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Living Like an Academic Athlete: How to Improve Clinical and Academic Productivity as a Gastroenterologist

2017; Elsevier BV; Volume: 154; Issue: 1 Linguagem: Inglês

10.1053/j.gastro.2017.11.017

1528-0012

Eric I. Benchimol, Richard Keijzer,

Personal Information Management and User Behavior

Entering a career in gastroenterology, be it as a fellow or new faculty, can be daunting and comes with expectations regarding academic and clinical productivity. Academic clinicians combine multiple tasks involving patient care, research, teaching, and administration. This mix may inhibit your ability to achieve your goals or the expectations of your superiors. The key to any new career is to establish a system to ensure success while minimizing the stress that may result from disorganization, decision fatigue, and overcommitment (to the wrong tasks). Living like an “academic athlete” (borrowing a phrase from a Harvard Business Review article on becoming a “corporate athlete”1Loehr J. Schwartz T. The making of a corporate athlete. Harvard Business Review. Harvard Business Publishing, Boston2001: 120-128Google Scholar) will help you to be happier, feel more fulfilled, and be more productive. The establishment of goals, objectives, routines, and self-restraint all resemble the intensive discipline of athletes required to achieve the highest levels of performance. Athletes cannot simply “show up” to work and expect to achieve their best. They start off the field using discipline, training, and preparation. This article reviews some systems, strategies, and technologies to help you achieve the goal of living like an academic athlete. First, we need to define productivity. It is common to respond to the question, “How are you?” with the word “busy.” However, having many outstanding tasks is not productivity. Instead, productivity refers to the act of being purposeful and achieving one’s goals in an efficient and effective manner. Athletes do not begin visualizing success after the game has already started. It is important to start any new career by establishing goals and objectives. Short- (3-12 months), medium- (2-5 years), and long-term goals (10-20 years) should be crystallized in your mind upon starting a position. These goals should be S.M.A.R.T.: Specific, Measurable, Agreed upon (with a supervisor, mentor, or stakeholder), Realistic, and Time based.2Doran G.T. There's a S.M.A.R.T. way to write management's goals and objectives.Management Review. 1981; 70: 35-36Google Scholar The goals should be reviewed regularly and may be revised when circumstances or priorities change. Your goals should guide your decisions to agree or decline tasks and opportunities. They should also guide the negotiations of your new position, including startup packages and protected time.3Mehta S.J. Forde K.A. How to make a successful transition from fellowship to faculty in an academic medical center.Gastroenterology. 2013; 145: 703-707Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The Pareto principle states that 80% of effects result from 20% of causes.4McKeown G. The unimportance of practically everything. Harvard Business Review https://hbr.org/2012/05/the-unimportance-of-practicall. Updated May 29, 2012. Accessed August 11, 2017.Google Scholar This means that 2 of the 10 items on your to-do list will produce more progress toward your goals than the other 8 combined! Establishing goals and objectives will allow you to identify these high-value tasks and activities. Early in your career as an academic athlete, you should establish a system to help you be more organized and productive. Table 1 lists resources to help you identify a system that fits your personality and work style. Getting Things Done by David Allen describes one of the most popular systems and can teach you some important principles even if you decide not to adopt it. First, all your thoughts, tasks, and goals should be written down (whether on paper or in an electronic system). Nothing should be left to your (regrettably unreliable) brain to remember. Your system must provide trusted places for your outstanding tasks, project lists, reference material required for the tasks, reminders, and ideas for future work. Second, your system should allow you to quickly process tasks that come across your desk, and to “touch it once.” You need to decide whether a task should be done immediately (“Do It”), delegated (“Delegate It”), or placed in your task manager or calendar (“Defer It”). As a rule of thumb, if a task takes less than 2 minutes, you should do it immediately; if it takes longer than 2 minutes you should defer it. We have suggested some task management applications in Table 2.Table 1Useful Resources for Productivity Techniques and TipsTitleAuthor/Creator/OrganizationDescription/URLBooks Getting Things DoneDavid Allengettingthingsdone.comWidely adopted productivity technique. Deep WorkCal Newportcalnewport.comScientific theory and practical application related to technique and benefits of scheduled, focused work. 7 Habits of Highly Effective PeopleStephen Coveystephencovey.comDetailed examination and practical application of techniques used by successful people to be more productive, happier, and feel more fulfilled. Eat That Frog!Brian Tracybriantracy.comTheory and practical application of technique of accomplishing most important task of the day immediately. Smarter Faster BetterCharles DuhiggCharlesduhigg.comEight key concepts are presented that explain why some people are more productive than others.Podcasts The Productivity ShowAsian Efficiency@productivityfmhttp://www.asianefficiency.com/podcast/ Beyond the To Do ListErik Fisher@ErikJFisherhttps://beyondthetodolist.com/ The Productivyist PodcastMike Vardy@mikevardyhttps://productivityist.com/category/podcast/ The Productive WomanLaura McClellan@LauraMcMomhttps://theproductivewoman.com/Blogs LifehackerLifehacker/Gizmodo@lifehackerhttp://lifehacker.com/ Asian EfficiencyAsian Efficiency@asianefficiencyhttp://www.asianefficiency.com/blog/ I Will Teach You To Be RichRamit Sethi@ramithttps://www.iwillteachyoutoberich.com The Productive PhysicianThe Productive Physician@ProductivePhyshttps://productivephysician.com/ UncluttererUnclutter@uncluttererhttp://unclutterer.com/ Zen HabitsLeo Babautahttp://zenhabits.net/ LifehackLifehack@lifehackorghttp://www.lifehack.org Open table in a new tab Table 2Useful Traditional and Technological Applications to Improve Organization and ProductivityApplicationLocationFunctionAdvantagesE-mail management (for a more extensive list see: http://www.capterra.com/email-management-software/) SaneboxSanebox.comEmail management to help with “touch it once” strategy. Quick responses, filters, save for later, etc.Multi-platform (Gmail, Yahoo, Outlook, Exchange, others)Learns what emails are important, reserves unimportant mail for later Boomerangboomerangapp.comEmail management to help with “touch it once” strategy. Quick responses, filters, save for later, etc.Multiplatform (Gmail, Outlook, Android)Uses artificial intelligence to help you write better emails that are more actionableSchedule emails to send at an optimal time, snooze messages, get a reminder if someone does not respond.Scheduling Paper Agenda BookAny office supply storeSchedule meetings the old-fashioned wayPrivacy: Collaborators cannot view your availabilityQuick entryAvailable in offline mode Google CalendarGoogle.com/calendarCalendar/schedulingShared calendarsPublic calendarsColored labelsIntegration with many other apps DoodleDoodle.comScheduling meetings/appointmentsEasy to find appointment time for many participants (voting on best time)MeetMe page: Show others when you are free/busy, allow them to suggest meeting timesMost functionality available in free version (ad supported)Task managers (for more extensive list see: https://zapier.com/blog/best-todo-list-apps/) Paper/PenAny office supply storeLists created on paper to manage tasksQuick entryVisible archive of historyAvailable in offline modeEasily organized OmniFocusomnigroup.com/omnifocusMac/iOS task management focused on GTD systemLocation-based alertsSort with projects or contextsCreating subtasksLabels and filtersMany options, but expensive Thingsculturedcode.com/thingsMac/iOS task management focused on GTD systemCalendar integrationAssign daily most important tasksPlan week ahead ToDoisttodoist.comTask managementMultiplatform (Mac, iOS, Windows, Android, Web)Location-based alertsCreating subtasksCollaboration on shared tasksLabels and filters ToDoAppigo.comTask management focused on GTD systemMultiplatform (iOS, Mac, Android, Web)Location-based alertsAssign daily most important tasksCollaboration in teamsTime monitoring Pomodoro TimersTraditional: Grocery or department stores Apps: zapier.com/blog/best-pomodoro-apps/Bursts of focused works interspersed with brief brakesEncourages focused workForces breaksAllows for tracking of timed segments RescueTimerescuetime.comTracks online time and categorizes activities into productive, distraction, or neutralAssigns daily productivity scoreBlocks distracting websites during focused work periodsTracks offline work time (paid version only)Multiplatform (Mac, Windows, Linux, Android, Chrome, Firefox) TogglToggl.comTracks online time, categorizes activitiesProject management: Estimates project timelines and keeps track of progressTracks time of team members, creates timesheetsMultiplatform (Mac, iOS, Android, Windows, Linux, Chrome)Integration with team management software (Asana, Basecamp, GitHub, Teamweek)Note taking and information storage EvernoteEvernote.comCollect and creates notesMultiplatform (Mac, Windows, iOS, Android, Web)Tag notes and/or place in foldersPersonal email address for forwarding emailsPowerful web clipper browser extension, one click access to original source pagePowerful searchTeam collaboration and chat Microsoft OneNoteOnenote.comCollect and creates notesMultiplatform (Mac, Windows, iOS, Android, Web)Tag notes and/or place in foldersWeb clipperIntegration with Microsoft OfficeJournaling Pen/PaperAny office supply storeImproves memory, makes learning easierEnhances creative expression, promotes mindfulnessPrivacyNice to pull a past journal off the bookshelf and read about your past achievements or concerns Day OneDayoneapp.comMac/iOS app to promote journalingPrivacy (password protect)Not as cumbersome as paper journalPublish to email, blog, social media 5 Minute JournalIntelligentchange.comJournal and iOS appStructured questions for daily 5-minute journalingMeditation/mindfulness HeadspaceHeadspace.comGuided mindfulness meditationExcellent training for meditation rookies (free)Guided meditation for variety of purposes (general, relationships, health, happiness, productivity/focus, etc.)Gamification—collects personal statistics, rewards streaksConnect with friends to track progressModules to teach children to meditate BuddhifyBuddhify.comGuided mindfulness meditationGuided meditations for variety of purposesCollects personal statisticsGTD, getting things done. Open table in a new tab GTD, getting things done. Daily journaling of accomplishments and most important tasks will help you to prioritize. We recommend a structured journal entry to gather your thoughts and goals at the beginning or end of the day. Examples of questions that could be answered in a journal entry include: “What did I learn yesterday?”, “What did I accomplish yesterday?”, and “What are my three most important tasks for today?” (the tasks that fall in the top 20% according to the Pareto principle). The 5-Minute Journal (Table 2) offers a structured journal format with example questions. Most productivity systems suggest completing your most important task first thing in the morning (Eat That Frog!; Table 1). Grouping tasks into an Eisenhower box can help you to prioritize your day and determine whether these tasks are important and/or urgent.5Wikipedia. Time management. https://en.wikipedia.org/wiki/Time_management#The_Eisenhower_Method. Updated July 31, 2017. Accessed August 11, 2017.Google Scholar This method is named after President Dwight Eisenhower, who was known for his extreme productivity. He famously said, “What is important is seldom urgent, and what is urgent is seldom important.” The Pomodoro technique suggests using a timer to divide the day into focused work sessions (without interruption) interspersed with scheduled breaks (with tracking of segments achieved on a daily/weekly basis). Other suggestions include daily calendar notation upon completion of an important task. This is dubbed the “Seinfeld technique,” after the comedian’s response to the question of how to become a better comedian: mark the calendar with a big red X after writing a joke every day, and “do not break the chain.”6Trapani G. Jerry Seinfeld's productivity secret. http://lifehacker.com/281626/jerry-seinfelds-productivity-secret. Updated July 24, 2007. Accessed August 11, 2017.Google Scholar Most successful athletes use routines to physically and mentally prepare themselves for their best performance. Similarly, we can use routines and rituals to prepare for the day or wind down after a difficult day. Many highly productive business people rise early to get their most important work done before the distraction-filled day begins. Irrespective of whether you are a morning person or night owl, a morning ritual helps to prepare your body and mind for the day. A few beneficial morning rituals include rehydration with a large cup of water, meditation to calm your mind, journaling, stretching or exercises to get your heart pumping and blood flowing, and eating a nutritious breakfast. This routine will create the momentum required to face your busy day. Similarly, an evening routine will help you to wind down and allow you to have a healthy sleep, which plays a major role in physical and mental recovery. Your routine should start 1 hour before your bedtime. Eliminating electronic screen watching helps to increase sleep quality.7Heo J.Y. Kim K. Fava M. et al.Effects of smartphone use with and without blue light at night in healthy adults: a randomized, double-blind, cross-over, placebo-controlled comparison.J Psychiatr Res. 2017; 87: 61-70Crossref PubMed Scopus (88) Google Scholar Applications to reduce the blue light emitted from phones and computer screens in the evening may provide benefit. You may review the tasks completed that day and prepare your goals for the next day to prevent your mind from dwelling on incomplete tasks in bed. Journaling, meditation, and reading may also be part of your evening routine. Although many people feel highly productive when they respond immediately to a new email or instant message, even while working on an important task, our brains do not function at peak performance while multitasking.8Charron S. Koechlin E. Divided representation of concurrent goals in the human frontal lobes.Science. 2010; 328: 360-363Crossref PubMed Scopus (111) Google Scholar, 9Clapp W.C. Rubens M.T. Sabharwal J. et al.Deficit in switching between functional brain networks underlies the impact of multitasking on working memory in older adults.Proc Natl Acad Sci U S A. 2011; 108: 7212-7217Crossref PubMed Scopus (147) Google Scholar It is impossible to establish a focused work mindset while being repeatedly interrupted with tasks perceived as “urgent” (but frequently are not). It is essential to block time in your calendar and protect your mind to think deeply and achieve the flow state required for high productivity. This means avoiding interruptions that are not related to the task at hand. It can take up to 20 minutes to refocus on the task after you respond to a notification or email.10Mark G, Gudith D, Klocke U. The cost of interrupted work: more speed and stress. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. April 5-10, 2008; Florence, Italy.Google Scholar We recommend turning off all notifications (email, texts, social media, and pagers) while working on important tasks during scheduled blocked intervals of work. Instead of checking your email throughout the day, we recommend checking your email at the beginning and end of your work day. Processing your emails should follow certain rules: delete the email if unimportant, respond if it takes less than 2 minutes, put it in your task manager if it takes longer than 2 minutes (ie, do not use your inbox as a to-do list), or archive it for later reference if it contains important information. Try to touch an email only once to limit the time spent in your inbox. Similar strategies can be applied to social media, which can be used for both personal and professional purposes. Schedule time to check social media and post content, or use applications that allow the scheduled posting of your content. Time for productive activities should be scheduled in your calendar, and ruthlessly protected. These activities should include scheduled time for writing or administrative work. It is also important to schedule time for clinical and educational activities. Just as interruptions result in unfocused or superficial research and writing, dividing your attention is unfair to your patients and trainees. Your calendar should reflect your priorities for the day and week, and establishing a recurring appointment with yourself to achieve your focused work state is the best way to avoid time-wasting meetings being added to your calendar (with the best of intentions) by you or your administrative staff. Block your time to avoid others blocking you from achieving your goals! It is vital to establish the importance of your schedule with members of your team. For example, urgent issues (sick patients, scheduling requests, advice-seeking colleagues) can easily consume your day allocated for academic activities. We recommend establishing a weekly or biweekly time for review of patient issues, scheduled in your calendar. If urgent issues arise, your team could message you (for emergencies requiring action within minutes) or email you (for issues that require a response at the end of the day). By scheduling your patient review, you will be able to avoid interruptions and enter a flow state focused on your patients, thereby providing more efficient care and avoiding medical errors resulting from distraction. Finally, it is important to use the words “no, thank you” frequently. Tempting opportunities will arise in patient care, administration, and research that may not fit with your goals and objectives. These offers should be met with a polite, but firm negative response. This can be politically tricky if the offers come from a superior, who may be expecting an enthusiastically positive response. We suggest, as have others,11Rustgi A.K. Hecht G.A. Mentorship in academic medicine.Gastroenterology. 2011; 141: 789-792Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar that you work with a mentor throughout your career. Your mentor can help you to determine whether new opportunities fit with your established goals, or whether you should decline. If the latter is suggested by your mentor, you should politely state, “I was intrigued by your request, but my mentor has suggested that I decline.” Mentors should be enthusiastic about being blamed for keeping you on track! Although we have provided suggestions for technological tools that help with productivity (Table 2), the choice of when to use technology is personal. Many productivity systems, including Getting Things Done and the Bullet Journal, started with pen and paper (or a cooking timer in the case of the Pomodoro technique) and have more recently been adapted to technology. You will likely adopt a mix of technology and traditional methods to achieve your goals. The advantage of traditional pen and paper include privacy, lack of downtime, and the ability to visualize handwritten pages quickly and easily. Most important, writing things down is typically done more deliberately than typing, thereby improving memory, mindfulness, and reflection.12Mueller P.A. Oppenheimer D.M. The pen is mightier than the keyboard: advantages of longhand over laptop note taking.Psychol Sci. 2014; 25: 1159-1168Crossref PubMed Scopus (526) Google Scholar Technology can be distracting, but also provides advantages: easily adding or deleting entries, storage of unlimited and searchable reference material for projects that is available anywhere (in the cloud), sharing with collaborators, and detailed time logging of activities. You should not ignore technological productivity options, even if you use a paper journal and agenda. Academic athletes cannot ignore self-care and expect to perform at an elite level. Sleep, diet, exercise, and mindfulness have all been demonstrated to improve energy, productivity, and efficiency. Recent research has emphasized the importance of sleep hygiene in achieving safe patient care13Patient Safety Network. Fatigue, sleep deprivation, and patient safety. https://psnet.ahrq.gov/primers/primer/37/fatigue-sleep-deprivation-and-patient-safety. Updated September 1, 2016. Accessed August 11. 2017.Google Scholar and maintaining health.14National Heart, Lung, and Blood Institute. What are sleep deprivation and deficiency? https://www.nhlbi.nih.gov/health/health-topics/topics/sdd. Updated June 7., 2017. Accessed August 11, 2017.Google Scholar Similarly, the volume and quality of your work will be adversely affected by routinely sleeping fewer than 7 to 8 hours per night.14National Heart, Lung, and Blood Institute. What are sleep deprivation and deficiency? https://www.nhlbi.nih.gov/health/health-topics/topics/sdd. Updated June 7., 2017. Accessed August 11, 2017.Google Scholar There is strong evidence that the quality of your sleep is affected by alcohol, drugs, exposure to screens and blue light, and an uncomfortable sleeping environment.15St-Onge M.P. Grandner M.A. Brown D. et al.Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association.Circulation. 2016; 134: e367-e386Crossref PubMed Scopus (439) Google Scholar Also, exercise (particularly in the morning or early afternoon) has been demonstrated to improve both sleep and productivity. Of course, sleep, exercise, and healthy eating will help you to avoid illness, which will naturally impair your productivity. No amount of extra time at your desk or in clinic is worth the damage caused by poor health. Spiritual enhancement and mindfulness (whether in the form of prayer, meditation, or simply quiet time with your thoughts) will train your mind to focus, recognize distraction, and recover. It is important to recover from the busy and stressful week of an academic clinician by engaging in pleasurable activities that will replenish your energy. Even short bursts of focused work require recovery. A general rule-of-thumb is that 5 to 10 minutes of recovery is necessary for every 60 minutes of intense work. Achieving your career goals requires goal setting, a task management system, and ruthless protection of your time. It also requires self-discipline, practice, and fluidity. You may experiment with different systems before finding the one that fits with your personality and work style. Once you do, and by applying the above suggestions, you will find that your skill and endurance will improve rapidly. Your career as an academic athlete will result in a sharp increase in productivity and, most important, both life and career satisfaction.