Otolaryngology resident workflow: A time-motion and efficiency study

Andrew Victores, Jess Roberts, Angela Sturm-O'Brien, Nina Victores, Wil Uecker, Bobby Alford, Mas Takashima

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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. Study Design. Time-motion study. Setting. 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)708-713
Number of pages6
JournalOtolaryngology - Head and Neck Surgery
Issue number5
StatePublished - May 2011
Externally publishedYes


  • Duty hours
  • Education
  • Otolaryngology resident
  • Time-motion

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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