career. Of course, your clinical work should complement your research. Indeed, your clinical observations, frustrations, and failures should be a major source of the questions you pose in your research. But both of them require adequate blocks of your full attention. Having to switch back and forth between them several times a week is a recipe for frustration and failure. Many successful clinician–trialists from in-patient disciplines solve this by devoting specific blocks (of, say, 1 month) of ‘on-service’ time to nothing but clinical service and teaching. When on-service, your total attention can be paid to the needs of your patients and clinical learners. No time is spent writing, travelling, attending meetings, or teaching non-clinical topics. This total devotion to clinical activities often will permit you to take on more night call and a greater number of patients and clinical learners. (For example, during each month ‘on’ my medical inpatient service at Oxford I took call 10 times, and my clinical team of up to 16 learners and visitors admitted about 230 patients. Moreover, in addition to our individual daily bedside teaching rounds, my two Fellows and I provided over 50 hours of extra, ‘learner-level’ clinical teaching.) When ‘off-service,’ however, your time and attention should shift as completely as possible to research and non-clinical teaching. Ideally, you should have no night-call when you are off-service. Moreover, you need not routinely see every discharged patient at a post-hospital out-patient follow-up visit (by ‘phoning my patients’ General Practitioners within 48 h after admission and again within 48 h before discharge, I reduced my outpatient follow-ups by >95%). If you are worried about getting rusty or out of date between your months on service, why not shadow the rounding teams on relevant services for a week just before reassuming command? (I alternated between the coronary care and intensive care units for my ‘warm-up’ weeks.) Surgeons coming off a period of full-time research may want to ‘warm-up’ by assisting at a few relevant operations before taking over. Like so many other elements of your academic success, this sort of time-management is fostered by the development of a team of like-minded individuals who spell one another in providing excellent clinical care. A survey of physicians in their second decade of clinical practice suggested that there needs to be at least three like-minded clinicians to make this strategy work [3]. Clinicians in other fields (e.g., intensive care and many of the surgical specialities) sometimes find it preferable to allocate time to in-patient clinical practice in units of 1 week. Another variant of scheduling is practiced by my former graduate students whose incomes are derived solely from private practice. They devote 3 weeks each month to intensive clinical practice, followed by a ‘free’