Program Director’s Corner – July 2018
My Advice to New Program Directors
Dr. Richard Auchus
rauchus@med.umich.edu
Program Director
University of Michigan
I am hardly the most qualified to advise people how to be a PD. As my swan song, for what it is worth, this is what I have learned over the last 7 years.
Becoming a Program Director is a lot like becoming a parent for the first time. When you got the news, you were elated and could not wait for the day. When the day/child arrives, you are suddenly overwhelmed, and your life is never the same. Neither event comes with an instruction book like “How to be a Program Director.” You learn the jargon, requirements, and pitfalls on the fly. We all have a thousand other duties, and just when you thought the program was on auto-pilot, a new problem rears its ugly head. So here go the top 10 tips, in no particular order:
#1: Recognize what is important and what is not – prioritize your efforts.
No program is perfect, but some problems can shut you down. If any serious violations were identified on your last external or internal review, these have to be resolved and resolved quickly. Examples include problems with duty hours, supervision, curriculum gaps, and fellows dropping out of the program. You will have hundreds of decisions to make, like final rank list (matters) to what lunch to serve applicants (does not matter). Take your time on what matters, and delegate or flip a coin on the rest.
#2: The fellows need to recognize you as their advocate.
Like soldiers going into battle, you will have to convince fellows to do a lot of duties they do not want to do, and they will have many complaints and suggestions. In fact, many of their comments are totally valid and can improve the program. Ask them to propose solutions, and you might be surprised how close to the mark they will come. You will not be able to fix everything, but if you fix one or two things a year, you will be a hero. You have to listen, and they need to know that you are trying.
#3: Your Program Coordinator knows more than you do.
Unless your Program Coordinator is also new (bad, bad idea to switch both together), the Program Coordinator can keep you on track and out of trouble. Let him/her tell you what priorities and deadlines are coming at each month. Find out where you had problems with the Annual Program Evaluation (APE) and plan the first baby steps to address together. Never, never dismiss the email or call that starts, “We have a problem…” – although often there can be a quick fix if you prioritize well.
#4: Get help.
If you are so fortunate to inherit a program that is swimmingly successful and fully compliant, you have hit the jackpot. For the rest of us, this is not a one-person job. Senior faculty are helpful for institutional memory but are often out of touch with current regulations (“…when I was a fellow we had to….”). Junior and mid-career faculty who like to work with fellows will jump at the chance to do something substantive that they believe in. Ask the investigators to help with research and the clinician-educators to do the Mini-CEX’s. Explore the possibility of an Associate Program Director, but realize that this position will require funded effort – and it might mean splitting yours! Also identify 1-3 experienced Program Directors for other fellowships in your department who really know what they are doing. Invite them to lunch, pick their brain, and see what works for them where you are. They will be perhaps your most vital asset.
#5: Set the highest standards you can and do not compromise.
Never take an unqualified fellow to fill a slot. You will drag everyone else down. Never tolerate people who do not recognize your authority – you are their boss, not their friend, although hopefully you will be both towards the end. Recognize success publically and failure privately. See my Oct 2017 PD’s corner on Remediation for more details.
#6: Realize that you never have to be perfect, just getting better.
It took me about 4 years to realize that the APE process is really like Quality Improvement: Plan-Do-Study-Act. Like those function limits in Calculus class, you can iterate a hundred times, and as long as you keep getting closer, you never have to get there. The trick is not to deteriorate in other categories while you are trying to fix 2-3 others in a given year. Like we say in mass spectrometry regarding assay optimization, “You are never done.”
#7: Be chummy with your local GME head/Designated Institutional Official (DIO).
I have slept or written manuscripts thru many an institutional GME meeting in the back row (but not all for sure – it is also a good time to do institutional web-based compliance training). Still, make it a point before or after to introduce yourself to the DIO and make sure they know who you are. You will need their help eventually. Do not be afraid to brag about what your program has accomplished, but always report that your program is under-resourced when surveyed – the squeaky wheel gets the grease.
#8: You cannot teach a pig to sing. It frustrates you and annoys the pig.
Perhaps one of the most valuable lessons I have learned in academic medicine from Phil Majerus, MD at Washington U when I was an MSTP student. If you have a faculty member who refuses repeatedly to comply with standards for evaluations, supervision, or learning objectives, it is not going to happen. Either do it yourself if you can, or drop him/her from the rotations. If your requests for resources are denied repeatedly from an administrator who just does not get it, then ask someone else or repackage and disguise your request to address something they care about.
#9: Use APDEM!
There is no point in re-inventing the wheel. APDEM has made tremendous strides during the short time that I have been involved in providing resources, best practices, and networking for Program Directors. You cannot plagiarize facts, but you can shamelessly take templates and ideas. Guess what – nobody cares if it was not your idea! We are all in this boat together, and if we each do a little, we all get a lot.
#10: Be the role model.
Maintain 100% honesty and integrity. Never, ever go back on your word. You might have promised something that for reasons beyond your control you cannot deliver, and fellows will understand that. On the other hand, if you intentionally deceive your fellows, you are finished, and your program will get a bad name. Take responsibility and be accountable. It is OK to joke around about the system, but do not be a hypercritical whiner in front of them. Word gets around today at the speed of light, and there are no secrets. Fellows will emulate what you show them.
I am still open for comments and questions, and I will see you at ENDO and AACE.
Signing Off,
Rich Auchus