The Pediatric Emergency Department is a place where solid time management skills, good multitasking and efficiently dealing with interruptions are key skills to master as early as possible. In the ED we experience frequent interruptions that lead to lapses in our tendency to get things done. Basically, if you are interrupted more often and get distracted by these interruptions you’ll have to multitask more. Experienced emergency medicine attendings will respond to interruptions then go back to their pre-interruption task. They can take new interruptions (a nurse asking for a Tylenol order) and compare them with what they are doing (writing discharge instructions) and determine that the latter is going to free up a room faster, and thus move things along quicker for the department as a whole. So, they discharge the kid first, then write the Tylenol order. This efficiency is enhanced by clinical experience and their achieved ability to multitask. Inexperienced residents may be interrupted but fail to return to the pre-interrupted task (write the Tylenol order – but then move onto something else with that patient, neglecting to return to discharging the other patient).

It is important to note that earlier in their clinical development residents are more likely to have prolonged or permanent breaks in task completion in response to an interruption even when the interruption is less important. Advanced trainees are more likely to respond to an interruption with a brief break and return to the pre-interruption task. That is, there is less latency in moving from task to task. This seamless movement form patient to patient is one of the hallmarks of an experienced ED provider, and is not generally achieved until at least midway through residency. Context is important too – sicker, and more complex patients are more likely to leave novices lost in the weeds regarding how to proceed.

As a supervisor, in order to effectively assess this milestone we suggest that you: