How I Work Smarter: Alexandra Mannix, MD

Alexandra Mannix

One word that best describes how you work?

My work style is very Task-Oriented. I have a To-Do list that I regularly update and is always prioritized.

Current mobile device

iPhone

Computer

MacBook Pro (at home). We have PCs at work.

What is something you are working on now?

I’m currently working on a project looking at both gender and racial bias in the SLOE. This has been something I was interested in for a while, and it’s been really exciting to see the project take off.

How did you come up with this Idea/Project?

I have a gender research group, which includes female and male faculty from all across the country and Canada. Over the past 2 years, we have published 4 articles (with 3 more in the process). We are in multiple time zones AND are all Emergency Medicine Docs. This group functions primarily on Slack and we use google docs for our writing. Both of these platforms have really helped improve our efficiency and communication.

What’s your office workspace setup like?

I have an office in my home, which includes my laptop and an extra monitor. Prior to COVID, I did a lot of my work from my work office, but due to COVID, I have been working much more often from home. Having dual monitors has drastically improved my ability and efficiency when working from home.

What’s your best time-saving tip in the office or home?

Make a to-do list, prioritize it, and start at the TOP! It’s so easy to start with the “easiest” task, but starting from the TOP helps me stay ahead of deadlines.

What’s your best time-saving tip regarding email management?

Know it is OK to have unread emails. I have 4 email accounts and it was physically impossible to stay on top of all of them. Prior to starting my faculty job, I always wanted my inbox to say 0. I had heard from so many people to just RESPOND and move on- but when I did this I felt like I was ALWAYS at work. I just can’t live like that. (I also turned off that little red number on the email app on my iPhone. This was mostly done for my wellness).

What apps do you use to keep yourself organized?

Google docs- so I can access my work everywhere (home computer, office computer, cellphone, etc). I also LIVE my life on my google calendar. I have multiple calendars (Personal, Med Ed, Clerkship, Residency, Sim Center, SheMD, Shifts, Etc). Each has its own color, which visually helps me stay organized. I block out days off and post/pre-night shifts, so I don’t accidentally schedule a meeting at noon on those days.

How do you stay up to date with resources?

Twitter… Which I admit is not the best option. I haven’t found a platform I love.

What’s your best time-saving tip in the ED?

Try not to get distracted. Complete a task before moving on. Multi-tasking is basically impossible, but efficiently task completing and task switching IS possible.

ED charting: Macros or no macros?

100% all about the macros and “dot phrases” that include *** (so I have to update them). And DON’T duplicate your work when using Macros. EG. if you already clicked it, don’t type it too.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

Make a to-do list, prioritize it, and start at the TOP. It’s ok to outsource (groceries, cleaning, whatever). Make your partner a real PARTNER.

  • What advice would you give other doctors who want to get started, or who are just starting out?

Block out time (just like you block out a shift) on your calendar for you, your wellness, and your family.

  • Is there anything else you’d like to add that might be interesting to readers?

Develop good sleep hygiene. It is vital in Emergency Medicine.

Who would you love for us to track down to answer these same questions?

  • Melissa Parsons. @MEParsonsMD
  • Kat Ogle @DrKittyKat
  • Al’ai Alvarex @alvarezzzy

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

By |2020-12-23T13:38:11-08:00Dec 11, 2020|How I Work Smarter, Medical Education|

How I Work Smarter: Luz Silverio, MD

how I work smarter Dr Luz Silverio

One word that best describes how you work?

Fitfully and obsessively

Current mobile device

Two: an iPhone 8 supplied by my job for clinical work, and an iPhone 10 for home.

Computer

A very old MacBook Air that constantly pings me, requesting “more space.” I keep putting it in larger rooms, but…

What is something you are working on now?

I’ve been working on a series of 5-10 minute talks to be given prior to shifts that I call “Journal Watch Pictionary.” I read journal articles and then illustrate their key points using my own medium-poor quality cartoon illustrations. It’s fun and I like making people guess what I’m trying to draw, especially because I feel like that helps them pay attention and learn. It also keeps people up-to-date with current literature without having to get pedantic.

An example of the doodles used to illustrate Journal Watch Pictionary

How did you come up with this Idea/Project?

One of my life goals is to do only high-yield projects. The Journal Watch Pictionary project serves several purposes:

  1. It forces me to read journals.
  2. It allows me to be playful and do art.
  3. It creates a theme for small disparate talks so I can slowly build a “body of work.”
  4. Frankly, it’s easier than cobbling together a talk de novo.

What’s your office workspace setup like?

I use this terrible roll-top desk that was a gift from my father-in-law. It’s not a functional modern-day workspace by any means because there is no space for a large monitor. On the other hand, it has lots of cool cubbies into which I can put flash drives, pens, highlighters, random electronic equipment for podcast recording, and it has a good-sized work surface. The nicest thing about it is that it has a roll-top, which means I can spread my stuff all over the desk and then if I want to look respectable and put together (this is theoretical as this is the pandemic and no one has entered my home for the past 3 months) I can just roll it closed. Even better, it locks, so my 2-year-old has no access to my clinical stuff and he can’t do “projects” using my expensive fountain pens or steal my magic rub eraser.

how I work smarter Dr Luz Silverio office setup

The rolltop desk in action

What’s your best time-saving tip in the office or home?

At home: Outsource/delegate. I very carefully weigh the cost and time it takes to do work myself and then often hire someone to do it for me. To be honest I often think I’m doing really well with outsourcing/delegating and then I’ll get stressed out and realize that a good percentage of my stressors are things that I should/could be handing off. I then outsource/delegate more!

At “office” (imagine roll-top chaos): I’m quick to call someone if there’s any miscommunication although sometimes people are nervous to answer the phone. I find it easier and more efficient than a weird song and dance that you have to soft-peddle with emojis. Most of the time we are all good people doing our best but that doesn’t come through on the screen sometimes.

What’s your best time-saving tip regarding email management?

I try not to get too worried about being behind on emails. By this I mean I don’t get all verklempt about taking a while to respond to someone, but of course I apologize if an answer has been wallowing for weeks. If something is important and someone’s really burning up about a response, they’ll nudge me again!

What apps do you use to keep yourself organized?

Google Keep (which is like post-its for your computer and phone), Google calendar. I am a big fan of a handwritten checklist and a timeline for a day with hours and tasks designated for each hour. If a task takes less than an hour that means I’m winning! If a task takes more than an hour it means I’m still winning because I’m doing the task.

High-tech scheduling system

How do you stay up to date with resources?

I read Annals of Emergency Medicine and the Journal of Emergency Medicine. I also read ACEP Now and EM News. I get these all delivered to my house because I hate trees. In all honesty, I have found that trying to read and absorb on my computer screen is not as enjoyable as reading in print, and for something as arduous as reading primary literature, I need to make the experience as delicious as possible. This means that I am often reading these periodicals in a bubble bath, with a face mask on (one of the nourishing ones, not the disease preventers), and a glass of wine on the rim of the bathtub. Every shift I force myself to ask a clinical question and then that’s my homework assignment for my next shift. My last clinical question: Ward catheters and Bartholin cysts: Do we still have to do this? I also listen to podcasts on my commute but don’t consider that groundbreaking.

What’s your best time-saving tip in the ED?

When asking someone to do something, say something nonclinical first. For example: first say, “Cool looking truck! I would get it in red.” Then say, “Could you recheck the vital signs in bed 5A?” This is super important in the long run–when people like you, they have your back, anticipate clinical problems for you, aren’t afraid to speak up if they think you’re wrong, and in general, prioritize you higher for future clinical interactions. Also, if you’re “rude” later (i.e., direct and forthright) they know it’s because you mean business.

ED charting: Macros or no macros?

Macros with care. More importantly, if you haven’t tried Dragon or other dictation software in the past 5 years it has gotten a lot better

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

Just remember, “If I were a dude, would I care?”

  • What advice would you give other doctors who want to get started, or who are just starting out?

Be humble, be kind, remember that there are many ways to spread health and wellness in the clinical context. Listen and absorb when you have capacity and give yourself some grace when you have no capacity left. Try to do multi-purpose projects. If you find out that you hate what you’re working on at least it’s high yield.

Who would you love for us to track down to answer these same questions?

  • Erin Kane
  • Jen Abele

Read other How I Work Smarter posts, sharing efficiency tips and life advice.

IDEA Series: Virtual “Faux-tation” Rotation for 4th Year Medical Students Interested in Emergency Medicine

Visiting clerkships have traditionally offered the opportunity for extended contact among medical student applicants and residency program representatives, allowing for enhanced assessment of mutual compatibility. Accordingly, visiting clerkships are consistently rated as an essential consideration among residency program leadership when reviewing applications, and among medical students, as they determine “fit” [1,2]. The COVID-19 pandemic has resulted in institutional restrictions on visiting clerkships. Despite the now limited opportunities for medical students to see residency programs of interest in-person, demand for these experiences remains high. Opportunities that allow for increased interaction among medical student applicants and residency programs that maintain compliance with COVID-19 restrictions are needed to fill this gap. Virtual rotations have previously been described in the literature in multiple other specialties [5]. Several emergency medicine programs have advertised a formal virtual rotation experience via the Council of Residency Directors’ (CORD) listserv that offers course credit to student rotators.

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How I Work Smarter: Geoff Comp, DO

Geoff Comp

One word that best describes how you work?

Deliberate

Current mobile device

iPhone 7

Computer

MacBook Pro

What is something you are working on now?

I am working on a series of EM department recommendations for the treatment of various environmental conditions, including heat associated injury and hypothermia, with multiple residents interested in wilderness medicine.

How did you come up with this Idea/Project?

Like all great projects, these were developed while chatting about interests over beers! We reviewed current recommendations from various sources during a wilderness medicine interest group meeting and discovered the department does not have official guidelines for these topics.

What’s your office workspace setup like?

Unfortunately, most work is done on the couch. When I need a truly dedicated space, I use my wife’s home office for multiple monitors and a desk.

What’s your best time-saving tip in the office or home?

Rely on a schedule! Be mindful and deliberate with your time so you can focus on a specific project for a shorter period of time in a day and know the boundaries of a new task. My calendar has brief “work periods” of 1.5 hours, where I turn off external alerts/distractions and plug away at a predetermined list of goals for one project. Also, use applications that will communicate with all of your devices seamlessly. If your email, calendar, to-do list, personal finance, etc. don’t play well with all of your devices, you won’t use them.

What’s your best time-saving tip regarding email management?

Don’t use it as a to-do list. I work hard to go through emails in the morning and at night and clear out or address them. If it is a request for a task or a new project/opportunity, I will respond right away with acknowledgment and let the person know I will give a full response before a deadline. Then that task gets added to my own to-do list, rather than the constant reminder and irritation of a positive email balance that continues to spiral out of control.

What apps do you use to keep yourself organized?

Apple Calendar app. My work, personal, and family calendars all get pushed to this. I have sub-calendars for to-do lists, exercise, work meetings, etc. I always open this up and make sure I am available before agreeing to a commitment.

I also recently switched to Microsoft To-Do after the app “Wonderlist” was acquired by the company. It allows me to create a specific “next step” action items for big projects and allows for some success momentum as I see progress. I can make personal deadlines and reminders as well as assign tasks to a daily to-do list.

How do you stay up to date with resources? (FOAMed, CME, Current Events, etc.)

With targeted subscriptions and personal organization. I subscribe to only a handful of resources that are automatically emailed to me or populate my podcasting app. It is very easy to get overwhelmed by all of the incredible resources out there. I use Feedly as my aggregator and will scroll through frequently. After I exhaust my “go-to” resources, I search for Google FOAM.

What’s your best time-saving tip in the ED?

Identify roadblocks to your flow and address them early on to decrease your aggregate cognitive load over the duration of your shift. Procedures and in-depth exams take priority so I can free up that mental space and be ready for more patients. #StopPuttingOffTheLumbarPuncture

ED charting: Macros or no macros?

Absolutely. I use “dot-phrases” when documenting and have a pre-populated chart. If you use macros, make sure you either created them yourself or are very aware of everything included in it and ultimately in your note. You always want to make sure every portion is reviewed to ensure all of the abnormal findings are changed from your prepopulated “normal exam.”

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient? (Give multiple if you have them.)

Have and rely on a family and personal time calendar. I tend to have a self-inflicted busy schedule due to projects and work events, and it is easy for me to see free time and fill it up with work. However, I know it is essential for me to prioritize my family and ensure my wellness. My wife has access to edit my electronic calendar, and we frequently block off and reserve time for date night or time with friends. This helps me turn off “work brain,” as I am forced to complete my daily goals before spending time together, and I am not always thinking of my other projects or work.

Prioritize your work, not someone else’s. It is easy to start the day looking at your email and complete tasks like getting documents signed, responding to requests, and completing EMR training modules (yuck). These are all based on someone else’s timelines rather than your own. It is easy to go through a large chunk of time in your day completing tasks without making progress towards your personal goals and ultimately feel like you were “busy” but not “productive.” I set aside time blocks where I don’t respond to emails/slack/text messages and focus on one of my own projects.

Identify all of the small steps needed to accomplish a big goal and give yourself some wins by completing the tasks. It is sometimes very daunting to think of how to start or end a new project or job. I spend some time being mindful of all of the smaller steps that will need to be completed before finishing a final product. If you set and complete specific, measurable, and time-sensitive goals, you will gain that momentum to finish that fantastic project!

  • What advice would you give other doctors who want to get started, or who are just starting out?

Never stop learning. When you finish residency, continue to take the same advice we give to new residents: read as much as you can, learn something new each day from a patient. We are fortunate to have the best job in the world, and we must continue to grow and learn, allowing us to provide the best care possible throughout our careers.

  • Is there anything else you’d like to add that might be interesting to readers?

Work with a mentor! Find someone you think has a sound system for organization or efficiency and reach out to them to ask what they do.

Who would you love for us to track down to answer these same questions?

  • Mike Gottlieb
  • Drew Kalnow
  • Luz Silverio

Read other How I Work Smarter posts.

By |2020-10-08T16:10:34-07:00Oct 9, 2020|How I Work Smarter, Medical Education|

How I Work Smarter: Meenal Sharkey, MD

How I Work Smarter Sharkey

One word that best describes how you work?

Thoroughly

Current mobile device

iPhone 11 — my whole life runs because of this phone!

Computer

MacBook Pro — thank goodness for the iCloud that syncs my calendars, notes, and texts

What is something you are working on now?

Just finished the Grounded in EM curriculum and am now creating a Grand Rounds for Evidence-Based Medicine for Sepsis.

One of my weaknesses is public speaking and also evidence-based medicine presentations. I like the concept of sepsis in general, so I picked this topic on purpose. It combined a topic I enjoy and an area of weakness, in the hopes that I’ll become a better clinician and educator because of it — I present it in September so we will see!

What’s your office workspace setup like?

HAHA. I live in a state of chaos with three kids and my husband, a newly-minted EMS fellow after finishing an EM residency. I typically work at the dining room table or on the kitchen counter, either once the kids are napping or asleep, or during quiet time. My husband has a study, which I often use as it has a door that closes (and locks!), but with the quarantine and 3 little kids not in school or daycare, there is always a lot of banging on the door for entry! Pre-COVID, I would often drop my kids off to daycare, so they have lunch and a nap on days I needed to get work done and go to a coffee shop around the corner, and then pick them up once nap time was done. I would get 2-3 hours of uninterrupted work time, and wouldn’t miss much of their day as they had lunch and then a nap. I honestly get more done when I’m working outside of the house, as I am not seeing other tasks that may need done or around distractions (laundry, dishes, dog walks, couch and TV time, etc).

What’s your best time-saving tip in the office or home?

I have several “notes” in the notepad function on my phone and laptop that I regularly update: To-Do lists, notes on resident progress, email drafts, grocery lists, kids needs, web-searches that I want to do. Since the program updates across my phone and laptop, I can jot down notes during the day when I’m on the move, dictate emails while I’m at my kid’s tutoring, etc. I can pick up the work right where I left off when I have more focused time on my laptop once my kids go to bed or I have some quiet time during the day.

What’s your best time-saving tip regarding email management?

I have three email addresses (one for personal, work, and clerkship/faculty). Within each, I have created filters for specific email addresses that auto-tags the emails. That way, I can quickly browse through and not be overwhelmed. I try to do my best to keep a zero-inbox, which for me is hard since I have a lot of FODSI (fear of deleting something important). Instead, I opt to have everything tagged so I can quickly archive when I feel like I have addressed the email.

What apps do you use to keep yourself organized?

I use the Notes function on my computer quite a bit! I have a shareable calendar with my husband and my parents to keep track of the logistical aspect of shifts, kids, after-school activities, etc. Basic, I know, but it works for me!

How do you stay up to date with resources?

I like to really make the most of my commute, so I’m a big fan of listening to Rebel EM and EMRAP on my drives into work. I get on Twitter a few times a week to see what is new there. I also really like JournalFeed and Pediatric EM Morsels for tidbits that go to my email, and will catch up on these every few days. I usually get my current events from my husband as this is an area that he likes to stay on top of, and I….don’t.

What’s your best time-saving tip in the ED?

  • While working, I make a list of the room number, the patient/CC, and then two boxes. One box signifies I’ve completed the HPI, PE in their ED chart, and the second box means I’ve completed the EKG/MDM. I cross out the entire line once I’ve signed the note. This keeps me on top of my notes, as that tends to be the area where I can quickly become behind. It also entices the type-A in me to check off the unchecked boxes!
  • The nurses are essential for patient throughput. I update my nurses on my plans for patients, and so they are moving the patient through their course actively, rather than reacting to orders in the computer. If you see a nurse starting an IV at the bedside, alert him or her that you need blood cultures, lactate, VBG, ammonia, etc, so that they don’t have to go back in afterward. Alert them of the meds/fluids you will be ordering if you’re all in the room together so that they can go to the med room rather than go to the computer to discover they have ordered. Do your best to batch your orders rather than trickling them in as this is extremely frustrating for them and slows your turn-around time! The nurses are an excellent resource for the vague/nebulous patient complaints, to get a different perspective for what the patient really wants or is concerned about.
  • I also have perfected my clean catch urine sample spiel, which I recite while walking patients to the bathroom!
  • I am especially more vigilant of specific tasks in the last 3 hours of the shift! Prioritize pelvic exams early in the patient course!

ED charting: Macros or no macros?

I do use macros, but I am deliberate about confirming that all the auto-populated areas are true! My biggest time savers are a pre-populated neuro exam, back exam, and extremity exam, as I do the same thing every time.

Advice

  • What’s the best advice you’ve ever received about work, life, or being efficient?

One of my senior residents told me once: “The goal is to get out on time, with your notes done, and make decisions your mom would be proud of” — I loved that! I love practicing medicine, but I also love leaving work behind to spend time with my family. Rather than finding a balance that suggests equal weight, I consider all my various roles as a massive juggling act, re-focusing on the task that is my hand, and then on to the next. And I wouldn’t have it any other way!

  • What advice would you give other doctors who want to get started, or who are just starting out?

In the beginning, it is typical to have self-doubt, but that WILL go away! You trained for this, and you ARE good at this. It takes a little while to get your bearings in a new role, so give yourself a little time and a lot of grace.

  • Is there anything else you’d like to add that might be interesting to readers?

As cliche as it is, find something outside of work that you LIKE. You don’t even have to be good at it, just enjoy doing it! It will replete you on days on which you feel like you don’t have anything left.

Who would you love for us to track down to answer these same questions?

  • Laryssa Patti
  • Brian Barbas
  • Eric Blazer

Read other How I Work Smarter posts.

By |2020-09-17T16:51:51-07:00Sep 18, 2020|How I Work Smarter, Medical Education|

IDEA Series: 3D-printed pediatric lumbar puncture trainer

Pediatric lumbar puncture trainers are less available than adult trainers; most are the newborn size and quite expensive. Due to age-based practice patterns for fever diagnostic testing, most pediatric lumbar punctures are performed on young infants, and residents have fewer opportunities to perform lumbar punctures on older children.1 Adult lumbar puncture trainers have been created using a 3D-printed spine and ballistics gel, which allows for ultrasound guidance.2 No previous model has been described for pediatric lumbar puncture.

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A Recipe for Success: Virtual Alternatives to Residency Pre-Interview Receptions

The COVID-19 pandemic forced sweeping changes to graduate medical education over the last several months, and as we plan for the new academic year, it is clear that residency recruitment will fundamentally change as well. The Association of American Medical Colleges (AAMC) released a position statement encouraging medical school, residency, and faculty interviews to be held virtually [1]. While there is precedent for holding residency and fellowship interviews online [2-4], these new circumstances present significant challenges for applicants and residency programs alike.

One important change will be the loss of the pre-interview reception. Information exchange between students and residents over dinner at these receptions influences rank order list decisions [5,6]. These receptions provide opportunities for applicants to learn about resident life, satisfaction with their training, cost of living, and many other topics not authentically covered during the interview day. How can residency programs address the information gaps that will result from the loss of pre-interview receptions? Well-designed virtual receptions can provide a unique welcome to applicants and a means to communicate directly with faculty and residents. Here are some suggestions for the use of video conferencing to create ‘virtual receptions.’

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By |2020-08-26T16:13:14-07:00Sep 4, 2020|Academic, Medical Education|
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