03. Reflections of a seasoned program director: Setting yourself up to thrive

Introduction

You have been offered the role of Program Director, and in addition to wanting to provide an excellent program for your residents, it is important to consider how you and your career will thrive. With strong mentorship and support from your leaders and your team you can be intentional with your planning and set yourself up for success. Enjoy these reflections from those who have gone before you, with hope that it offers some wisdom as you embark upon this path.

Give yourself time to settle into your new role

One of the biggest challenges we face as new PDs is developing an understanding of the full scope of the role. Its just hard to, until you are truly in the weeds. Usually you will already be familiar with some aspects of the job, having watched your own program director when you were a trainee, which is a nice perspective, and perhaps also having worked with and observed your predecessor in your current program. Unless you are launching a new residency program, you will have to take over the steering the ship (your program) while it is moving full steam ahead; to navigate appropriately, you will need to grasp the full scope of the work involved fairly quickly. Give yourself time to settle into the role, and if possible, a long runway of overlap with your predecessor is ideal to set you up for success. Have regular meetings with the outgoing PD and the PA who supports your program to keep you on track as you learn the role. And always ask lots of questions.

One of the smartest things you will do is to communicate regularly with a wide range of people who are there to support you.

Don’t be afraid to ask for help

It cannot be emphasized enough, how good communication and cultivating relationships with a wide range of people are important keys to success. You will reap the benefits of this practice when you inevitably need help! It’s quite possible, in fact probable, that at some point in your tenure as PD you will come across a problem you may not completely understand and/or know how to fix. But if you know whom to call on for help, you are halfway there to solving it.

One of the first things you might want to do in your new role as PD is to discuss the challenges you see in your program with people who are good problem solvers. Their insights will be helpful in guiding you towards a solution. In addition, they may suggest others who might be helpful in specific types of situations.

One piece of wisdom that was passed on to me, was to always remember that the residents often have the best solutions to issues within the program. And its true. For example, if there is an issue in your program directly related to the experience of the residents on their rotations or with their curriculum, remember it’s the residents that have first-hand knowledge of the issue, they are in the trenches. They are often an underutilized resource when it comes to coming up with thoughtful, practical solutions to problems that directly, or indirectly affect their training.

Meet regularly with the leader who oversees your portfolio around the issues in your program, especially when you start out. They will be an invaluable resource in terms of support, mentorship and helping with problem solving. From time to time, there may be things that you and your direct leader may need help with; in such cases there are many other resources available to you including your Associate Dean PGME.

As PDs, we feel a kinship to other PDs. Be sure to keep in touch with other program directors both at your institution and across the country. Program directors in your specialty may have regular meetings as a group (once to twice a year) either in person or virtually and often respond quickly to email requests with questions. They are a collective wealth of knowledge. They may have had to deal with similar issues and can share these experiences, or they may be able to share with you or direct you to useful resources.

You will find that sometimes you will engage and rely on people who are experts in other areas, that you might not have imagined. For example, a number of years ago, we had to relocate some of our resident on-call rooms to make space for some outpatient clinic rooms. Well, there was a lot to consider. From ensuring the terms of their contract were met to advocating for the things that were important to them around having a safe and secure space, to being close to the patient areas etc. I found myself in a boardroom with the hospital architect, discussing the possibilities as to where these on call rooms could go. We pulled out really long rulers and found ourselves measuring massive building plans to see whether the proposed new location for the sleep rooms would meet all of these diverse and important requitements.

Never shy away from asking for help. You will end up networking with interesting people in a wide variety of roles in all areas of your hospital and beyond your institution. This is the diverse team that will help you to provide an outstanding program for your residents, through providing their expertise and helping you to manage a diverse array of issues.

Organize your time

At the outset of your tenure as a PD, it is important to work with you leadership to ensure you have been allotted the time you need to do the job well. It is well recognized in postgraduate medical education that time needs to be carved out for the PD role; PD duties cannot simply be added on to an individual’s other full-time responsibilities. Talk to seasoned PDs to determine how much time/effort the job will require, then set yourself up for success by negotiating enough time to do the job well. Some institutions have a standardized approach to calculate the fraction of a work week that PDs will need to devote to running programs of different sizes.

Once this time is carved out, there will be many competing demands on it. It’s important to be purposeful and prioritize what tasks you will focus on and when you will do them. There are many deadlines in the life of a PD, you will learn what these are and schedule around them. Skills in time management are a huge asset and can be learned.

The first step in organizing your time is to get a sense of everything you need to do. A great starting place is to get a broad overview of the activities you are responsible across the breadth of the program. Review your program’s master organizational yearly schedule; try to look 9–12 months out so that you have an idea of the entire academic cycle. Take note of the important activities that must be done in a specific time frame, and then block time for them in your calendar, way ahead of time before your calendar fills up. Assign priority levels to tasks based on how they relate to the master schedule, and the timeline. For example, when the CaRMS match is happening, resident selection activities are a priority (see chapter 9). When your program’s Competence Committee is reviewing your residents’ performance (see chapter 20), activities such as fireside chats with your residents are important to have scheduled to discuss their progress. If your program’s accreditation visit is on the horizon, block plenty of time for preparation, well in advance of the visit: the earlier you start preparing, the better (see chapter 26).

Once you’ve blocked the necessary time for your must-do priority activities, you can see where your other activities will fit in, the ones that sometimes don’t seem to rise to the top of the to-do list. Find out how long these activities should take and when they need to be completed. For example, if you’re asked to review abstracts or prepare a workshop for conference, ask the organizer about the time commitment and deadline. Start with that date and work backwards to block the time required to get the task done. If you don’t end up needing all the time that you’ve allotted to a task, excellent, you can use it for something else! It’s an amazing feeling to suddenly have some “found time” in your calendar.

As with all roles, it is vitally important to prioritize personal commitments and find that important balance. If there are important personal tasks that you need to attend to, such as child related activities, block the necessary time in your calendar. It’s easier and less stressful to put personal tasks in your calendar in advance than to cancel or reschedule activities when you realize you are double-booked.

Remember that you can’t always do it all, all the time. You may find that you have days where your calendar just feels like you are booked solid with no breaks. If someone is helping to organize your calendar, ask them to schedule a little bit of time here and there for you to take a breather and catch up. If you do a lot of your work virtually, as has been the case for many PDs during the COVID-19 pandemic, it is even more important to schedule breaks because it can be really challenging to be in front of a screen for prolonged periods of time.

At the end of the weekend, it is helpful to look at your upcoming week and prepare a to do list. At the top of your list put the important things that must get done for the week, such as preparing for a meeting tomorrow, that requires a review of documents. Do these tasks first. You may not get to the bottom of your list each week but creating a list will help you to be productive.

Sometimes, however, it doesn’t matter how diligently and thoughtfully you organize your time: there is just too much going on. As discussed in the previous section, don’t be afraid to ask for help. If you feel overwhelmed, speak to the people who may be able to take some tasks off your plate, whether it’s a colleague or your team.

It is important to recognize that your day will not always unfold according to your plan. For instance, something might happen in the middle of the night that will completely change your priorities for the next day. Flexibility is key.

Plan for your future

While there is a huge learning curve involved in becoming a PD, and it will take time to settle into the job and to become efficient, you will find it so rewarding.

Remember to give yourself time to learn and gain experience, and when you are feeling more settled you may want to take on additional roles that require your expertise. In fact, people will come to you and ask you to help and even lead other initiatives given your growing experience as a medical educator.

As your career progresses you will learn so much, gain so much experience and develop important networks. Some of these networks may lead to being offered additional leadership opportunities, either in parallel with your role as PD and/or in the future. In some ways, you might not be able to imagine what some of these opportunities might lead to, so embrace them!

It is important that ensure you have mentors who will guide you in this role and around career path. Seek them out and rely on their wisdom. Importantly they may advise you when you might want to be thinking about promotion. Most institutions provide support around the process for promotion including workshops on how to prepare your dossier as well as information around the timeline. Take the time to consider whether this is something you want to pursue and attend information sessions. Approach colleagues who have gone before you for advice and examples of dossiers to review.

Conclusion

Taking on the role of Program Director is a wonderful career opportunity and it is key to set yourself up to thrive in the role. With some intentional planning from the outset, and advice from those who have gone before you, you will enjoy this time and your career will flourish.