05. The role of the program administrator

Introduction

Every residency program in Canada has administrative support. Although the scope of that support may differ among institutions, and even among programs at the same institution, almost everyone in postgraduate medical education (PGME) would agree that the program administrator (PA) plays a critical role in the success of a residency program. Given the many hats that a PA wears and the fact that those hats come in a variety of colours, sizes and styles, it is important for new PDs to check in early with their PA to understand the scope of the role and how it is defined.

PAs are likely to describe themselves as someone who:

• Coordinates activities and resources in support of the postgraduate program, such as:
  • creating and maintaining the rotation and teaching schedule, in some cases at multiple sites;
  • working with the PD to ensure that all the objectives of the program are met and the program functions efficiently within the structure outlined by the Royal College accreditation standards;
  • keeping all educational program materials up to date;
  • making revisions to program documentation as required and ensuring these are distributed appropriately to the relevant individuals; and
  • supporting committee functioning (e.g., residency program committee, competence committee);
• Is personally and professionally committed to the success of the program; and
• Monitors and supports the personal and professional well-being of residents.

PAs work closely not only with PDs but also with the program’s residents, the faculty, the PGME office staff, and other PAs and site coordinators. A major part of the PA’s role is completing daily administrative tasks to keep the program running smoothly and ensuring that all goals and objectives of the program are met and that the program functions within the structure outlined by accreditation standards and relevant workplace related policies and procedures within an organization or jurisdiction.

The bottom line is that the PAs are often the glue of the program and the source of all sorts of important information. Fortunately for you and for your program, PAs know what’s what. They know when things need to be completed. They know whom to contact for assistance. They typically know where the residents are supposed to be and when they need to be there. They know when meetings are scheduled and who is participating. They just know! On the off chance that they don’t know, they know where to find the answers.

If you are new to your role as PD, you may be still figuring out how the PA can help you and how you can help them. This chapter serves as an introduction to what you can expect of your program’s PA.

Supporting faculty

Supporting faculty is a major part of a PA’s role. Complex schedule management is a key responsibility: PAs coordinate everything from academic sessions and journal clubs to rounds and other clinical activities. Many go out of their way to make sure that the faculty have the information they need, when they need it. PAs also assist in creating, coordinating and communicating personalized academic teaching schedules. This includes reminding faculty when they will have a learner with them. They also often have to complete a variety of complex administrative duties in support of the department, special projects and/or senior administrators.

Supporting residents

PAs support residents in a countless ways. For example, they support resident wellness, provide academic support, encourage growth opportunities and support learning development. In fact, it’s often the breadth of the PA’s support that residents appreciate most.

Supporting resident well-being is arguably a key and valued component of a PA’s role. The start of residency is a time of significant adjustment and can be a substantial stressor for learners. Many residents find it difficult to adjust to their new environment. It can be overwhelming for them to figure out how to organize their responsibilities with respect to the program, their family and friends, their health and so on. PAs will often help guide them through this transition. This includes being there for the residents in a variety of ways, such as serving as a part of their support system and acting as a sounding board. PAs are often a resident’s “go-to” person when they have a question or need. If residents have something going on in their personal or professional lives, PAs may be one of the first people to know about it. PAs are often ready to help residents connect with the support that they need.

PAs also help residents become comfortable accessing their academic material as required, and they ensure that residents’ clinical schedule reflects what they need to meet the requirements of the program. These processes and procedures are reinforced over the years to ensure that residents have been provided with everything they need to prepare themselves for independent practice.

PAs can also help promote opportunities for residents outside the program. For instance, they may gather and disseminate information from other centres about upcoming fellowships and career options. In addition, PAs may help to coordinate requests for residents to teach junior learners. PAs will also ensure residents are aware of other academic opportunities, such as electives and conferences.

Finally, PAs provide support when a resident is on an enhanced learning plan or undergoing remediation. PAs and PDs work closely together to ensure documentation is accurate and complete. The paper trail may be long, and often a lot of filing and tracking needs to be done to maintain a resident’s file. The goal is to ensure residents are well supported on their road to success.

Program design and change

PAs provide significant support when programs are being redesigned and changes are being implemented, such as during the transition to Competence by Design. Once changes have been implemented, PAs continue to ensure that their program is meeting the new requirements. Many PAs thrive in periods of change, as they get to use their creativity to innovate, collaborate and execute new and wonderful ideas for the program.

Scheduling

Another critical aspect of the PA’s job is scheduling. PAs participate in the coordination of residents’ clinical and academic schedules. This is a huge task, no matter the size of the program, and involves multiple considerations. Once the schedule has been completed it is imperative that it gets communicated to all stakeholders, and this is often the role of the PA. The PA’s goal is to make sure preceptors know to expect a given resident and that residents know where to go for each block.

Maintaining the academic schedule will also typically fall within the PA’s role. The PA may be responsible for ensuring that facilitators are available and scheduled for sessions, and for coordinating the logistics, including conferencing technology. Frequent communication regarding academic sessions ensures that residents are aware of where and when sessions will take place, and involved staff need to know that their residents will be leaving the clinic for their protected academic time. In addition, PAs gather and consolidate pertinent prereading material and make it available to residents in a timely manner. Building a schedule involves more than just putting pen to paper. It’s a multifaceted process that has been improved and perfected over time. Once PAs are comfortable with the overall schedule, they collaborate with their PD and seek confirmation and/or approval when necessary.

Working with PGME and university staff

The structure of the school will dictate how the program communicates and interacts with other areas of the institution. All postgraduate programs will report to the PGME office at their university. PAs will often interact with the PGME office on the program’s behalf and share required information. They will often serve as the information hub for their program, and they will know where to direct questions to obtain answers. PAs liaise extensively with a variety of offices (the list will vary, depending on the university’s structure) and act as a resource for many different groups. The PA can also liaise with appropriate offices related to equity, well-being, and help navigate policies regarding occupational health where appropriate.

Administrative duties

PAs need to ensure that the program runs smoothly. They may be involved in many tasks to varying degrees, such as assessing and processing residents’ requests for leave and coordinating payments and reimbursements for residents and faculty. Most PAs will do some type of administrative work, although their exact duties will differ from institution to institution.

One very important administrative responsibility relates to the organization of the meetings of various committees, such as the residency program committee and its subcommittees (e.g., the competence committee). Rooms need to be booked, invitations need to be sent and agenda items need to be compiled.

PAs play a major part in establishing, organizing and supporting the competence committee. They will meet with the competence committee chair to map out timelines for the scheduling of meetings on the basis of the residents’ progression through training.

Given that PAs are often at the front line of the program, their job may involve a significant amount of communication, including responding to a large volume of email messages on a daily basis. Many of the email messages they handle involve critical/sensitive issues that need to be dealt with. PAs are often entrusted with the authority to address many such issues without involving PGME management or their PD other than copying them on their response.

PAs take care of all the logistical aspects of the meetings, such as booking rooms, inviting members to attend the meetings and advising members of who is doing file reviews. They also pull together residents’ files for review. Depending on the institution, this may involve pulling files from various places and collating the documentation, or summarizing reports using graphs or charts (to provide committee members with something that is easier to digest than a lengthy Excel spreadsheet). Essentially, PAs consolidate information to make it easier for the academic advisors to do their job.

The PD and the PA — a dynamic duo

When a PA learns that a new PD will soon assume the helm of the program, many questions may come to the PA’s mind: How does this person work? What sort of involvement in the running of the program will the new PD want to have? Will this person respond to email messages within minutes, or is it more likely to take days to get a reply? Will the new PD have time to meet with me on a regular basis? Will I still have the autonomy and decision-making ability that I had with the outgoing PD? How long will it take to build a trusting relationship with the new PD? In the fullness of time, these and other questions will be answered, and the PA and PD get into a groove, but if a new PD is mindful of how their PA is feeling during the early part of their term it can make the transition period a bit smoother and less stressful for both of them.

The best programs are the ones where the PD and PA team establish a good working relationship. These relationships take time and energy to build, but the investment can and does reap benefits for the program overall. The best PA and PD teams have clear expectations of one another and they know the other person will deliver on their commitments. Although it can be challenging, it’s crucial for the PD and PA to ensure that they allocate sufficient one-on-one time for working together. Regularly scheduled meetings are the key to a successful working relationship with the PA: they will be one of the most important meetings of the week for both the PD and the PA. It is difficult to pick which of these words is more important: regular or scheduled. In the beginning, the meetings will help the PD and PA to build a strong, trusting working relationship, and they will help the new PD to get to know the ins and outs of the program. As the PD’s comfort level and experience with the program grows, these meetings will probably evolve into opportunities to discuss ways to build the program by implementing improvements and introducing innovations. Each meeting should have a set agenda, with both the PD and PA bringing issues to the table. These meetings will also promote job satisfaction as knowledge is shared and ideas are discussed regarding the future of the program. They will help both the PD and the PA to understand each other’s goals, and over time their expectations and priorities will be better aligned. These meetings will help to keep everyone informed, minimize unwanted surprises and improve efficiencies.

Setting your program’s PA up for success

PDs play an important role in ensuring that PAs are respected and valued in their role. Others will notice when you consult your PA on important decisions, when you give them autonomy to make decisions and when you have their back. Be mindful of how your actions will affect their ability to do their work and to take pride in that work. As the PD, you will help to ensure that the PA has the tools required to do their job well. In some cases, you will also help secure the support of others when and where it is needed. This could come in the form of administrative support, technological support, PGME office support, residency program committee support, competence committee chair support and of course support for professional development. You can also work to help your PA assess and improve their professional development needs through various opportunities for training and capacity building such as the Program Administrators’ Conference at the International Conference for Residency Education etc.,

To be successful, everyone needs to receive praise as well as constructive feedback from the people overseeing their work. When problems, gaps or pitfalls in the program requiring attention are identified, it is important that you and your PA work together to find strategies to fix them. You will need to work together to decide on a solution and may even need to present it to the residency program committee for review and/or approval. It may sometimes be necessary to have a difficult conversation with a resident, staff member or faculty member to help build better relationships. In some cases, you may need to talk to other PDs to see if any other programs have experienced similar issues and may be able to provide ideas for solutions. It is also important to create space to debrief challenging or emotional aspects of your work together.

Time management is challenging for everyone, but it cannot be overstated just how critical it is for you to make yourself available to your PA in time of need. PAs value PDs’ time and, as such, endeavour to make all meetings meaningful. It is crucial that regular, prescheduled one-on-one meetings remain a priority and that you avoid cancelling these meetings. Email is a useful form of communication, but it’s not enough: so much more gets done when there is a verbal conversation.

Finally, be mindful of the wellness of your PA. PAs are known to bend over backward for their residents and to go the extra mile to ensure their programs hum along. It’s easy to let them do these things, but their hard work sometimes comes at a cost that should not be overlooked. Work–life balance and wellness are as important for your PA as for everyone else in your program, so check in regularly to ensure that their work is manageable and rewarding. If it isn’t, then work with your PA to find workable solutions.

Conclusion

Remember that PAs are proactive, and they’ll happily take initiative within your program. Effective PAs see where things are working well and also highlight where improvements can be made. They see where there are gaps or holes in the program and they will make recommendations and suggest efficiencies to the appropriate people or group, to find solutions. Successful PAs take much pride in their program. Their ultimate goal is to make residents feel valued and to see “their” residents succeed. As such, PAs drive and strive for continuous improvement in the program. They may seek out feedback from the residents to learn what they think is working well and what isn’t, and they may look to the residency program committee for the same type of feedback. The desire to help to make the program the “best of its kind” is a key driver in the PA’s performance. This translates to unparalleled effort and high job satisfaction.

These few pages are just the highlight of what PAs across the country do for their programs. It’s impossible to overstate the impact that a positive relationship between you and your PA will have on your program. Given the ability and freedom to collaborate and innovate with each other and with other stakeholders, you will both experience personal growth and success. Working hard, working together and working with pride will deliver winning results for everyone involved.

Further reading

• Accreditation standards.  http://www.royalcollege.ca/rcsite/accreditation-pgme-programs/accreditation-residency-programs-e

A new system of residency accreditation, CanERA, was fully implemented and applies to all accreditation reviews.  For more information about CanERA, including access to the General Standards of Accreditation for Residency Program and General Standards of Accreditation for Institutions with Residency Programs (“CanERA general standards of accreditation”) please visit www.canera.ca.