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Transforming from Coordinator to Manager: Essential Responsibilities of a Successful Residency Program Manager

Published:October 10, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.09.001
      Perspective Viewpoints
      • The role of program manager continues to grow in complexity with increased knowledge and training now needed to become a productive and thriving member of the program leadership team.
      • This comprehensive job description endorsed by the Alliance for Academic Internal Medicine is a tool that will aid in position classification and hiring by human resources and other officials who may not fully understand graduate medical education.
      • This standardized job description and baseline qualifications allow for programs to recruit and retain individuals who will be successful in running the day-to-day operations of the program.
      • This standardized job description may help programs determine if they have enough full-time equivalent dedicated time and support under the new Accreditation Council for Graduate Medical Education (ACGME) requirements effective July 1, 2022.

      Introduction

      In 2002, the Accreditation Council for Graduate Medical Education (ACGME) instituted the Outcome Project, which established 6 core competencies for residency education and changed the scope and depth of the program director and program coordinator responsibilities dramatically.
      • Swing SR.
      The ACGME outcome project: retrospective and prospective.
      The paradigm shift changed the ACGME-defined program coordinator role from primarily clerical/secretarial in nature to a managerial one, necessitating specialized knowledge of ACGME requirements, project management skills, and the ability to function as an integral part of the program leadership team. A testament to the evolution of this position is the creation of a professional certification, Training Administrators for Graduate Medicine Education (TAGME),

      Training Administrators for Graduate Medical Education (TAGME). Available at: https://tagme.org/how-to-apply/get-certified. Accessed May 5, 2022.

      that can be achieved through experience, education, leadership, and scholarship. Because of the increasing demands and complexity related to the role, this article will refer to the program coordinator position as program manager to better match the demanding job description to the actual performance required of the position.
      • Gilfedder KR
      • Giacomo C
      • Randall J
      • Wilson GL.
      Medical education manager: a title worthy of the description.
      The role of the program manager has changed significantly and now includes additional responsibilities in which increased knowledge and training is needed to become a productive and thriving member of the leadership team. A comprehensive standardized job description will help recruiters better recognize the depth and complexity of the position and realize the qualities needed to hire (and potentially retain) individuals who will be successfully fulfill this role.

      Program Manager Job Description

      ACGME recognizes the program manager as an essential member of the leadership team critical to the success of the program. The program manager handles the day-to-day operations of the program, ensures compliance with the accreditation board and institutional deadlines, and serves as an important liaison among learners, faculty, other staff members and ACGME.

      Accreditation Council of Graduate Medical Education. Common program requirements for residency II.C.2. Background and intent effective Jul 1, 2021. Available at: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency2021.pdf. Accessed May 5, 2022.

      Residency and fellowship program managers work under the direction of and in conjunction with the Program Director. They may also work under an institutional graduate medical education (GME) office or another institutional entity that oversees training. Many fellowship program managers are supervised by division administrators who may not comprehend the complex requirements involved or the responsibilities of a program manager.
      The responsibilities of the residency or fellowship program manager vary greatly among institutions as well as among programs within the same institution. Recently, ACGME released full-time equivalent (FTE) guidelines related to the program manager and additional administrative support.

      Accreditation Council for Graduate Medical Education. Program requirements for graduate medical education in internal medicine, residency II.C. Program coordinator. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2022v3.pdf. Accessed May 5, 2022.

      It is important to define and outline the responsibilities that are routinely performed by program managers across the country. With the input of these program managers, the Alliance for Academic Internal Medicine (AAIM) supported the creation of a program manager job description.

      Alliance for Academic Internal Medicine (AAIM). Job description for a successful residency program manager. job description: residency program manager - AAIM. Available at: https://www.im.org/about/governance/constituent-councils/program-admin/residency-program-mgr-description. Accessed May 5, 2022.

      AAIM is a national organization representing educators and administrators from all specialties of internal medicine in both undergraduate medical education and GME. AAIM empowers academic internal medicine professionals through professional development and enhances health care through research and collaborative efforts with stakeholders on key issues impacting internal medicine academia and its communities.
      Although the program manager job description is lengthy, the list is essential for educating those unfamiliar with the demands of managing a GME program or tasked with supervising individuals in the role. Not every residency or fellowship program manager is directly responsible for all of the tasks listed in the job description, but experienced program managers are often required to do most, if not all, of these duties. The foundation for understanding the skills needed to be a successful program manager starts with understanding the key components of the job responsibilities as outlined in Table 1.
      Table 1Key Components of Job Responsibilities
      For full job description endorsed by AAIM, see https://www.im.org/about/governance/constituent-councils/program-admin/residency-program-mgr-description.
      Administrative

      Executes institutional or program activities with high degree of independence; partners with PD in operational and financial management of program.
      Clinical Experience and Educational Schedules

      Creates/Monitors trainee schedules and manages rotation schedules throughout year; monitors compliance of work hours.
      Credentialing

      Provides detailed info about the physicians who trained in the program; ensures state licensure requirements are met; maintains documentation for board eligibility.
      Evaluation

      Assists in development of evaluations and ensures completion; attends CCC to take minutes/track action plans; submits milestones to ACGME and board entities.
      Didactics and Educational Content

      Works with PD to ensure didactics cover deficiencies seen in both in-training and board exams; schedules didactics and speakers; tracks and enters trainee and faculty scholarly activity in ADS.
      Faculty

      Trains and enrolls faculty in residency management system; compiles faculty evaluation data used for annual evaluation of teaching effectiveness; tracks activities of core faculty for annual reporting.
      Finance

      Creates GME budget with projected rotation schedule, off-cycle training, and grant participation; monitors operation income and expenses; processes vendor payments; and completes budget control reports.
      Human Resources

      Issues contracts, new hire, promotion, or termination documents; advises trainees, faculty, and staff on HR, recruitment, and visa issues; consults legal counsel on hiring and disciplinary actions; manages and trains other staff assigned to program.
      Information Technology

      Develops program-related marketing materials, forms and reports; develops and maintains multiple databases for documentation required by ACGME; trains faculty and staff on use of the residency management system, ADS, ERAS, NRMP, FREIDA and other board reporting sites.
      Medical Students, if applicable

      If no dedicated student coordinator, arranges student electives, rotations, didactics, orientation, and evaluations of the medical students.
      Recruiting/Onboarding

      Ensures recruitment requirements meet institutional and ACGME guidelines; coordinates all recruiting interviews, ranking meetings, and adequate match quota; reviews credentialing documents and resolves issues as they arise; develops orientation processes as needed.
      Program Accreditation

      Advises PD on issues related to the requirements from accreditation agencies, national boards and governing bodies; sits on Program Evaluation Committee; critically evaluates program information in preparation for annual ACGME ADS update.
      Wellness

      Coordinates wellness activities; monitors trainees for signs of excessive fatigue and burnout; refers appropriate resources as needed.
      Professional Development

      Investigates and keeps apprised of requirements and changes within the specialty; updates PD of GME trends; may mentor others; may attend or present at local, state, or national conferences.
      Other

      Participates with development of DEI policy and practices; assesses training program strengths and weaknesses and makes recommendations; may assist with military-specific requirements as needed.
      ACGME = Accreditation Council of Graduate Medical Education; ADS = Accreditation Data System; CCC = Clinical Competency Committee; DEI = diversity, equity, and inclusion; ERAS = Electronic Residency Application Service; FREIDA = Fellowship and Residency Electronic Interactive Database; GME = graduate medical education; HR = human resources; NRMP = National Residency Matching Program; PD = program director.

      Knowledge, Skills, and Abilities

      A standardized job description and baseline qualifications for experience and education allow for programs to recruit and retain individuals capable of managing a residency alongside the program director (Figure 1). AAIM recommends these levels to elevate the position to match the responsibilities. Although there is no specific degree in GME management, human resource departments often require a degree for higher level (eg, manager) positions. Additionally, a program manager applicant must be skilled in administrative leadership to succeed in the job.
      In addition to the recommended experience and educational background, certain knowledge, skills, and abilities are necessary for a successful program manager (Figure 2).
      Figure 2
      Figure 2Essential knowledge, skills and abilities of a program manager.

      Knowledge

      The program manager must have in-depth knowledge of accreditation and board certification requirements to be able to advise the program director and learners of changes or proposed action items related to those requirements. Additionally, program managers are often asked about policies relating to human resource management, licensure rules, institutional and program policies, financial guidelines, and recruitment matters and systems. Because the program manager is frequently the first point of contact for learners, it is important that the program manager be committed to continuing knowledge development in all these areas.

      Skills

      The program manager is responsible for creating and analyzing databases, developing program-related educational or marketing materials, generating data metrics, and training faculty, residents, and other coworkers in the use of program software. Strong technological skills are crucial to mastering a residency database system, compiling and presenting data, and overseeing successful recruitment seasons as well as a multitude of other duties in the program manager job description.
      Another important skill is budget and financial planning. Program managers need to understand complex budgets and funding sources to not exceed their institutional funding for FTEs and financial budgets for program events, office supplies, recruitment activities, travel, and so on.
      Conflict management and relationship building are crucial. Remediation is part of all training programs, and the program manager plays a leadership role in achieving remediation. The program manager serves as counselor and advisor to both program directors and learners in remediation cases. Furthermore, many program managers oversee other staff members. As a key member of the leadership team, management and organization skills in all these areas are critical to the success of the program.

      Abilities

      What makes the residency and fellowship program manager such an important part of the program leadership team is the effective use of interpersonal aptitudes. A program manager's ability to adapt to the rapidly evolving environment of GME and to clearly communicate and partner with the program director, learners, GME office/institutional entities, and ACGME or other accrediting bodies is what makes the program manager essential to the smooth operation of any program.
      Additionally, the program manager is usually the first point of contact for program recruits; these interactions can make significant impacts on candidate rank lists. Program managers must be able to multitask, prioritize, and solve problems on a daily basis while maintaining a positive and calm demeanor with all the program stakeholders. Only self-motivated and proactive individuals will succeed in the program manager position.
      Program managers are thinking about what is coming up next month, in 3 months, in 6 months, and 12 months, all at the same time. They are quietly watching their learners for signs of burnout, and it is not uncommon for program managers to be the first ones to recognize potential problems. Although running an efficient office and leading a program that exceeds ACGME requirements is a goal for all residency and fellowship program managers, there is also the desire to ensure an environment where learners thrive.

      Program Manager Burnout

      Like learner and program director burnout, program manager burnout is becoming more common. GME continues to evolve in complexity, leading to additional responsibilities without additional administrative support.
      • Fountain D
      • Quach C
      • Norton D
      • et al.
      The perfect storm is on the horizon!.
      Furthermore, lack of recognition as a managerial-level position makes it more difficult to recruit and retain qualified individuals.
      Table 2 displays results from the 2018 and 2019 Association of Program Directors in Internal Medicine (APDIM) Program Administrators Annual Survey; APDIM is a founding member of the Alliance and encompasses the residency program faculty and staff. Program managers are passionate, loyal, and dedicated to their programs and learners. However, 75% of program managers work in excess of 40 hours a week, most without compensation for those extra hours. Thirty-five percent report that the need for overtime is due to a lack of appropriate administrative support to manage the program. Almost one-half of program managers report they have considered resigning their positions in the last year, and one-quarter meet the screening criteria for burnout (two-item Maslach Burnout Inventory).

      Alliance for Academic Internal Medicine (AAIM). Alliance Submits Comments on Proposed ACGME Section II CPR Revisions. 2021. https://www.im.org/news/advocacy#acgmeCPR. Accessed May 5, 2022.

      Table 2APDIM Program Administrator's Annual Survey
      Select results of the 2018 and 2019 APDIM Program Administrator's Annual Survey. The 2018 Annual Survey was granted exempt status from human subjects research review by the Northwell System Office of the Institutional Review Board (IRB). The 2019 Annual Survey was granted exempt status by Pearl IRB (study #18-AAIM-104).
      20182019
      Met criteria for burnout
      Screening for burnout was determined by respondents who reported “once a week” or more often to 1 or both of the following questions from the Maslach Burnout Inventory-Human Services Survey, which has been recognized for its factorial validity (see citations that follow): How often do you feel burned out from work? and How often do you feel you've become more callous toward people since you took this job? See Maslach, Christina and Susan E. Jackson, MBI-Human Services Survey (published by Mind Garden, Inc., www.mindgarden.com, 1983), and Wilmar B. Schaufeli and Dirk Van Dierendonck, The construct validity of two burnout measures, Journal of Organizational Behavior 1993;14(7):631-647.
      24% (95% CI: 20-28)26% (95% CI: 22-31)
      Considered resigning42% (95% CI: 36-49)49% (95% CI: 42-56)
      Worked more than 40 hours a week83% (95% Ci: 78-87)91% (95% CI: 87-93)
      Not compensated for work more than 40 hours a week68% (95% CI: 61-74)63% (95% CI: 57-68)
      Working more than 40 hours due to lack of appropriate administrative support for the program46% (95% CI: 39-53)40% (95%: 35-44)
      APDIM = Association of Program Directors in Internal Medicine; CI = confidence interval.
      Note: In 2019, 123 program coordinators reported their program(s) increasing in size in the past 5 years; 95 reported that there was no increase in administrative support to support program size change.
      low asterisk Select results of the 2018 and 2019 APDIM Program Administrator's Annual Survey. The 2018 Annual Survey was granted exempt status from human subjects research review by the Northwell System Office of the Institutional Review Board (IRB). The 2019 Annual Survey was granted exempt status by Pearl IRB (study #18-AAIM-104).
      Screening for burnout was determined by respondents who reported “once a week” or more often to 1 or both of the following questions from the Maslach Burnout Inventory-Human Services Survey, which has been recognized for its factorial validity (see citations that follow): How often do you feel burned out from work? and How often do you feel you've become more callous toward people since you took this job? See Maslach, Christina and Susan E. Jackson, MBI-Human Services Survey (published by Mind Garden, Inc., www.mindgarden.com, 1983), and Wilmar B. Schaufeli and Dirk Van Dierendonck, The construct validity of two burnout measures, Journal of Organizational Behavior 1993;14(7):631-647.

      ACGME FTE Revision

      Table 2 demonstrates that in 2019, 123 program coordinators reported their program(s) had increased in size in the last 5 years. Yet, more than 75% of those programs showed no correlated increase in administrative support for the program.
      In February 2022, ACGME released new guidelines regarding dedicated time and support needed for the administrative efforts required of a program manager, which are based on size of the training program.

      Accreditation Council for Graduate Medical Education. Program requirements for graduate medical education in internal medicine, residency II.C. Program coordinator. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2022v3.pdf. Accessed May 5, 2022.

      These FTE requirements were effective July 1, 2022, and will be enforced July 1, 2024. The requirements are different for each discipline; for internal medicine and all of its subspecialties, the program manager base dedicated time and support for residency programs is 0.5 FTE and for fellowships is 0.3 FTE, regardless of the program size. The ACGME guidelines denote additional administrative FTEs for residency programs that range from 0 for less than 7 residents to an additional 4.6 if the program has more than 226 residents. Fellowship program additional FTEs support ranges from 0 for less than 3 fellows and reaches 1.16 for more than 46 fellows. For example, a residency program approved for 126 residents would need the base FTE of 0.5 plus additional aggregate support specified for administration based on the size of the program, which is 2.6 FTE in this case. The total amount of FTE required to support a residency program of 126 trainees is the equivalent of 3.1 full-time employees.
      The AAIM program manager job description can help programs determine if they have enough FTE dedicated time and support as required by ACGME to successfully run their training program. Additionally, this FTE requirement should be revisited each time the program complement increases.
      A potential unintended consequence of ACGME's FTE requirements for the program manager and additional administrative support may be fewer people hired at the level of program manager, supplementing that time with lower-level office assistant positions. Concerns arise that institutions will only view program accreditation activities as those duties that fall under the program manager. There are many important program activities that are not directly related to accreditation but are essential to successful management of a training program. For example, recruitment is not a topic in the ACGME program requirements, but it is an important activity for GME programs. All essential duties are important in the management of a program. A decrease in FTE of the program manager could have catastrophic consequences related to program manager burnout and retention.

      Conclusion

      The program manager is an indispensable leader of residency and fellowship training programs and deserves recognition that matches the job description. The comprehensive job description highlights the essential duties for program managers and demonstrates the importance and complexity of this position. Due to the annual variation, fulling training a residency or fellowship program manager takes multiple years, which further dictates the importance of preventing burnout often caused by lack of administrative support and improper classification of the program manager position. This comprehensive job description is a tool that will aid in position classification and hiring by human resources and department officials who may not fully understand GME. As institutions evaluate positions related to GME management, consideration should be given to the rigorous responsibilities required when determining FTE needed to perform these demanding duties. Appropriate recognition and support of the program manager role is essential to retaining our successful program managers.

      Acknowledgments

      The authors thank Lisa Willett, MD, MACM (University of Alabama at Birmingham) and Cara Giacomo (Greenwich Hospital/Yale New Haven Health) for their support and contributions to this manuscript.

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        Medical education manager: a title worthy of the description.
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      3. Accreditation Council for Graduate Medical Education. Program requirements for graduate medical education in internal medicine, residency II.C. Program coordinator. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2022v3.pdf. Accessed May 5, 2022.

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        The perfect storm is on the horizon!.
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