Hi everyone,
I don’t know who built my resident schedule, but it couldn’t have been too hard. We had no clinic blocks—just an afternoon each week, every week. Except for oncology, all floor rotations were similar, differing only by location—VA or HUP. Everyone had MICU, CCU, night float, a couple of electives, and vacation—it was just a matter of when.
Building the modern schedule is harder. First, because of work hour limits, we have more residents and more schedules to build. In our department, we create schedules for 163 interns and 189 seniors when you account for internal medicine residents plus rotators from anesthesiology, psychiatry, EM, IR, PM&R, Ob-Gyn, and Bridgeport. Categorical residents get ambulatory blocks two out of every eight weeks. We aim to evenly distribute night rotations, blocks at the VA and YNHH, electives, ICUs, and floor rotations. We want every categorical resident to rotate at least once on every specialty during their training. And, as mentioned last week, we assign required rotations to interns and PGY3s.
We want the schedule to be humane. As much as we can, we assign electives and vacations during the six weeks between ambulatory blocks. We avoid scheduling grueling rotations back to back (no MICU-to-MICU). We try to meet personalized requests, for example, scheduling specialty experiences for residents making career choices. We have to build a robust backup pool for each block, because you can’t predict pandemics. Finally, we try to give residents their first choice of vacation blocks, which we achieve most of the time.
Our Chiefs have made the annual schedule since forever, and they will tell you that the permutations, limitations, and considerations I’ve outlined just scratch the surface. Every year, they build the schedule one resident at a time, aiming to meet each trainee’s personal and professional needs. They’ve largely succeeded, but they’ve also paid the price, spending endless hours tackling mathematical conundrums, last-minute staffing changes, and incompatible requests. Delivering the schedule on time each spring is a testament to their effort.
This year, we are plunging into an exciting new approach, working with an innovative company called Scheduling Wizard to build the schedule. So far, from what we can tell, we will create another excellent schedule, but without consigning the Chiefs to sleepless nights and endless hours spent staring at spreadsheets. They will still spend a lot of time on the schedule, but they will also have more time to focus on other projects, such as planning education.
All of which is to say we are entering a new era, using a new approach to building our huge, complex schedule while ensuring every resident has a year which is as close to ideal as we can make it.
Enjoy your Sunday, everyone. I’m headed out for a long bike ride on the Farmington Canal.
Mark
P.S. What I’m reading and listening to:
- This Is How We Get Moral A.I. Companies By Paul Ford
- Measles Took My Daughter. This Is What I Want Everyone to Know. By Rebecca Archer
- Show us the evidence for the value of medical AI in Nature Medicine
- An Attack on Sam Altman Sends a Terrifying Message By Aaron Zamost
- What I Learned About Billionaires at Jeff Bezos’s Private Retreat By Noah Hawley
- Practical Tips for Clinical Stabilization in Septic Shock By Ashish K. Khanna, et al.
- Shock Not Advised By Elizabeth Rourke, M.D.
- Stephen Latham: The End of Irreversibility On Health & Veritas with Howie Forman and Harlan Krumholz