Rheumatologist Shares Lessons Learned in 20 Years as Program Director

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When I came to Washington University School of Medicine (WUSM) in St. Louis in 1996 to become fellowship program director, the previous program director had left, and the two fellows who had been selected both backed out (this was before the match). I was handed a stack of manila folders, which contained the previous documentation. From my involvement with the medicine residency program at Marshfield Clinic (1986–1996), I had learned a few things about the rules, but other than recognizing that I was required to notify the Residency Review Committee of the change in program director and reading the list of citations from the previous site visit, I knew nothing.

And a new site visit was coming.

I did not want to become the first WUSM Rheumatology Division to lose accreditation. What was I to do?

Although I don’t presume to be able to tell anyone how to be a program director, I can share with you a few things that I have learned that might be helpful in the process of becoming a program director, because it is an iterative process.

Find a Program Director Mentor

I had the good fortune of knowing Neal Roberts, who was a brand new intern at Duke when I was a hapless medical student on my first clinical rotation. (That was when I was hooked by rheumatology after seeing several great cases, but that’s another story.) Unlike the resident and other intern, Neal was a natural mentor and helped me enormously by teaching me how to become a clinician in training. He went on to fellowship at the Brigham, then faculty at Medical College of Virginia, where he ultimately became program director. So 20 years after we met at Duke, I called Neal for help.

I learned from Neal’s boss at the time, Shaun Ruddy, that Neal’s most recent site visit resulted in five years of accreditation with no citations—the program director equivalent of pitching a perfect game in baseball. So I knew I had found the right guy.

Neal was very generous with his time, and he gave me a loose-leaf notebook that he had prepared for the site visitor, with this advice: “Make it easy for the site visitor to find what he/she is looking for.” With his guidance and advice, I passed my first site visit—even though it was far from pitching a perfect game.

The Program Directors’ Conference

This event is your guide to success. I was fortunate that the inaugural Rheumatology Fellowship Program Directors’ Retreat (now the Program Directors’ Conference) occurred at exactly the right time for me. This has become an annual event supervised by the ACR’s Training and Workforce Committee.
Walter Barr—a program director rock star if there ever was one—took this program from its infancy to a playbook for becoming a great program director. I still have copies of his classic “25 Things I Wished I Had Known When I Became a Program Director.”1 Walter tragically died in the prime of his career, but those of us who had the great fortune of knowing him will never forget him.

Don’t Be Afraid of the Residency Review Committee

The annual Program Directors’ Conference gives you, as program director, a chance to meet one on one with a high-ranking representative of the the Residency Review Committee (sometimes even the top dog) to discuss any concerns you might have about your program being in compliance, especially the difference between “musts” and “shoulds” in the program requirements. And don’t take it as a personal failing when you get a citation; everyone gets them.