Time Management: Medical School’s Greatest Challenge?

Beginning medical school is one of the greatest adjustments a person will ever make.

“Medical school is a whole new beast that the student has to learn how to tame, and things pick up very quickly, right from the beginning,” says Adam Gaetz, a first-year student at Central Michigan University College of Medicine, Mount Pleasant, Michigan, and national chair of medical education for the American Medical Student Association.

The key is “being able to adapt, keeping an open mind, and learning how to prioritize your academics and balance them out with your personal life,” Gaetz told Medscape Medical News.

Different Stages, Different Needs

Sanjay Desai, MD, chief academic officer and group vice president of medical education at the American Medical Association, divides medical school into three phases, each requiring a different time management strategy: Pre-clerkship, clerkship, and the months of the fourth year, when students are applying for residency.

Students are relatively prepared for the primary tasks of the first phase — which typically spans the first 2 years of medical school — and is didactic.

“This is largely the same format they experienced in college, where content is delivered through a variety of different tools, and they need to absorb information,” Desai told Medscape Medical News.

What may complicate time management is that some students may be at a different life stage than they were in college, Desai noted. They may be in significant relationships, for example, or have families.

“Managing a family, a relationship, and schoolwork is difficult,” he said.

Raphael Shankman, who is married, has experienced this challenge. The third-year student at Rutgers New Jersey Medical School, Newark, NJ, characterizes his transition from college to medical school as a “very difficult adjustment” because, “for every hour of lecture, there were 2 or 3 hours of studying, which was a big shock.”

Joel Rosenbaum, MD, a hand surgeon affiliated with Holy Name Medical Center, Teaneck, NJ, said the first 2 years involved a “challenge of focus.” There were “blocks of time available, since my courses didn’t take up the whole day, and I learned to use time between the ‘big blocks’ to study for my courses, as well as for the Step exams.”

The second phase usually takes place during the third and fourth years of medical school. “Students are at the hospital, doing their clerkships,” Desai said. “They’re waking up at different times, staying up at different times, and their time is controlled by others more than they’re used to.”

He encourages students to “learn from peers who have just gone through the same clerkship they’re about to enter, asking about challenges in schedule and other areas and anticipating them.”

Triage and Budget

“Triage” refers to the “sorting of patients for treatment priority” in emergency situations, addressing the most urgent cases first and less urgent cases afterward.

A similar approach can be taken to tasks and study topics demanded in medical school, according to Katherine McOwen, PhD, senior director of Educational and Student Affairs at the Association of American Medical Colleges.

“Maintain a careful list of everything you have to do, with the most important things first, and when you’ve finished one, you can move to the next item on the list and then the next one.”

Rosenbaum agreed. “One of the most important lessons I learned in medical school, in terms of time management, was to look at my day as a series of ‘slots’ and prioritize the largest first, then fill in the smaller slots, and then the smaller ones.”

He used a helpful analogy.

“Imagine if you have a jar and you want to fill it with large rocks, gravel, sand, and water. If you put the large rocks in first, then fill the spaces around them with gravel, then fill the remaining spaces with sand, and then pour the water in, you can get everything into the jar. But if you put the items in the wrong order, they won’t all fit into the jar.”

Gaetz used a different analogy, comparing the arranging of time with creating a financial budget.

This “requires thinking, how much money you have, what your expenses are, and how you’ll divide up the money responsibly.”

He budgets his time on a weekly basis.

“For any given block, I’ll look at the academic calendar and what the schedule will be each day — where I need to be, what lecture material needs to be reviewed, what patient cases need to be done in a small group, what quizzes need to be taken, the schedule of the cadaver lab, etc.”

He puts all of these into his own personal calendar, together with other involvement, like organizational activities or meeting with friends and family.

Some weeks may be “heavier” than others. The light weeks can be used to prepare for the heavier weeks. “I can bolster my personal study time by looking ahead at the next week, seeing how dense the material is, and how I might want to get ahead and start learning now.”

Nothing is too “inconsequential” to put on the to-do list. Shankman includes the smallest tasks, right down to making his bed or preparing lunch for the next day. “These things help me get on track for the day. Seeing items checked off boosts my confidence and helps me push me through the day,” he reported.

Some people prefer paper-and-pencil calendars or diaries, while others prefer apps on their computers and phones. Several apps and software products can assist in scheduling, tracking your progress, and sending you reminders, such as Google Calendar and Todoist.

Organizing Time and Space

McOwen recommends the Pomodoro Technique — a time management approach designed to help with study.

Pomodoro is Italian for “tomato” and was named after a tomato-shaped kitchen timer. Students focus very hard for about 25 minutes, followed by a short, 5-minute break. Then another intensely focused 25 minutes, followed by another 5-minute break. After four 25-minute units, the break can be expanded. Organizing study time in this way optimizes learning.

She also recommended the “spiral of learning” approach. The student “returns to difficult content multiple times, taking small bits and returning to the content. You study something on day 1, then return to it a week later, and then maybe a few weeks after that, so you’re constantly reinforcing the knowledge you’ll need,” she explained.

Where you study and how your space is arranged may not sound as though it’s related to time management, but there is a connection, according to McOwen. “Find a sound place to work, a quiet place where you can maintain organization in whatever format that works for you,” she suggested. The more organized you are with your surroundings, the more efficiently you’re likely to use your time.

Use Resources to Avoid Stumbling Blocks

McOwen recommends taking advantage of the structured student supports offered by medical schools, such as faculty mentors. “Time management is one of the biggest challenges students will face. Mentors can help students learn the necessary skills and habits.” Turning to mentors and other supports is “not a weakness in any way,” she emphasized. “That’s why those supports are there — to help students succeed. In fact, medical schools want learners who can identify their own challenges and seek assistance.”

Fellow students are a tremendous resource, McOwen added. More advanced students can offer tips about how they managed time during their rotations, and classmates can be study partners. McOwen called group study a “great way to circle back to important content.” The group can decide together what to focus on, and people with strengths can help those with weaknesses. Being in a group also helps keep participants on target and can make studying more efficient.

Don’t Just Work, Work, Work

Desai emphasized that being in medical school requires “deliberate effort to create time for necessary things — self-care, exercise, relationships, and things that make students healthy at work.”

Gaetz agreed. “It’s important to make personal time for yourself to nurture your mental health while also creating an environment where you’ll succeed academically. You have only so much time in the day outside of classes or rotations, which must be spent studying, engaging in personal time and self-care — cooking for yourself, making sure your living space is clean, getting outside, and getting enough sleep.” These must be scheduled and organized carefully. “And don’t feel guilty taking time to yourself,” he added.

Desai, McOwen, Rosenbaum, Gaetz, and Shankman reported no relevant financial relationships.

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape Medical News and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).