How To Be More Efficient On Your Rotations [Medical Students And Residency]

Are you having trouble managing your time on rotations? Do you get out of the hospital later than sooner? Perhaps you’ve been thinking of ways on how to be more efficient on your rotations?

Rotations, especially for med students new to it, can be really stressful, overwhelming, time-consuming, and many other levels of discomfort.

But don’t worry, you are not the only one to feel the same way. I wasn’t 100% perfect either on my first set of rotations and I can tell you, not all residents are as organized and ready as some young med students and even premeds may think.

In this post, we’re going to discuss how to better plan and prepare to be more efficient on your next clinical rotations, whether you’re a medical student, an intern, or a resident.

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Efficient and Productive Rotations

Today’s post is truly dear to my heart as it’s about being efficient and productive, specifically in the realm of clinical rotations.

How to be more efficient on your rotations, you ask? 

One thing I realized, for a lot of my students as well as the interns that I now work with as a medical resident in Internal Medicine, is that there is just a lot of room for inefficiency. 

Through my experience, I’ve learned how to get faster at things like writing notes, seeing patients, and just being able to get out of the hospital and making sure that patients get amazing care, all while still being able to do it efficiently. 

I’m going to break down the most common areas that we will fall in terms of being unproductive and how to be able to get past them, basically how to be more efficient on your rotations. That way you’re not spending an excessive amount of time in the hospital or doing things like writing notes.

Tip #1: Find Out Your Roadblocks

The first place to start with efficiency is truly understanding what makes you inefficient.

Now that sounds like a very obvious thing to say, but really when you ask people, especially medical interns and residents, “Why are you staying so long in the hospital?”

Most people will tell you, “I’m just not very good at managing my time,” but when you ask them to dive deeper into that, they just don’t really have a good answer for you.

They don’t really know what is causing them to be slow, so they just think that they’re slow in general. And honestly, that’s not true.

Really focus on what is taking you the most amount of time.

Is it interacting with patients? Is it pre-rounding in the morning and looking at vitals, labs, and information? Is it writing everything down? Is it perhaps (probably the most common answer for people) doing your notes? 

Or is it getting your orders down in the afternoon, just being comfortable leaving the hospital and saying, “It’s going to be okay. Somebody else will be watching for my patients and I can now go home and be myself.”?

These are all different things to consider as rooms for inefficiency, and once you identify that, you can finally start taking the steps to work on them.

Tip #2: Tackle Roadblocks Early In The Day

Now that you understand your roadblocks and inefficiency on your rotations, I recommend that you try to do them as quickly as possible into your day.

So, a great example in residency for first-year doctors and interns is usually writing notes. 

It just takes so much time to understand what goes into a note and how to do it efficiently. 

I find that a lot of the interns I work with will probably start doing their notes not until late afternoons, as opposed to where I can probably go into work tomorrow and have my notes done before rounds.

And it’s not because I’m a faster typer or I just suddenly know what goes into a note… I just know how to approach it.

If writing notes is going to take you the most amount of time, I recommend you try to do it as quickly as possible into your day.

Tip #3: Know The Mini Tasks

When I’m writing my notes, I know that if this is going to take me the longest time, I have to think about everything that goes with it.

So then I know I’ll have to:

• write my note
• see my patient
• look at their vitals
• get comfortable with creating an assessment and plan for that specific day

Once you understand all the mini tasks that are in the way, you can start working on making those more efficient before you can even get to your time cruncher.

Tip #4: Do Not Write Everything Down

When I used to do my pre-rounds as a new doctor, I would write everything down: labs, vitals, overnight events.  I would have them on a piece of paper, and I would have one paper for each patient.

I realized that with this method, it would take me forever to go through the data that I wouldn’t be able to actually go see my patients.

If I decided to go the other way and focus on my patients instead (and if that ever took too long), then I wouldn’t actually be able to get to my notes.

So I asked myself, “How can I pre-round quicker?”

Well, the first thing is, if I see vitals and they’re normal, why write them down?

Obviously, if my attending wants it, then I can write those down after doing my notes or while doing my notes. But I don’t need to do that now because right now, I want to see my patients. The other notes, I can add on to afterward.

It’s similar to labs. If the labs are normal, if I don’t need to make any adjustments for electrolytes or I don’t need to start thinking about an assessment because everything is normal. I just put a quick check into their name and I move on to the next patient.

So for me, my approach is: look at the vitals. If the vitals are okay, I’m not going to write that their labs are okay. In fact, I’m not going to write anything down. This way I just look at overnight events by quickly scanning through the notes. If there’s nothing there, then I move on and I know that the patient has been reviewed, in terms of pre-rounding. And I would do that for every single patient.

Tip #5: Have A Set Time For Tasks

What I really try to do is complete my tasks within a set amount of time.

One common theme that we have here on The MD Journey is I try to give myself time constraints for everything I do. Not only does it force me to try to hit each time constraint, but it also forces me to be efficient within that specific task.

This approach of going through the vitals and not writing anything down – it’s really something I’ve created because I wanted to hit that time limit I gave myself.

So in a similar fashion, once you’re trying to parse through the tasks that you have to do in order to be efficient throughout the day, ask yourself:

• What time limit do I want to do?
• How quickly do I want to get through all my pre-rounding?

If you have 10 patients, ask yourself, can you pre-round on all of them within 30 or 45 minutes? Let’s say that you need to see these patients and seeing each one takes you very long. Ask yourself then, how can you speed up that interaction?

Obviously, you don’t want to be rushed when you’re interacting with your patients, but think about what questions you need to ask before you walk into their room. That way you can have a very effective conversation.

Once you determine what physical exams you want to do on them – make sure that you jot those in your notes and then quickly either (1) tell the patient that you’ll come back to avoid any long conversations, or (2) just give them a quick brief update on what you think the plan would be while again still telling them that you’ll be back to give them more information.

All of this works really well with helping me go 30 minutes to pre-round on my patients and then spend 30 to 40 minutes to actually see all of them without spending an excessive amount of time during each phase.

So far, I’ve given you an approach on how to look at the tasks that are in your way before you get to your time cruncher. And you can make those more efficient even if you spend the same amount of time on your notes or seeing patients.

In the past where it may have taken me an hour to do the pre-rounding, I’ve now gone through the pre-rounding and seen the patients by this time.

And now I can finally dive into the notes — the key on how you can be more efficient on your rotations — because that just happens to be the thing that keeps interns in the hospital longest!

Tip #6: Focus On The Task At Hand Unless Paged For An Emergency

It’s really hard to focus on things when you’re getting pages and you’re not sure when to put orders in.

Usually, I like to create a very systematic approach.

My first rule is if I get a page and it’s not urgent, then I’m not going to respond to it immediately. 

I’m going to finish whatever it is that I’m doing, and that just helps keep me focused and in a sense of flow.

Tip #7: Work On One Patient At A Time

Another thing I do to help keep me focused is to go from patient to patient instead of trying to go back and forth between my notes and orders.

For example, once I’ve rounded all my patients, I would want to first do the note of the person who’s going to take the longest time.

Usually, it’s very typical for us to do the quickest notes first just so we can have a sense of accomplishment, but I think that would most likely cause a delay later in the day where you’re just trying to work on those very busy, dense notes later on.

So instead I try to do the heaviest notes first which usually happens to belong to my sickest patients anyway.

I pull up their notes. I pull up their orders. I then pull in the orders that I want to do for the day. 

And I try to work on that note as quickly as possible.

Now you may be asking, “Well, I’m not sure if my assessment and plan is correct, what should I be doing?” 

Well, you can do one of two things.

1. Pend your notes and update later.

You can pend your note with what you think the assessment and plan should be and update it later, or…

2. Write your best assessment and plan and adjust later.

You can do what I do, sign the note with an assessment and plan you think you’re going to carry out, and if anything changes, you have the power to attend, assess, and adjust your note later on.

With this, you could have been completely right and everyone agrees with your plan. In the case that they don’t, you can make minor adjustments later on without having to work on the entire note from scratch.

Key Points

With that, I’ve given you a breakdown of finding your most inefficient task and trying to do it as quickly into the day as possible. Here’s a quick overview:

Do your most inefficient task early

A lot of the interns I work with are still slow in their notes and they still don’t try to prioritize doing their notes until much later. Honestly, I would try to flip that approach if it’s possible for you.  

Focus on the task at hand outside of pager emergencies

Now for the rest of your day, how can you be more efficient? We’ve already talked about not responding to pages as quickly and not responding to requests immediately, unless it’s an emergency that you can’t delay it. 

Systematize your daily tasks

Maintain various systematic ways and checklists that you can use for the rest of your day – that includes all of the things you want to do for each patient as well as the things that you want to do before you leave.

That way if you have any downtime, you can look at the remaining items you have left and potentially work on those to make sure you don’t have to do them later on.

If you know me well enough, I could go on and on and on about efficiency.

But to make sure that this post doesn’t go too long, I do recommend the Crushing Clinicals Course for students on their clinical rotations. If you want more step-by-step advice and want to learn not only how to be more efficient, but also be more knowledgeable and confident as a new doctor, this course is perfect for you!

In need of some immediate FREE resources? Check out the Med Vault for FREE Access to our full library of video courses & over 30 step-by-step guides for medical school.

And finally, you may be in medical school and you want tips and strategies that will help you avoid pitfalls (like most students do), and become more successful. You know it’s still gonna be hard, but you want to enjoy the process.

You may want to learn how to study better, and have better time management and productivity. Then check out the Domination Bundle!

It’s literally all the guides and resources that I put together when I was in medical school and things that I wish that I used back then. And it’s been reviewed by hundreds of students. So check it out here if you’re interested.

Did you find this post on how to be more efficient on your rotations helpful? If yes, then check out these related articles below:

• How To Use Picmonic To Study For Clinical Rotations [How To Get Honors]
• How To Study For Shelf Exams For Your Rotations Effectively [How To Get Honors]
• How To 10x Your Clinical Rotations Results: A Simple System
• What Are Clinical Rotations Like? [Detailed Breakdown]
• How To Give Better Patient Presentations On Your Rotations [How To Get Honors]
• What Is A Transitional Year Residency?
• How To Prepare Yourself For Residency [Step-By-Step]
• Best Resources For ICU Rotations [Full Breakdown]
• How To Write A Good ERAS Personal Statement [Ultimate Guide]

Until the next one my friend…