Weekly Protected Flexible Time Emerges as a New Lever for Resident Learning and Well-Being

Medical residency has long been described as a crucible: a period of intense clinical training in which young physicians absorb enormous amounts of knowledge while simultaneously absorbing the emotional weight of patient care. What has been less well understood is how the structure of a resident’s week shapes both what they learn and how they cope. A new case study published in Academic Psychiatry by researchers at the University of Toronto’s Temerty Faculty of Medicine suggests that a surprisingly simple intervention, a weekly block of protected flexible time carved out of the clinical schedule, can serve double duty, supporting both learning and well-being at once. The work, led by Erene Stergiopoulos, Maria Berseneva, Adrienne Tan, Maria Mylopoulos, and Deanna Chaukos, offers a detailed portrait of how one psychiatry residency program reorganized time itself as an educational and wellness resource.

The stakes of the question are considerable. Burnout and depression among resident physicians are among the most consistently documented problems in graduate medical education. A widely cited 2015 meta-analysis in JAMA found that more than one in four resident physicians screened positive for depression or depressive symptoms, and more recent work published in JAMA Network Open in 2024 has tracked the duration of new-onset depressive symptoms during residency, showing that the burden is not merely transient. Research in the New England Journal of Medicine has also linked long work hours to depression in first-year physicians. Against this backdrop, residency programs have experimented with a dizzying array of wellness initiatives, from resilience workshops to mindfulness sessions, often with disappointing results. Critics have argued that many such programs place the burden of coping on the individual trainee while leaving the underlying structure of work untouched, a mismatch captured in prior studies of wellness curricula that concluded that one size does not fit all.

The Toronto team approached the problem from a different angle. Rather than adding another wellness activity on top of an already saturated schedule, they asked what would happen if residents were simply given back a recurring, protected block of flexible time each week, time that could be used for learning, reflection, administrative catch-up, or recovery, according to each resident’s own needs. The idea, credited in the paper’s acknowledgements to Dr. Susan Abbey, was dubbed A&P time, and it was embedded into the routine operations of the residency program rather than offered as an optional extracurricular. The design principle was that the time had to be genuinely protected: shielded from clinical duties, pages, and the ambient pressure to be perpetually available.

This framing draws on a growing body of theory in medical education around what researchers call adaptive expertise. In contrast to routine expertise, which allows clinicians to perform familiar tasks efficiently, adaptive expertise is the capacity to handle novel, ambiguous, and complex situations, to reason through problems that do not map neatly onto prior experience. Scholars including Mylopoulos and colleagues have argued that medical education systems tend to optimize for routine competence while systematically underdeveloping the habits of reflection, experimentation, and self-directed inquiry that adaptive expertise requires. Unstructured time, paradoxically, may be one of the few reliable incubators of those habits. When every hour of a resident’s week is scheduled, there is no room for the exploratory, self-directed learning that turns knowledge into judgment.

There is also a practical precedent. A 2020 study in JAMA Otolaryngology–Head & Neck Surgery examined weekly protected nonclinical time in a surgical residency and found associations with lower burnout and improved well-being among residents. The Toronto case study extends this line of inquiry into psychiatry, a specialty where the emotional demands of the work are distinctive and where the boundary between professional and personal depletion can be especially porous. By treating the intervention as a program evaluation rather than a formal experiment, the researchers were able to capture rich, contextualized feedback from the residents who actually lived with the schedule change, analyzing their responses using established thematic analysis methods.

The regulatory environment matters here as well. Both the Accreditation Council for Graduate Medical Education in the United States and the Royal College of Physicians and Surgeons of Canada, which accredits the Toronto program, have general standards that require programs to protect time for education and to attend to trainee well-being. In practice, however, those requirements often collide with the relentless arithmetic of clinical service coverage. Education time is frequently the first casualty of staffing shortfalls, and wellness programming is frequently layered on top of unchanged workloads, producing what earlier researchers have described as mixed messages about wellness and work. The Toronto intervention is notable precisely because it attempts to reconcile the two: the protected block is framed simultaneously as learning infrastructure and as a well-being measure, on the theory that the two functions reinforce each other rather than compete.

The findings of the case study, as reported in the article, highlight how residents used and experienced the flexible time in ways that varied widely from person to person, echoing the earlier lesson that uniform wellness offerings fail because trainees’ needs are heterogeneous. Some residents directed the time toward scholarly projects or targeted study; others used it to catch up on the administrative backlog that otherwise bleeds into evenings and weekends; others treated it as recovery time. The unifying thread was not the specific activity but the experience of autonomy and protection, the knowledge that a defined portion of the week belonged to the resident rather than to the service. That sense of ownership, the authors suggest, is what converts a scheduling change into a support for both learning and well-being.

The study also engages with a deeper tension in medical training, one articulated in a 2024 New England Journal of Medicine perspective on distinguishing necessary from unnecessary discomfort in training. Medical education has traditionally valorized hardship, operating on the assumption that enduring difficulty is itself formative. But the evidence on resident depression and burnout has steadily eroded the case for indiscriminate suffering. The Toronto team’s intervention occupies a thoughtful middle position: it does not remove the genuine challenges of clinical work, which remain the core of learning, but it removes a specific and arguably unnecessary form of discomfort, the chronic scarcity of self-directed time. In doing so, it reframes well-being not as a set of coping skills to be taught but as a structural property of the training environment itself.

Methodologically, the work is a case study, and the authors are appropriately measured about what that means. It describes a single program’s experience, evaluated as exempt from review by the University of Toronto Research Ethics Board, with data and evaluation materials available on request from the corresponding author. The qualitative approach, grounded in Braun and Clarke’s thematic analysis, prioritizes depth and transferability over statistical generalization. The researchers acknowledge the residents who participated and note that their feedback directly shaped ongoing program development, an iterative quality that distinguishes program evaluation from one-off research. Funding was provided in part by an Academic Scholars Award from the Department of Psychiatry at the University of Toronto, awarded to Dr. Chaukos, and the authors report no conflicts of interest.

For residency programs elsewhere, the takeaways are likely to resonate well beyond psychiatry. The intervention is cheap, requiring no new curriculum, no additional faculty, and no novel technology, only the political will to defend a recurring block of time against the constant encroachment of service demands. The evidence base, spanning the otolaryngology burnout study, the broader literature on adaptive expertise, and now this Toronto case study, converges on a common insight: time is not a neutral container for training but an active ingredient in it. How a program structures a resident’s week sends a signal about what it values, and programs that protect flexible, self-directed time may be making a measurable investment in both the competence and the durability of the physicians they produce. As graduate medical education continues to grapple with a mental health crisis among trainees, the simplest interventions, giving residents back a few protected hours and trusting them to use them well, may prove among the most powerful.

Subject of Research: Weekly protected flexible time in a psychiatry residency as an intervention to support resident learning and well-being

Article Title: Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being

Article References: Stergiopoulos, E., Berseneva, M., Tan, A., Mylopoulos, M., & Chaukos, D. (2026). Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02430-9

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02430-9

Keywords: residency training, physician well-being, burnout, medical education, adaptive expertise, protected time, psychiatry, graduate medical education, program evaluation, mental health, thematic analysis, University of Toronto