Texas Engineers in the Department of Mechanical Engineering and the Department of Operations Management, in conjunction with the UT Health Science Center – San Antonio (UTHSC-SA), have developed new procedures for scheduling medical residents over the year to allow more time for them to sharpen their skills and provide outpatient care.

UT Austin Researchers:

Jonathan Bard, Industrial Engineering professor

Douglas Morrice, Operations Management professor

Zhichao Shu, Industrial Engineering graduate student

Development: A series of algorithms for assigning internal medicine residents to monthly rotations over the year that separates their in-hospital time from the time they spend treating the local underserved population.

Until now, annual block schedules have been created manually over several weeks by the residency program director in each medical school department.  The process has always been tedious, with some residents receiving much more training opportunities and front line experiences than others.  Improving this balance has been a perennial goal of all accreditation and oversight boards that govern medical education.

Why It Matters: At the start of each academic year, residents are given a set of monthly assignments called rotations that form their annual block schedule. Rotations are designed for intensive training across a wide range of specialties such as geriatrics, surgery, obstetrics, and pediatrics. Medical residents are also expected to care for patients in a primary care setting throughout their program. This allows them to treat the same patients over time, developing relationships and managing preventive care and chronic illnesses. If the block schedules are not carefully conceived, many residents will not receive the required training and develop the proficiencies needed to practice on their own.

How it works: A mathematical model is first built to represent the scheduling problem. To find solutions, it was necessary to decompose the model in to several parts and solve each in sequence. The algorithmic process starts with a list of required and elective rotations that are available to each resident, depending on his or her post-graduate year. Also included are minimum and maximum requirements for each rotation for each resident and collectively for each cohort as a whole. The computational step is directed at ensuring that all educational constraints are satisfied and each resident is given a 4-week hospital assignment followed by a 1-week outpatient clinic assignment.  This is known as “4+1” blocks.

A comparison of the schedule produced by the algorithms developed by the UT researchers with the 2014-15 schedule used by the internal medicine department at UTHSC-SA showed a near perfect balance in rotational assignments and a 10% increase in the number of patients that residents can see each week in their clinics. 

Published: Journal of the Operational Research Society, “Annual block scheduling for internal medicine residents with 4 + 1 templates”

What’s Next: To make the methodology more widely available, it is necessary to package it in a decision support system. The researchers are now defining the requirements for such a system and talking to other medical schools to establish collaborations.  They are also in discussions with a software company that markets similar staff scheduling products.