Program coordinators are the glue of graduate medical education programs (GME). They frequently manage day-to-day operations and facilitate relations between residents, faculty and staff members, as well as the Accreditation Council for Graduate Medical Education (ACGME).
With this high responsibility comes stress. More than half of all program coordinators suffer from anxiety and depression, and one-third experience burnout or emotional exhaustion. Nearly 30% are also likely to leave within one year of taking on this type of job.
Responding to high turnover during and after the COVID-19 public emergency, the University of North Carolina (UNC) Hospitals’ Graduate Medical Education Office created a professional development initiative to ease burnout and create clearer career pathways for these important personnel.
The effort was driven by a recognition that coordinator retention is critical to program success.
“Our programs are so much better supported when we have coordinators that stay long term or when they stay with the institution and move into other types of leadership roles,” said Kelly King, C-TAGME, director for graduate medical education at UNC Hospitals.
Elevating the coordinator role
Turnover among program coordinators remains a challenge across GME nationally. Because many coordinators enter the role without realizing its long-term career potential, UNC has focused on helping them envision a future in academic medicine.
“Nobody goes to school to become a GME administrator. That wasn't anything that I learned about in college. I didn't even really know what this was until I kind of stumbled into my first job as a program coordinator,” said King.
The role of the program coordinator has evolved significantly in recent years. Historically viewed as mainly administrative support, coordinators are increasingly being recognized as leaders within residency and fellowship programs.
“What we’re doing as institutions is to support that leadership model and to grow and change the culture at our institutions,” said King.
Changes in ACGME requirements now identify coordinators as key members of program leadership teams. This key shift started to change the national conversation about the role of coordinators in the world of GME. Taking this into account, UNC developed what it calls a “backbone structure,” which serves as the foundation for its program coordinator professional and personal development efforts.
“Coordinators are the backbone of all of our programs, and our programs wouldn't stand without them,” King said. They’re the operational leaders who keep programs running smoothly and are often very hands-on with the residents and fellows.
Providing them with the tools, recognition and development they need will help strengthen GME programs and encourage long-term careers in the field, she emphasized.
Despite growing national recognition, King believes many institutions still have work to do to fully embrace program coordinators as leaders rather than solely administrative staff.
This hasn’t always been fully appreciated outside the GME world—and sometimes even within it, she noted. Program coordinators can unfortunately be taken for granted, and their roles are not always amplified or recognized as much as they could be.
One of the challenges is that it's difficult to fully articulate the scope and impact of what program coordinators do to people outside of GME, she noted.
Adapting to changes in the post-public health emergency work environment has been another challenge. Many program coordinators are working from home—they’re not in the same clinical working spaces they once occupied. Finding ways to connect and engage program coordinators in this new environment remains one of the biggest issues facing GME programs nationwide, King admitted.
Candid conversations identified needs of coordinators
UNC’s program development began with extensive conversations with coordinators about their needs and challenges. “A lot of listening” took place, King said.
When she joined UNC's GME office, she found communication barriers between the central office and program coordinators.
“It felt very much like a fortress. There was very little information coming out and very little information coming in,” King said.
This approach wasn’t serving either the GME office or program coordinators well. As a result, UNC focused on breaking down barriers, opening lines of communication, and having candid conversations about where gaps existed and what coordinators needed to succeed.
Those discussions revealed that program coordinators were just as passionate about their work as leaders in the central GME office. By engaging coordinators directly, the institution was able to identify unmet needs and develop resources to address them.
Academy offers lessons in conflict management
UNC’s approach combines technical training with leadership development. Coordinators receive education on GME regulations, systems and processes, while also developing skills in communication, conflict management and leadership.
One key component is the GME Leadership Academy, a competitive nine-month cohort program that offers advanced leadership training and support for personal and professional growth. A senior program coordinator proposed the idea for creating such an academy several years ago—an avenue to focus on the soft skills needed for leadership such as managing conflict.
Topics include navigating situations when program coordinators and program directors aren't seeing eye-to-eye, handling difficult conversations and effectively communicating with trainees.
Two “buckets” comprise the professional development approach, said King. One is the technical side of GME administration, and the other is leadership development and the skills needed to succeed in those roles.
UNC supports that development in several ways. In addition to the Leadership Academy, it offers program coordinator forums where the GME office shares information and resources with coordinators. Additionally, there’s a peer-led Program Coordinator Council that focuses on networking, peer support, social connections, and the one-on-one training and mentoring that help program coordinators succeed at the institution.
By engaging coordinators directly, UNC has identified gaps in resources, support and professional development opportunities.
In the path to leadership, “everything is offered to everybody,” King said. In GME, there's a common belief that it takes about three years to become fully comfortable in the program coordinator role. In the first year, coordinators learn the terminology to understand the many moving parts. During the second year, they begin to anticipate what's coming next. By the third year, they're able to confidently anticipate challenges and know how to approach them.
"The nature of what we do in GME is so cyclical that you could do something once in June and then not see it again until the following June,” said King. For this reason, “there’s large opportunity for knowledge to fall by the wayside.”
This is why repeated exposure and ongoing development are so important. UNC addresses this through a rolling model that brings new coordinators together with more experienced colleagues. This makes sure that “everybody has access to the same information at the same time,” she explained.
Improving performance and confidence
While coordinator retention remains an ongoing challenge, King said the initiative has produced meaningful improvements in collaboration, confidence and accreditation readiness.
One notable outcome has been a dramatic reduction in accreditation citations.
“Three years ago, we had a total of 44 citations across all of our 92 programs, and we have eight now across all of our programs,” she said.
Many coordinators initially lacked confidence speaking in front of groups, even during internal meetings. UNC has intentionally encouraged coordinators to present their work, speak publicly and develop communication skills as part of their professional growth.
Those efforts have translated into presentations at national specialty meetings as well as the North Carolina GME Annual Educational Conference, which is heavily attended by program coordinators.
"We've really tried to provide opportunities for them to practice some of these skills that they're learning," King said, noting the program's broader goal is to help coordinators move beyond simply managing daily responsibilities.
“What we're talking about is moving beyond just how do you survive in your role and really how do you thrive in your role and how do you find joy in what you're doing,” she said.
Through the NC GME Collaborative, UNC is helping to develop a conference session where coordinators will reflect on the impact they have had on trainees or the impact trainees have had on them. Bringing these relationships back full circle “has been pretty powerful,” King said.
Opening spaces to coordinators
UNC plans to continue expanding its GME Leadership Academy, strengthen mentorship opportunities and explore partnerships with other institutions. Ultimately, King believes intentional investment in coordinators is essential to the success of residency and fellowship programs.
For organizations looking to better support program coordinators, King recommended integrating development into a broader GME leadership strategy rather than treating it as a standalone initiative. She also emphasized the importance of trust, inclusion and recognition.
During the public health emergency, UNC began inviting coordinators to the GME Committee meetings, something that was previously unheard of. The institution also established an annual coordinator award to recognize outstanding contributions.
“Opening spaces to them really increases the trust and that they feel valued,” King said. “Any way that institutions can find to really highlight the work that's being done at the program coordinator level and celebrate that and to shine a light on it, really has a long-lasting impact.”
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