Time management skills

Time flies.
[Invitation to the Krewe of Nereus Carnival Ball via wikimedia]

We ask students to do a lot in 15 minutes, so time management skills are crucial. When I have students who have a hard time completing the encounter, I frequently give feedback about time management skills. Much of this feedback centers around asking questions & giving directions in clear, concise ways.

This is a living list. Last updated March 21, 2015

• Practice: Students who need more practice asking questions often ask an unfamiliar question in several different ways all as one sentence, which takes up time. For instance: "How can I help you today, what's wrong, what seems to be the trouble?"

• Only ask one question at a time: Don't stack questions. For instance, "Do you drink, smoke or do drugs?" or "What makes it better or worse?" It seems like it might save time, but as a patient, it's difficult to track multiple questions and it may take me time to formulate a comprehensive answer. I may even forget to answer one of them if one of the questions is more important to me than the others. This is especially important if multiple questions have different answers, if there are three or more questions, or if I am in a lot of pain. Plus, as an SP I may have been instructed only to answer the last question, which requires the student to go back and ask the other question(s), anyway. Sometimes one open-ended question can be better than a series of closed questions. For example, "How much do you drink in a week?" gets more information in one question than "Do you drink?" which often needs to be followed up with "How much would you say you drink in a week?" anyway.

• Shifting questions: Similarly, If I don't interrupt a student, I have often found one question can transform into a different question before the student finishes speaking. For instance: "Can you tell me about the quality of the pain, like does it radiate or can you tell me how long you've had it?" If I had interrupted as soon as I heard "quality," the student would have received a much different answer.

• Trailing off: If I don't interrupt a student at the end of a question that is mostly done but the student hasn't actually stopped talking, a student may look at me expectantly and then trail off. For instance: "Have you noticed X or Y... or...." As a patient, I am highly unlikely to interrupt my doctor, so I ask them to finish the sentence; "Or...."? Usually students repeat the question more concisely.

• Repeated questions: In addition to making me feel unheard as a patient, repeating a question uses up unnecessary time.

• Using jargon: If a student uses a word I don't understand as a patient, I may have to ask them to repeat it so I know how to answer. Or I may use other techniques to answer, all of which take more time than necessary.

• Mumbling: Similarly, if I don't understand what the student is saying, I may have to ask them to repeat the word or the question.

• Taking notes: If students don't have good personal shorthand, they may use a lot of time writing out entire sentences with my answers. Even writing "high blood pressure" takes a lot more time than "HBP". The notes students take during the encounter shouldn't be the same ones they will submit as documentation or as part of a SOAP note. Using more abbreviations and symbols will save students time during the encounter.

• Clear directions during physical exams: Clear, simple instructions during physical exams are an easy way for students to save time. Any confusion or misdirection takes time to correct. I find this to be especially true for musculoskeletal & neuro exams.

• Expectations management: As a patient, knowing what to expect is a huge relief and gives me a lot of confidence & trust in the student doctor. Why are you asking this question? What are we doing next? Why is this exam being done? Students often skip this step because it seems to take up precious time -- but I think it's crucial. As above, anything that causes friction and confusion often eats time, so good expectations management usually makes things run more smoothly and quickly.

• Ungowning and draping instructions: similarly, when a student is not clear about ungowning and draping instructions, it can take a lot of time to clarify. If I am uncertain, I may move more slowly. If the student's instructions are unclear, I may not do what the student doctor expects me to do, which requires more explanation. Best practice (ungowning): "Would you please untie your gown and lower it to your waist?" Best practice (draping): "I'm going to lay this sheet over your legs. Please lie back and lift your gown to just below your breasts so I can examine your stomach." 

If students save even just 30 seconds to a minute using these techniques, it may be just enough for them to close the encounter and leave the room before time is called. As a patient, attention to these details also gives me a lot more confidence in them and I will probably feel more comfortable during the encounter.

Extra credit:
During encounters I listen for students who explain a question or exam with more detail after I've expressed uncertainty verbally or nonverbally -- that is almost always a sure sign the student could have saved time by explaining it first more clearly.