Objectives
At the end of this chapter you will be able to:
- understand that your training may not have totally prepared you for all aspects of the program director role and that it’s okay! You can give yourself time to grow into the job.
- employ strategies to maximize your success as a program director
- identify sources of help/support for the challenges you may face
Introduction
You have just been appointed as a new residency program director in your department. Congratulations! You are going to love it. Whether your program is large or small, whether it is running smoothly or needs some work, and whether you have been given a thorough orientation to your new role or just the keys to the office, a good-luck fist bump and not much else, you are probably feeling a bit daunted by all the responsibilities that come with your new job, and what you don’t yet know. This chapter is designed to provide you with some of the insights that come through the reflections of experienced program directors.
Communicate, communicate, communicate
Effective and skilled communication is one of the hallmarks of operationalizing any successful residency program. As a PD, you will be the originator, recipient, or amplifier of much of the communication that takes place your program. Take this opportunity to try to hone your skills in this area. Effective communication will not only make your program better, but it will also make your job easier. When starting to take on and manage some of the typical issues that come up in residency training, loop in more people than you think is necessary, as you may find you end up needing them. Somewhere along the way, you’ll make a connection that’s really going to help you with your work.
You may constantly feel flooded with information, so it will be important to decide how you’re going to manage the volume information coming at you and ongoing communication about a variety of topics, multiple times a day. How will you arrange your files? Managing email communication can be particularly challenging. Some PDs deal with emails as they arrive and try to touch them once; others scan the subject line and look for the urgent ones, flagging the rest to be handled later. It will be important to find a strategy that works for you and helps keep you organized. (You will find that your residents will often email when they have free time, so it is not unusual to get an email at 2:00 a.m. while they are on call. If you happen to be awake when the message arrives (and you shouldn’t be), you don’t have to email the resident back right away, but you do need to realize that you will sometimes wake up to an issue and will need to figure out how to manage it. Whichever method of managing emails you decide to employ, try not to open an email multiple times. Schedule a bit of time (and protect it) at the end of the day to review all that day’s messages to ensure that you don’t miss anything.
Meet regularly with your Program Administrator (PA). They are a key partner in this work. This action will save you a lot of time. Your PA will know what’s going on and what needs to be done, often before you do. Regular communication with your PA will ensure that you know which tasks have been completed and which ones are still outstanding. It also helps to make a plan for the week and get a sense of which tasks are becoming urgent in the office.
Make a point of talking to and checking in regularly with your residents. This might be regular open ended town halls, fireside chats, or small groups. Preparing them for independent practice is the reason your residency program exists. As discussed later in this chapter, you won’t be able to ensure that the program is meeting their needs unless you have a good understanding of what those needs are.
Finally, run things by other key faculty members in your program, informally and formally through your RPC. They will feel much more a part of your program if you ask their opinion, solicit suggestions and engage them in the activities and decisions. They are your brain trust so rely on them.
Despite your best efforts to be a good communicator and keep on top of all the issues, sometimes you will still find out things after the fact and need to respond to them. This is all part of the journey, and these experiences will help to inform your CQI approach moving forward to mitigate similar occurrences in the future.
Understand your residents’ unique needs and then work to address them
The primary goal of any residency program is to provide robust training that meets all the required standards and will equip its residents to practise independently, meeting the needs of the population they will serve. As a PD you will be managing a group of junior physicians most of whom, are at a transformative stage in their lives, not only in their professional lives but also — quite often — in their personal lives. To ensure that your residents thrive in your program, you will need to understand what they need on both fronts and then how to support them in such a way that they can meet their goals.
You will find that there is a significant supportive component to your position. It is a privilege to be able to provide this support to this evolving group of learners, as they navigate their training. In addition to overseeing the curriculum, providing your residents with the appropriate learning opportunities and making sure that they develop the required competencies, you have an important role to play in ensuring that they remain physically and emotionally well (see chapter 11). Be prepared to help your residents to deal with any family or other personal challenges or emergencies that may arise.
Your own training in some ways will have provided some knowledge for you of many of the traditional aspects of the PD role, but perhaps not for the relational aspects of the job, and of course all the “behind the scenes” activity. Developing a mutually respectful and trusting relationship with your residents will be a key element of your success in supporting their journey: you may not know exactly what they need unless they feel comfortable telling you. It can be helpful to chatting with more experienced PDs to get advice and to try strategies that have worked for them. For example, you might consider meeting regularly with your residents for fireside chats. It might be helpful to create a short agenda as to what you want to talk to them about, to help the conversation flow. When you start out, you may not always know how to respond to issues and questions raised, so tell them you will seek out guidance/answers and loop back. As you become more familiar with their needs both individually and collectively, you will eventually have the information and solutions needed at your fingertips.
Some of the needs related to resident groups are very specific, and you will become familiar with them over time. Sometimes you may be surprised at what falls in your lap and is your responsibility! Many of the needs are specific to their training environment and others are related to external factors such as the collective agreement in the jurisdiction in which they work. For example, there may be guidelines in the collective agreements specific to the places where they sleep while they are on call: the doors may need to have locks, there may have to be a secure space for their personal items, and the rooms may have certain requirements such as a lamp, a telephone and a pillow. It may be your responsibility to ensure that these requirements are met. Some needs may be situational, for example who would have predicted a global pandemic and how it would affect residents in their roles as learners. During the COVID-19 pandemic all PDs had to adapt to the measures required to keep our residents and patients safe, while continuing to train and provide care. It required a communication strategy that provided them with the information they needed while allowing a forum to ask questions and get the support they needed for their individual circumstances.
Cultivate a growth mindset
As a new PD you will face many challenges you have not confronted before. Be confident that you will figure things out as you go; being adaptable is key to success.
Be intentional about cultivating a growth mindset (see chapter 14), both personally and in your residents. Many people will provide advice, input and feedback about your program. Consider their input, and see it as an opportunity to think differently, look at the program through a different lens and perhaps make changes for improvement. Encourage your residents and faculty who come to you with concerns, to also come with solutions and ideas.
Consider a scenario in which a small number of residents in your program express concerns to you about a particular issue. Let’s use on-call as an example. It is likely that you need to get more information, to fully understand the concerns and plan the next steps in finding a solution. Consider taking an appreciative inquiry approach: ask your trainees what they like and find valuable about their call, what they would change if they could and how your program could potentially do things differently, to provide the best training possible. This positive framing can help guide the conversation towards brainstorming around productive and constructive solutions to move things forward. Importantly, the residents have an opportunity to provide valuable input co-create the solutions with you.
Always be mindful of the fact that your residents and colleagues will be watching how you respond to and manage feedback about your program. You have a key opportunity to role model a growth mindset for those around you. This will encourage them to embrace this approach and potential opportunities for change and growth. As your program goes through challenging periods, be sure to tell your colleagues regularly how much you value their time and investment in the training program. You can’t do this work without their important contributions and it’s important that they know how much it is appreciated. Be sure that they also receive academic recognition for this medical education work, through the local processes at your institution. In addition, think about mentoring them for leadership roles which may arise, and suggest them for collaborative projects which may come along.
Be prepared to support trainees and teachers who are struggling
At some point in your tenure, you may need to support some of your learners facing academic difficulties and some of your faculty members who may be under performing as teachers. Other PDs who have gone before you have faced similar challenges, and you will not have to reinvent the wheel in determining how to respond. It is important to familiarize yourself with the procedures that have been established at your institution to guide your actions and know who you need to engage to help support you through it.
It can be challenging to address performance issues. As you learn about the processes you need to follow, you will become aware of a wide range of resources you can draw upon, and you will see that there will be significant support. A good place to start your learning on this subject is to read the relevant chapters in this handbook. Chapter 13 discusses how to identify and support residents in difficulty, Chapter 17 offers strategies to help faculty members with less-than-stellar teaching skills and Chapter 12 discusses how to respond when teachers behave inappropriately.
Conclusion
Your time as a PD will be one of the most fulfilling periods in your career with enormous growth and opportunity. It is a privilege to be a part of the journey that will train this group of physicians to practice your craft. As you invest in this process you will reap both professional and personal rewards.
Enjoy this this handbook. It is our collective goal that it will provide you with evidence-based and experiential guidance on how to make the most of this opportunity you’ve been given.