Efficiency of Task Switching and Multi-tasking: Observations of Pediatric Resident Behaviors When Managing Interruptions to Daily Workflow

Efficiency of Task Switching and Multi-tasking: Observations of Pediatric Resident Behaviors when Managing Interruptions to Daily Workflow

Jennifer R. Di Rocco, DO, Assistant Professor of Pediatrics, JABSOM; Associate Program Director, UH Pediatric Residency Program; Master of Education Candidate, University of Cincinnati/Cincinnati Children's Hospital

Summary of Project Concept:

The daily practice of medicine is fraught with frequent interruptions that a busy clinician must manage appropriately in order to ensure the best patient care possible. Tasks that are urgent and time-sensitive must be prioritized, organized, and balanced with numerous other tasks requiring completion during the day. Physicians must also maintain the necessary flexibility required to adapt to unexpected events that inevitably surface regularly during a busy clinical workday. The ability to expertly manage interruptions may be considered under the umbrella of the "art of medicine," which is not found in textbooks and can be difficult to teach. Additional challenges in this era of limited duty hours include limited patient exposure with less time to develop the skills for effective management of interruptions. Some young clinicians seem to easily triage tasks as they are presented, while others struggle with this role.

Pediatric residents have graded autonomy as they progress through a program, with a steep learning curve in their first year. From an initial dependence on the senior resident and faculty when starting as a new intern to improved ability to independently practice as they near the start of their second year, each intern matures both clinically and professionally at various rates. The Accreditation Council of Graduate Medical Education (ACGME) has assigned 21 pediatric milestones that must be reported back to them twice yearly with a resident's progress along the continuum. Milestones describing the degree of medical knowledge, trustworthiness, leadership, teamwork and stress management skills are all required and applicable to the topic of one's ability to manage interruptions appropriately. The description of the "Patient Care 2" milestone, which reads "Organize and prioritize responsibilities to provide patient care that is safe, effective and efficient" addresses the concept of the "optimization of multitasking" in the milestone discussion. This is described as a higher level of clinical achievement in which a physician demonstrates concurrent task completion in a manner ends to a more efficient workflow without compromising patient safety. The complex set of behaviors described by this milestone can be best observed and assessed when a resident has increased responsibility and leadership roles including supervising a team, managing pager calls and admitting new patients simultaneously. Some residents in our program in recent years have struggled in supervisory roles, specifically with this milestone, but some have excelled, despite having less practice than prior decades of trainees. Understanding the factors contributing to how pediatric residents manage interruptions (from "novice" interns to "expert" third year residents) should be helpful towards designing curricula for mastery of these skills in our program and in others across the nation.