Strategies to Enhance GME Program Coordinator Job Satisfaction and Well-Being
Introduction
Program and institutional coordinators in graduate medical education (GME) have very complex jobs that are often highly pressured and demanding, requiring a diverse skill set to manage effectively. While these positions can be immensely gratifying, the demands and pressures inherent in the roles pose threats to job satisfaction as well as risks to mental health and well-being. A national survey of 6372 coordinators found that 20.4% reported being dissatisfied or very dissatisfied with work, and 27.9% reported being likely or very likely to leave their job in the next year.1 Of the coordinators surveyed 36.3% screened positive for burnout, 23.9% reported moderate to severe symptoms of depression, and 30.5% reported moderate to severe anxiety symptoms. The survey also explored potential stressors as well as satisfiers in the work environment that can contribute to distress, and conversely, satisfaction with work, with the hope that these could be potential targets for intervention. This article and a companion webpage under construction at Learn at ACGME2 are intended to begin that process, highlighting potential approaches already in place across the country designed to reduce stressors/dissatisfiers and enhance coordinator work lives.
The approaches described below are organized into 7 categories:
Interactions and relationships with residents, fellows, faculty, and leadership
Workload, work efficiency, work flexibility, and work pressure
Community and professional development
Self-advocacy
Meaning in work
Maladaptive perfectionism and other problematic mindsets
Data gathering to inform interventions
One important caveat to state before describing potential interventions—significant differences exist between institutions and programs relating to size and resources, so not all the strategies outlined below may be feasible in all institutions or programs.
Interactions and Relationships With Residents, Fellows, Faculty, and Leadership
Reminding and Tracking Down Residents and Faculty to Complete Required Tasks
These duties were the highest and third highest rated stressor/dissatisfier respectively in the coordinator well-being survey; however, interventions can be implemented to reduce this stressor and improve coordinator satisfaction. Proactively setting professional expectations for residents, fellows, and faculty can aid in timely completion of tasks. Successfully setting expectations is largely dependent on effective communication. Critical skills in communication include being clear and concise, preparing ahead of time to ensure you communicate clearly and calmly, being mindful of nonverbal cues and tone, and practicing active listening. Support, endorsement, and alignment in this messaging by program directors (PDs) are crucial.
Expectations also need to be clearly made to faculty with support from the PD, department chair, or division chief. One coordinator stated, “Expectation setting with faculty can drastically improve things. I’ve worked for 2 different divisions, and my level of frustration significantly decreased when the chief and PD made it clear that faculty (and fellows) needed to respond to my requests by the due dates.” Setting expectations may not always be sufficient, however, and may require making use of existing departmental hierarchies. In one program, if faculty do not meet deadlines for the annual list of scholarly activities, the coordinator reports noncompliant faculty to the department chairperson who then reinforces the expectation. Coordinators should be viewed as leaders in their own right, equipped with the authority to set expectations, manage relationships, and ensure alignment with Accreditation Council for Graduate Medical Education (ACGME) requirements. However, the approach of acting independently while strategically involving hierarchy as needed maximizes efficacy and reinforces coordinators’ critical role in program success.
Fostering Positive, Professional, and Respectful Interactions With Residents and Faculty
Expectations by PDs and department chairs for respectful behavior should be made clear, and unprofessional behavior should not be acceptable. Some programs include coordinators in evaluations of resident professionalism; others track compliance with required tasks on a quarterly basis to provide objective evidence of resident professional behavior. Professionalism is a critical competency, and issues should be identified and remediated early with coordinator involvement key in the process.
Inclusion in Leadership
The ACGME Common Program Requirements state that “the program coordinator is a key member of the leadership team.”3 Coordinators should be afforded the respect of other leadership team members. They should be included in institutional GME Committee meetings, and their input should be actively sought.
Workload, Work Efficiency, Work Flexibility, and Work Pressure
Workload
Effective communication with PDs and other supervisors is key to managing workload. Although sometimes difficult, coordinators should try to set appropriate boundaries and should not agree to unrealistic expectations or inappropriate job duties. Establishing and maintaining boundaries is not only appropriate, but necessary to maintain a healthy work-life balance and prevent burnout. Coordinators should clearly communicate their expectations for their availability after hours. When possible, coordinators should look for appropriate opportunities to delegate tasks.
Ideally, some kind of coverage should exist for vacation or personal leave, but the capacity to provide this may depend on the size of the institution/program. Coordinators may need to advocate for this or work out coverage strategies with colleagues.
Work Efficiency
Task automation has the potential to improve workflow and reduce the amount of time spent on various duties. Numerous resources exist that can be utilized, and coordinators can begin by familiarizing themselves with those that are available in their program/institution. For instance, utilizing QR codes or an automated system to track attendance at conferences, creating electronic forms to obtain information and/or signatures, and generating automated email reminders as well as automated reports to monitor work hour compliance and evaluation completion rates can increase efficiency and reduce stress. Coordinators should try to plan ahead as much as possible, setting reminders and creating and maintaining detailed checklists that include tasks, who is responsible, and completion deadlines. To support this planning process, Residency, Fellowship, and Institutional Coordinator timelines, a Program Coordinator Handbook, and a link to a free online learning path are available from the ACGME.4
Flexibility of Schedules
While traditional in-office hours have historically been the norm, in recent years many workers have benefited from hybrid schedules that allow for some remote work. Remote work can boost efficiency by providing dedicated time blocks for tasks that need extended focus.
Work Pressure
Many coordinators may feel a desire to be a “superhero,” taking initiative alone to tackle complex problems with multifaceted challenges and potential outcomes. While an admirable trait in many ways that can feel satisfying, this can ultimately lead to exhaustion and burnout. Handling work pressure requires a number of elements including resilience, ability to break down and prioritize tasks, and the ability to recognize goals that are realistic and achievable. This means setting boundaries, claiming protected time, accepting error and imperfection, communicating clearly to avoid misunderstandings, recognizing opportunities for growth, and engaging in stress relief practices.
Community and Professional Development
One of the primary drivers of growth, improvement, and job satisfaction is community formation. Participating in a professional network of individuals who share similar roles can foster a sense of collegial spirit that can be a source of much needed support. A network allows individuals to feel a sense of belonging, foster growth, share knowledge, promote collaboration, increase advocacy, and provide personal and professional support to one another. A network can vary in size, structure, and formality, with no single approach being better than another. Sometimes individuals may need to build or form their own network(s), although existing organized networks based on role, specialty, or geographic location can readily be joined.
Joining a professional network can facilitate mentoring, which may be particularly helpful early in one’s career. Entering a new role within medical education can often be overwhelming. By finding experienced individuals in similar roles, one can form mutually beneficial mentoring relationships. The mentor may have more professional expertise to share, and often the act of mentoring itself can foster an enhanced sense of community and job satisfaction, contributing to a sense of excitement in the work being done. Mentees can also share knowledge they have that the mentor may not. By engaging with others in networks, both formal and informal, individuals are more likely to find success and satisfaction in their work.
Significant professional development opportunities exist within the medical education community. The field of medical education is constantly evolving, and maintaining competence requires continuous learning. Numerous opportunities are available, many at no cost, relating to topics such as accreditation, residency management systems, software program utilization, leadership development, finance, and artificial intelligence. Although many are available at a national level, state-wide/metropolitan and institutional-level opportunities exist in many places that can support connection, mentoring, and professional development.
One of the more challenging professional aspects of the program coordinator role is in navigating relationships. Often, the coordinator becomes not only a member of the program or institutional leadership team, but also a confidante, intermediary, disciplinarian, and mentor. Developing skills for these complex roles can take deliberate effort but may be very beneficial to coordinators and those they are trying to help. Examples of beneficial skills include psychological first aid, providing effective feedback, and managing difficult conversations. Often, when individuals improve their competence in their role through development of new skills, they are more likely to experience enhanced job satisfaction, improved confidence, greater engagement, opportunities for career advancement, and ultimately improved job performance.
Self-Advocacy
Self-advocacy is required to ensure success in the program coordinator role. Self-advocacy involves communicating one’s worth, opinions, and concerns, as well as giving input on decisions that can significantly impact one’s life. Acknowledging one’s strengths, weaknesses, and needs is the first step to self-advocacy. Incorporating self-advocacy in the workplace can be beneficial in salary negotiations, promotions, professional development, and education support. In order to self-advocate, coordinators need to possess a strong knowledge of their roles, responsibilities, and job expectations, as well as their rights as employees.
Effective communication skills are also essential for self-advocacy. When advocating for oneself, difficult conversations may be necessary. These types of conversations with leadership and trainees, while challenging and potentially uncomfortable, can help build solid professional relationships that are beneficial to all parties. Potential areas for self-advocacy include ensuring a voice in decision-making (eg, GME Committee meetings, program-level meetings), establishing boundaries (personal and professional), and validating the position as one worthy of respect from faculty and trainees.
Self-advocacy is greatly enhanced by having allies. It is equally important to be an ally to others through mentorship of junior coordinators and advocating for the needs of others who may be marginalized in medicine.
Meaning in Work
Work becomes meaningful when individuals feel they have made a positive impact, whether through personal achievements, meaningful interactions, or contributing to their organization’s mission. While moments of meaning can be episodic, they can be cultivated intentionally. One approach is a practice called “3 good things.” At the end of the day, in a bedside journal, one can write down 3 good things that happened that day. Another approach that can be taken in conversations with others (as well as in meetings) is appreciative inquiry, which focuses on identifying successes and strengths, shifting the focus from problems to possibilities, and fostering a positive, impactful work environment.
Coordinators can also find meaning through continuous professional development. New coordinators may focus on mastering core skills, while experienced professionals can find purpose in mentoring, leadership roles, or leading change to improve workflows and program culture.
Equally important is respecting personal time away from work. Healthy boundaries, rest, and engagement in fulfilling activities prevent burnout and enhance creativity. Ultimately, creating meaningful work experiences requires self-reflecting, aligning with personal values, and pursuing growth.
Maladaptive Perfectionism and Other Problematic Mindsets
Common and problematic mindsets (eg, maladaptive perfectionism, impostor phenomenon, and toxic comparison) can all add to the distress caused by a less-than-ideal work environment. Individuals can learn to manage these mindsets so that they produce less distress by working one-on-one with coaches, mentors and/or therapists. A video workshop for coordinators is available at Learn at ACGME.5
Data Gathering to Inform Interventions
Surveys
Understanding the fundamental stressors of coordinators is critical in ensuring that coordinators feel satisfied and fulfilled in their positions. Surveys and other forms of data gathering can help achieve this understanding. While large scale national survey studies have been conducted that have helped categorize the degree of burnout and overall well-being of coordinators across the country, local surveys and other forms of data gathering can also be conducted at the institutional and departmental levels to assess coordinator job satisfaction and well-being, identify sources of stress and satisfaction, and find ideas for needed interventions and programming. Brief survey instruments can be followed by deeper dives to explore areas more qualitatively in focus groups and one-on-one conversations. For example, if a survey finds that coordinators have a low sense of community and belonging, the sources of this as well as potential solutions can be explored in meetings and conversations that can then guide needed action.
Conclusion
Program coordinators in GME face substantial pressures and stress in their positions. Efforts to improve their job satisfaction, reduce turnover, and improve their mental health are of vital importance for GME. This article is intended to be a step in that direction that can be built upon in institutions and programs across the country.
Author Notes
