A Proposed Formulation for Long-Term Medical Trainee Scheduling Problem

Samsul Amar1, I G. B. Budi Dharma, Andi Sudiarso

Department of Mechanical and Industrial Engineering, Universitas Gadjah Mada
Jl. Grafika 2 Yogyakarta, Indonesia, 55281
1

email: sams_amar@yahoo.com

Abstract
Medical trainee scheduling is a complicated problem due to the scale, the constraints
and the solving method. Some heuristics and exact methods have been developed to
solve the problem. Branch and Price is one .
Keyword: medical trainee scheduling, exact method, heuristic/meta-heuristic method.
Introduction
Medical trainee program is an important part
of medical education system. A trainee should
finish this program before getting the license as a
medical doctor. The reason is that he/she needs to
get exercise in real problems under supervision of
senior physicians before he/she can treat patients
independently. In other hand, medical trainee
program also becomes a part of personnel
fulfillment of the hospitals and the clinics, which
are related to the program.
Before starting a medical training program,
a schedule needs to be created considering some
rules to make the program effective. Although
medical trainee scheduling problem is important,
only a few studies published about this problem
compared with other scheduling problems in
hospital such as nurse scheduling problem (NSP)
and operating room scheduling. Burke et.al
(2004) succeeded to compile 140 papers from
international journal and 14 doctoral dissertations
about nurse rostering (a class of nurse scheduling
problem) while Bekkan (2010) can only compile
ten of medical trainee scheduling problems.
Scheduling trainees to perform some
activities in a certain period is complicated. The
problem contains a huge number, often hundreds
of thousands, of variables and constraints.
Medical trainee scheduling problem is more
complicated than NSP (Belien, 2007) because of
some conditions. First, medical trainee
scheduling problem is usually deal with longer
period than NSP; consequently, the number of
variable will grow dramatically. Second, trainees
still have to complete their education,
consequently, they have to perform much various
activities/posts, and the capacity of each post is
usually limited. These will increase the number

of variables and constraints. Third, unlike NSP,

an activity for a trainee cannot be separated by
other activities or by off time (vacancy period).
Trainee also cannot be replaced by other trainee
if he/she is not able to perform an activity. These
conditions will add some complicated constraints
in the modeling.
The main issue in solving this kind of
problem is the computation time. Using heuristic/
meta-heuristic
method can reduce
the
computation time but the solution may not be the
optimal one. Using exact method such as branch
& bound and branch & price can produce the
optimal solution but the computation time may be
not reasonable for most problems.
Formulation is an important step before
solving the problem. A problem may be
formulated into two or more formulations. A
good formulation will lead to a better
performance in term of faster computation time.
This paper proposes a binary integer
programming formulation to solve a medical
trainee scheduling problem and compares the
performance of the proposed formulation with
the typical formulation using standard branch and
bound method. The objective of this paper is to
propose a formulation and to show that a good
formulation can lead to much more better
performance than other formulation.
Research Method
At first, the problem relating to hospital
trainee scheduling is explored. The exploration
includes theory and literature work, and real
problem general observation. After define the
problem, the next activities are reviewing the
theories and literatures related to the problem,
and observe the real problem of hospital trainee

scheduling. Observation and interview are done

to get a clear perspective of the real problem. The
subjects of interview are the scheduler team, head
of department, senior physicians, trainees and
personnel of the posts. To build the model for the
clinical rotation scheduling, some data need to be
collected. The data includes: the scheme of
clerkship program, rules and regulation, capacity
of each post and the period in which the trainee
should perform, how the scheduler make the
schedule at present, and preferences of the policy
maker.
Two models of hospital trainee scheduling is
then constructed, i.e. the ordinary type of model
used by most researchers (Model 1) and the
proposed model (model 2). To compare the
models, 8 problem instances are generated. Total
computation time is the main parameters to
measure performance of the model. In order to
solve the problem instances using Model 1 and
Model 2, MATLAB and LP-Solve software are
used in a . The reason of using MATLAB is its
capability to perform matrix operation easily. The
matrix that represents the model is then solved
using LP-Solve, an open source-software to solve
linear programming problem.
Medical Trainee Scheduling Problem
The main issue of medical trainee
scheduling is how to schedule the trainees to
conduct the activities (to stay in the posts). The
trainees should conduct each activity in a certain
period, without violating some constraints. The
constraints usually emerge from the decision
maker, law and regulation from the governments,
safety, fairness, and trainee satisfaction. The
constraints may include: 1) coverage/capacity of
the posts, 2) number of period that a trainee
should perform an activity, 3) preference of the
trainee, 4) setup constraints (each trainee can
only start each activity once), 5) no more than
one activity per period for every trainee, 6)
previous schedule that has been made, 7) routing
rule of the activities, 8) maximum number of
consecutive holidays, 9) maximum number of
consecutive activities, and 10) minimum interarrival period of two trainees in a post.
Ideally, all constraints are satisfied.
However, this condition is difficult to be met.
Therefore, the objective function of the model is
usually to minimize the violation of the
constraints. A penalty is charge whenever a
constraint is violated. The value of the penalty
can be various based on the negative effect of the

violation. The set of constraints that can be

violated are called soft constraints while the strict
constraints that cannot be violated are called hard
constraints.

Summary
Medical trainee scheduling problem is a
complicated problem. Some heuristic and exact
approaches have been reported able to solve real
life problems. Branch & Bound and Branch &
Price are two exact methods that have been used
to solve such problem. Heuristic/meta-heuristic
approaches that have been applied to solve
medical trainee scheduling are Rounding
Heuristic and Genetic Algorithm. The exact
methods can find the optimal solution while
heuristic/meta-heuristic can find a good solution
in relatively sorter computation time but cannot
guarantee to get the optimal solution.
Other exact and heuristic methods such as
Column Generation, Dynamic Programming,
Branch & Cut, Branch & Cut & Price, Tabu
Search, Simulated Annealing, Fuzzy Logic and
Artificial Intelligence approaches may be
considered as solving methods for medical
trainee scheduling. Designing a good formulation
and preprocessing technique may also able to
reduce the computation time.
Combination of exact and heuristic
approach has been described in some research.
The research conclude that the combination has
some benefit and the next research in this area is
promising.

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