How To Select and Utilize Your Residency Leadership Team

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How To Select and Utilize Your Residency
Leadership Team

• E. Parker Hays, Jr. MD
• Carolinas Medical Center
• Charlotte, North Carolina

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Who Are You?

• Know your role, your strengths, your
  weaknessesand be honest.

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Job Descriptions

• Program Director
• Associate Program Director
• Assistant Residency Director
• Chief Residents
• Fellowship Directors
• Medical Student Director
• Other Residency-related Coordinators
• Didactics Coordinator
• Simulation Coordinator

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The Characters at Carolinas

• Associate PD (Jen Isenhour)
• Assistant RD (Mike Runyon)
• Residency Coordinator (Mary Fiorillo)
• Chair (John Marx)

• Associate PD (Jen Isenhour)
• Assistant RD (Mike Runyon)
• Residency Coordinator (Mary Fiorillo)
• Chair (John Marx)

• Associate PD (Jen Isenhour)
• Assistant RD (Mike Runyon)
• Residency Coordinator (Mary Fiorillo)
• Chair (John Marx)

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Associate Program Director

• Should be able to interchange with the PD
• Should complement the PD
• Should have a unified voice with the PD

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Associate Program Director

one-two punch n. 1. A combination of two blows
delivered in rapid succession in boxing,
especially a left lead followed by a right
cross. 2. Informal An especially forceful or
effective combination or sequence of two things.
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Associate Program Director

• Consider the big picture

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Assistant Residency Director

• Specific tasks in the core areas
• Specific tasks suited to the individual
• Specific classes?

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Chief Residents

• For whom are they working?
• A liaison between faculty and residents
• Scheduling
• Didactics, MMs
• Other significant tasks

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Chief Residents

• Have a written job description!
• Education
• MM, J Club, bedside
• Representation
• Faculty Mtg, Res Conf, Educ Cmt
• Administration
• On-call, schedules, Back-up/Vacation policy
• Recruitment
• Interviews, sched tours, night-before, slide show
• Orientation
• Coord new interns, rotators
• Benefits
• Shift/month, SAEM Chiefs Forum, dinners, undying
  love, etc.

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What Makes A Good Team

• Has clear objectives and a sense of purpose
• Has people with the relevant experience,
  capability and motivation to meet their
  objectives
• Performs the right work efficiently and can
  measure their success
• Has feedback mechanisms to continuously improve
  their performance
• Encourages members to contribute
• Develops the right methods for working together

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What Makes Good Team Members

• Get an old doctor who is really smartlike got
  straight As in collegesand a younger doctor who
  can learn fast on the team.
• Non-grumpy people who wont complain about
  whatever job you ask them to do.

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What Makes Good Team Members

• People who are good at it, whatever it is, but
  are fun and patient and wont cheat.

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Advice From Some Pros
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What Did They Say?

• Understand the behaviors of young faculty
• Newer grads expect to be able to apply the
  lessons learned without resistance, and those
  with leadership interest are usually
  aggressivePicking a junior faculty member often
  means a high-octane individual, but with
  pushback.
• Tell young members of your team your own career
  plans so they can plan for the future

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What Did They Say?

• Before going too far on a national search,
  looking at qualified, immediately available
  people at (y)our own institution is worthwhile.

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What Did They Say?

• Identify individual faculty strengths and use
  them
• Incredible mentor?
• APD, in charge of mentoring, feedback,
  remediation
• Great lecturer?
• Didactic coordinator
• Super organized, computer saavy, MBA or other
  training?
• APD for scheduling, block rotations, specific
  curriculum
• Enthusiastic, unfocused new grad?
• Simulation program, procedure labs, study guides

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What Did They Say?

• And conversely
• A brilliant lecturer and budding investigator?
• Doing the didactics, evals is a non-productive
  time sink. Take that away and put him/her in
  charge of the resident research program
• If you ask them to focus on their fortes, dont
  nickel and dime them with other stuff

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What Did They Say?

• Make sure they get along, and have some common
  thread to their leadership styles.
• Especially if they are in charge of different
  classes

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What Did They Say?

• Select the people that bring in the perspective
  and talents that will round out the teamas
  opposed to picking the person who is next in line
  or is making noise that makes it politically
  expedient to select them.

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What Did They Say?

• Have shared authority and responsibility. Five
  members, one person, one vote.
• Tasks are divided by preference-gtexpertise
  -gtseniority
• All are involved in decision making
• Once decisions are made, all support it
• All could function as independent PDs
• Requires trust, good communication, shared
  values, and constrained egos

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What Did They Say?

• Actively search for skills that you do not
  possess
• A good listener/dirt collector
• An OCD-driven metric person
• A negotiator
• A good recruiter
• And a glue person to make it all work smoothly

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What Did They Say?

• I am all business, know all the rules, and
  enforce the discipline.
• Joe is a great listener, has a touchy-feely
  management style, and gives the residents the
  warm fuzzies.
• I have no problem p--sing people off around the
  hospital if it is for the good of our residency
  (and sometimes just for fun).
• Joe is nice and everybody likes him.
• I am not terribly tolerant of rotating medical
  students...even the ones auditioning for a
  residency slot here (they slow me down).
• Joe is really nice to rotating medical students,
  and makes them feel welcome....hell, he makes
  them feel "like a valuable member of the team".
• I refuse to get involved in resident personal
  lives.
• Joe remembers birthdays and spouses/children's
  names.
• I don't hug.
• Joe hugs.
• My Pearl Know what you are good at...know what
  you are bad at. Find someone who does the stuff
  you are bad at really well. If you are lucky,
  that person will also be a great person,
  teammate, and friend (I lucked out).

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One Recent Version

• At Carolinas, we restructured our division last
  year and added new positions.
• How?

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Division of EducationDepartment of Emergency
Medicine

• Organizational Plan
• August 2008

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Division Of EducationMajor Areas of Involvement

• Medical Student Training
• Recruitment, Interviewing and Match
• Rotations and Curriculum
• Resident Evaluation and Counseling
• ACGME/RRC Accreditation
• Alumni Relations
• Fellowships

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1. Medical Student Training

• Selection of rotators
• Precepting, didactics, and evaluation
• Coordination of Resident Teaching Rotation

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2. Recruitment, Interviewing and Match

• Application Review
• Interviewing
• Rank List Formulation
• Match Coordination
• Websites
• FREIDA, EMRA databases

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3. Rotations and Curriculum

• Design of Program
• New Intern Materials
• Party, Class Trip
• Education Committee
• Committee Chair
• Rotational Feedback
• Feedback to Other Services
• Off-service Resident Education
• Didactic Curriculum
• Simulation Program

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4. Resident Evaluation and Counseling

• Incorporation Into Program
• Monthly Evaluations
• Annual Reviews
• Remediations
• Exit Interviews
• Summative Evaluations
• Job Counseling
• Recommendations

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5. ACGME/RRC Accreditation

• Annual Updates
• ACGME Resident Survey
• PIF Preparation and Site Visits
• Accreditation Communications

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6. Alumni Relations

• Database Maintenance
• Credentialing
• Recommendations
• Job Networking
• ACEP Dinner/Reception
• Website Alumni Page
• Future CME Meeting

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Personnel

• Hays Hs
• Isenhour Is
• Runyon Ru
• Pearson Pn
• Leuck Le
• Bullard Bd
• McBryde, others
• Fellowship Directors
• Chiefs
• Chair Mx

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Division of Education Organizational
Chart Revised 8/08
Chair (Mx)
Fellowship Directors
Program Director (Hs)
Associate Program Director (Is)
Chief Residents
Director of Medical Student Education (Ru)
Assistant Residency Director (Ru)
Residency Coordinator (Fi)
Director of Simulation (Le, Bd)
Director of Didactics (Pn)
Off-service Rotation Coordinator
Alumni Liaison
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Assistant Residency Director

• Application Review
• Interview
• Assist with Evaluations and Remediations
• Expanded roles by individual

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Division Of EducationMajor Areas of Involvement

• Medical Student Training (Ru)
• Recruitment, Interviewing and Match (Hs)
• Rotations and Curriculum (Is)
• Resident Evaluation and Counseling (Hs)
• ACGME/RRC Accreditation (Hs)
• Alumni Relations ( )
• Fellowships (Indiv. Directors)

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Got TeamNow What?

• A regular system of meetings and communication
• Make an agenda, keep minutes
• Regular interaction with the residency as a whole

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Mentoring Your Team Members

• Have a clue what your own career goals are
• Know their aspirations
• Create opportunity for them
• Seek their feedback
• Place unrest close to yourself
• Shackletons Way

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Take this home

• Know who you are first
• Find the right partner
• Clearly define the roles of team members
• Empower them, but with lines of reporting
• Structure your team to your institution and its
  missions
• Enjoy the privilege of leadership

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Thanks and Bon Chance