The ecology of program director leadership: power relationships and characteristics of effective program directors

Abstract

BackgroundProgram directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors.Main bodyThis perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective.ConclusionKeen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States

“…5 Historically, a stable division of plastic surgery faculty and physicians has been important to the caliber and continuity of resident education. 13 Despite the increase in recent appointments of plastic surgery PDs, the average time served as PD is greater than 3 years, which corresponds to the recommendations set forth by the ACGME that PDs should fulfill their role for a few years to fully acclimate and provide stability for the residency program. 1 All integrated plastic surgery PDs have an MD degree.…”

“…With more than half of integrated plastic surgery PDs being appointed within the last 5 years, this may demonstrate high turnover in academic medicine and may be disadvantageous for residency programs that frequently have new PDs appointed 5 . Historically, a stable division of plastic surgery faculty and physicians has been important to the caliber and continuity of resident education 13 . Despite the increase in recent appointments of plastic surgery PDs, the average time served as PD is greater than 3 years, which corresponds to the recommendations set forth by the ACGME that PDs should fulfill their role for a few years to fully acclimate and provide stability for the residency program 1…”

The mediating role of residents’ wellbeing between program leadership and quality of care: A cross-sectional study

“…Currently, program director leadership has not been defined outside the notion of expert and informational leader in the Accreditation Council of Graduate Medical Education Common Program Requirements. The program director position, being a position of leadership by virtue, should not only organize and implement curricula and evaluate residents, but also support, engage and inspire them, to direct their behavior towards a common goal [ 16 ]. Hence, including direct program leadership support in studies assessing residents’ wellbeing and their performance is highly warranted.…”

Satisfaction and attrition in Canadian surgical training program leadership: a survey of program directors

“…In addition, PDs are responsible for dynamic resident support, serving as career counsellors and safeguarding the educational and emotional needs of trainees while balancing busy clinical practices, and ensuring clinical services are staffed to maximize both trainee learning and patient care. [1][2][3] Program directors of clinical programs in other medical specialties in Canada and the United States have been identified as being at increased risk for emotional exhaustion and burnout. 4,5 Consequent turnover can affect faculty, trainees and the quality of residency programs.…”