Residency hacks: 3 ways to become more efficient every day

Editor’s note: The following article is from the June 2022 edition of The DO. We have updated it and are highlighting it in September 2024 as our monthly “throwback” article, our effort to share past columns to provide helpful advice and information to the osteopathic medical community.

Residency is often an endless struggle to fit all of the diverse, vibrant and beautiful facets of your life outside of medicine into the tiny, fleeting moments between shifts. Here are some residency hacks I’ve found to help you improve your work/life balance by becoming more efficient, reducing tedium and winning back moments of unallocated time to spend as you see fit.

The majority of the text below was written back in 2022 while I was still in the heyday of my residency. As proof of how fast medicine and technology is advancing right now, I would be remiss without adding some key updates to the original article.

Please note that this is not a sponsored article and I (and the AOA) have no financial incentive to mention the companies below in this article.

The key to better productivity in residency is to focus on the 3Ts:

1. Templates

Improving your templates is the best way that you can speed yourself up in residency. In a world dominated by electronic medical records (EMR) and stringent documentation standards, it’s impossible to succeed in medicine without using templates. However, many residents simply adopt the standard templates they find or inherit during PGY-1 year and don’t improve on them much. Fortunately, you don’t have to start from scratch either. Many EMRs have a user database that lets you search from a library of defaults or templates and order sets created by other users (i.e. Epic’s dot phrase search engine, or autotexts libraries in Cerner).

This results in lots of wasted keystrokes and cognitive energy composing notes that could be made essentially plug-and-play based on the most common presentations, plans and orders that appear in practice. 

One piece of advice I give to new interns, for example, is to make a template note, order set or assessment and plan based on every new disease process they see. That way, when another patient with that presentation shows up, they will have a foundation to build on and will start to memorize the workup and treatment of common conditions. 

Fortunately, you don’t have to start from scratch either. Many EMRs have a user database that lets you search from a library of defaults or templates and order sets created by other users (i.e. Epic’s dot phrase search engine, or autotexts libraries in Cerner). 

Technology has provided you the ultimate study partner: generative large language models (LLM) like Chat GPT or Claude are capable of both analyzing large amounts of text and PDF files as well as searching the internet to do their own research. You can use a LLM to craft starter templates on any given condition and then build on them with your own edits, speeding up the process significantly. You can then use the AI to easily make otherwise cumbersome formatting changes, like adding Dragon brackets, coding drop lists/click boxes or anything you need to make things workable, constrained only by the limits of your EMR. 

For assessment and plan blocks: Dotphrase.org

Unlike other dot phrase libraries that are hidden behind paywalls, DotPhrase.org is free and crowdsourced. The take-a-penny, leave-a-penny format is a great option for residents.

Find procedure templates here.

There are multiple residency programs and hospital sites that have public dotphrase/autotext libraries; the site above has some of the best I’ve found for procedure templates.

2. Technology

Most hospitals and residency programs will have access to a dictation technology.  Commonly, this may be built in or preloaded into your EMR. The two most widely used are Nuance’s Dragon Medical and M*Modal Fluency Direct.

Both software types excel at medical dictation and speech recognition, but the heart of their power is the ability to store and insert automatic text blocks, navigate a computer screen effortlessly and create macros that automate repetitive tasks.

Sadly, the full extent of functionality offered by the available medical dictation programs is extraordinarily underused by residents. In my program, I’ve observed the older attendings using voice recognition more.

To get started, you will have to contact your IT/EMR department and figure out which program you have, how to activate a profile, and what capabilities are available to you.  There is often a specific employee in charge of dictation, and they may be able to provide you with a tip sheet to get started.

If you want to dive in further, however, I recommend reading the product manual or online help guides specific to your dictation tool. 

I’d pay special attention to:

a) How to create simple macros,

b) Navigation commands,

c) Vocabulary training and

d) Microphone button mapping.

Likewise, with the advent of LLM AI, I highly recommend the second question you ask after “how do I get Dragon?” be “what generative AI am I allowed to use?” If you are lucky enough to be in a hospital system that is more permissive of AI (or even has an EMR with an integrated LLM) it’s in your best interests to adopt that so hard and fast the wheels on the nearest hospital bed will be spinning. Generative LLM AI can give you your own personal medical scribe, and will shorten your documentation to becoming almost instantaneous. Clinically-vetted decision support AI can help you produce evidence-based answers for the toughest, most nuanced questions in seconds. And with LLMs that have an advanced voice UI, you can even pre-flight your rounds presentations as if you were talking to a senior resident. This is literally just the beginning of what AI is capable of, but you will never learn anything about it if you don’t ask. 

This is a truly expansive topic, and unfortunately, most of it will require repetition and practice.  The earlier you start working on it, however, the easier things will go. Become good at dictation technology and I guarantee you will stand out from your fellow residents and finish your to-do list earlier each day.  

Product help site links to get you on the right track:

Nuance Dragon

M*Modal Fluency Direct

3. Task management

Task management is the art of figuring out what needs to be done when. This involves the higher-level skill of taking a bird’s-eye view of your to-do list for the day and figuring out the right order of how to do things. A lot of this will fall into place as you get more experience, but there are some universal tips that you can focus on as you start tackling the workload of being a physician.

Calling consults, especially those that require a procedure, should always be done as early as possible in the day. If you miss calling someone, you could wind up at the back of the waiting list and potentially delay a discharge.

Likewise, one of the best pieces of advice I got in my first year of residency was to keep a list on my patients of all the requirements each patient would have to meet in order to be discharged. If you approach every case by thinking about the disposition, it is easier to prioritize the things that are most important for completing the admission and avoid missing things that might keep the patient in the hospital unnecessarily.

Ultimately, this perspective helps you organize your tasks in the most efficient way possible by keeping the end goal in mind. If you are struggling with any aspect of your time management, your attendings and upper-levels are your best resource as they have most recently walked the same ground and figured out all the tricks.

These strategies above are the ones that I have focused on. Do you have other tips or advice for becoming more efficient in residency? Leave them in the comments below!

Related reading:

5 things you can do to prepare for residency before the first day

Start strong: Financial do’s and don’ts for med students and early-career physicians