Reflections from the Liminal Space: Five Tips from a New Program Director

By Thomas W. Davis (@thomaswdavismd)

Taking on a new educational role can be a challenge, but a challenged filled with excitement and opportunities. Recently, I had the opportunity to take on a program director (PD) role, having served as the associate program director for the previous three years. After reflecting on my role over the last twelve months I want to share five lessons learned.

Transitions are difficult

Think back to all the important transitions in your professional career: start of medical school, start of residency, junior faculty and educator. These transitions share certain similarities: a new language, a new schedule, and a new hierarchy. The first year as PD is a crash course on medical education language, interview season, meetings and personalities of the program. Being organized and having an outline for the year will help manage the changes. Do not lose sight of the fact that the residents and fellows are going through the same transition. They are used to how things were run and not sure about the changes that may be coming. They may challenge changes, complain that things are not the same. I have found it is best to have an open dialogue with your expectations for the program and for them.

Build your team

Building a team that compliments your leadership skills and style is paramount to building a successful program. The residents will need a variety of personalities and leaders to act as coaches and mentors as they go through residency. If you are a pioneer (big picture person) but know that you do not always complete the task, then you need a guardian to ensure you complete the tasks. Integrators help bring the team together and act as a confidant for the residents. Drivers help keep the program on tract. A team full of pioneers may lead to disorganized program or lack of completion of the details that make the program run. As a pioneer, I needed the combination of drivers, guardians and integrators to help ensure that the program ran smoothly. Understanding your leadership style and having an eye open to the additions to the team will allow an ease to complete all the work at hand. (1)

Set your course

Spend some time setting your course and creating both short-, mid- and long-term goals. As Simon Sinek has outlined leaders should Start With Why. (2) Start with your purpose and your aims for the program. Inspire the team to believe in your purpose and build your program aims from the inside out. Use your “why” statements to act as the guiding force for the changes you plan to make. Do not be afraid to make the big plans to change the program but ensure that you plan small steps to move forward. Garner buy in from the program as well. Be transparent with your plans, let the residents spend some time giving feedback, adjust the plan where you can and set a course with consistent information on how you are doing

Have patience with yourself

As you can see from above there is a lot that happens in the first year of taking over a program. You will make mistakes. You will have emergencies, challenges, curveballs, and successes, sometimes all in the same week. You need to rely on your team to keep you grounded and to focus on your goals. Find the successes and highlight them. Put your victories on a board to review. Save the positive emails, cards, letters. Positive psychology research has shown that cultivating a positive mind set, even in the face of failures, can improve productivity, creativity and engagement.(3) In fact, some have suggested it is another new form of intelligence – positive intelligence.(3) By reviewing your victories, you will stay more optimistic and have improved wellness. Happiness and positivity will be the means to success running your program

Be humble

Above all be humble. Ask for help. Seek mentors from other programs internally and externally. Use your team to the fullest. Use your residents for ideas and run the program like a consistent quality improvement project. Do not be afraid to apologize. Remember you are there to serve the residents under you. They will be your legacy, allow them to be the best physician and person they can be.


  1. Vickberg SM, Christfort K, Pioneers, Drivers, Integrators, and Guardians. Harvard Business Review. March-April 2017 Issue. Accessed July 19, 2017. Available at
  2. Sinek S. Find your Why. Accessed July 19, 2017. Available at:
  3. Achor, S, Positive Intelligence. Harvard Business Review. January-February 2012 Issue. Accessed July 19, 2017. Available at


Thank you to our editor, Teresa Chan (@TChanMD), for recruiting Thomas for this article!

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