“I Find It Quite a Privilege to Be Involved in Their Lives”: A Multinational Qualitative Study of Program Directors’ Perspectives on Their Relationships with Residents

Abstract

Phenomenon

Program director (PD)-resident relationships are important in shaping resident experiences and educational outcomes. Yet, there is limited literature on the development or meaning of these relationships, particularly from the PD perspective. Through qualitative interviews, we explore how PDs navigate their role to develop and maintain relationships with their trainees, and elucidate how these relationships impact the PDs personally and professionally.

Approach

Qualitative study using individual semi-structured interviews of former and current PDs (n = 33) from multiple specialties and hospitals in accredited residency programs in Qatar, Singapore, and the United Arab Emirates. We used attachment theory and narrative analysis to investigate how PDs perceive and describe relationship building with their residents amidst tensions of familiarizing themselves with their new role.

Findings

PD-resident relationships are complex and multidimensional, shifting over time, changing patterns and evolving to respond to different contexts. PDs initially negotiate their own roles, while navigating their relationships with residents and other stakeholders to create their professional identities. PDs develop professional alliances, defining for the resident the profession and its expectations. As residents negotiate the various challenges of their training, the role of the PD emerges into one of providing emotional support and advocacy. The support and attachment are often enduring and extend beyond the period of residency training.

Insights

Our study examines the experiences of program directors as they negotiate complex educator-learner relationships. The PDs described roles that extended beyond their job description. Although all interviewees reported that the PD position was challenging, they focused on the rewarding aspects of the job and how their relationships helped sustain them through the difficulties. Through their reflections, the PDs described the personal satisfaction and benefits of their interactions with the residents, and how the engagement contributed to personal and professional success.

Keywords:

• Residency
• program directors
• relationships
• international medical education
• graduate medical education

Acknowledgements

Open Access funding provided by the Qatar National Library. The authors wish to thank Siok Ching Chia, BS, National University Hospital for her assistance in executing the study. The authors also extend their gratitude to all the program directors who participated in the study for their valuable time and invaluable perspectives.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributors

DD, HI, DJS, JC and SA were involved in the conception and design of the study. DD conducted all interviews. DD and HI were involved in initial data coding. DD, HI, DJS, JC and SA contributed to the further analysis and interpretation of the data. DD wrote the first draft of the paper. All authors contributed to the critical revision of the paper and approved the final manuscript for publication. All authors are accountable for the manuscript.

Ethical approval

The study received approval from the institutional review boards of the Johns Hopkins University School of Medicine in the United States, Weill Cornell Medicine-Qatar, the National University of Singapore, Massey University of New Zealand, and the Tawam Hospital Human Research Ethics Committee in the UAE. All participants provided informed consent to be interviewed and for their quotes to be used.

Additional information

Funding

The study was supported by funding from the School of Communication, Journalism and Marketing, Massey University, Palmerston North, New Zealand.