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.
Highlights
Towards an ecological approach to program director (PD) leadership One of the central tenets of leadership theory is that leadership is not defined by position, but rather by commensal relationships with their followers, whereby they are expected to rise up to the expectations of followers and others within the enterprise [4]
System, and the community-at-large (Fig. 1). This creates a set of complex power relationships that influence the characteristics of effective PD leadership, such as authority, accessibility, adaptability, authenticity, accountability, and autonomy (Table 1) [2]
PD leadership is not well-defined outside of the Accreditation Council for Graduate Medical Education’s (ACGME’s) Common Program Requirements. This may change in the near future as the ACGME and the Organization of Program Directors Associations hosted a summit to begin to develop consensus on key aspects of successful program directors [3]
Summary
Keen 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
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