title: Otolaryngology resident workflow: a time-motion and efficiency study.
abstract: OBJECTIVE
  To investigate workflow in an otolaryngology-head and neck surgery residency program over 1 year and identify areas for improvement in the efficiency of resident education and training.
  
  
  METHODS
  Time-motion study.
  
  
  METHODS
  An urban, county hospital and a Veterans Affairs medical center hospital. Subjects and Methods. Eight otolaryngology residents (4 residents at postgraduate year [PGY] 2 and 4 at PGY 4) were studied using direct observations early and late in the 2008-2009 academic year. Resident activities were categorized, and a database program was generated for a handheld computer to facilitate time entry. Resident activities were classified into a taxonomy of tasks and their educational value was assessed. For each PGY level studied, observations were made for clinic and operative days.
  
  
  RESULTS
  Residents spent their day on direct patient care (43.5%), indirect patient care (33.7%), didactic education (9.6%), personal activities (7.5%), and transit (5.8%), with activities of marginal educational value consuming 16% of their time. Major inefficiencies included managing administrative tasks, scheduling, and technical difficulties. On average, residents devoted significantly more time to marginal tasks on clinic days (19%) than on operative days (12%; P < .001). These data were compared with previously published data obtained during the pre–Accreditation Council for Graduate Medical Education (ACGME) duty hour mandates era.
  
  
  CONCLUSIONS
  This study evaluates resident workflow and efficiency over the course of a PGY in an ACGME-accredited otolaryngology residency program. By understanding the time motion of residents, interruptions and inefficiencies in workflow can be identified to direct future changes to enhance resident education and training in the era of the ACGME duty hours mandate.
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Victores
authors.forename: Jess
authors.initials: J
authors.lastname: Roberts
authors.forename: Angela
authors.initials: A
authors.lastname: Sturm-O'Brien
authors.forename: Nina
authors.initials: N
authors.lastname: Victores
authors.forename: Wil
authors.initials: W
authors.lastname: Uecker
authors.forename: Bobby
authors.initials: B
authors.lastname: Alford
authors.forename: Mas
authors.initials: M
authors.lastname: Takashima
mesh_terms: D007396:Internship and Residency; D010036:Otolaryngology / Q000193:education*; D013996:Time and Motion Studies; D057188:Workflow