CV Fellowship Director Training: Management Skills-Video 4: Time Management, Delegation, and Succession Planning

Video Transcription

I'm John McPherson, Professor of Medicine and Vice Chair for Education in the Department of Medicine at Vanderbilt University.  I am also the Program Director for our Internal Medicine Residency Program. I would like to speak with you today about three important skills critical for any fellowship  or other program director, time management, delegation, and succession planning. As physicians and program directors, we have a somewhat unique mix of responsibilities  that include clinical responsibilities, but then additionally our duties as educational leaders. A 2012 study surveyed physicians in a matched population of other U.S. workers.  The study focused on career satisfaction, and this data represents relative satisfaction with quantity of both personal and family life, time by job.  This data demonstrates that physicians in general have lower career satisfaction with respect to time away from work compared to other American workers.  Take a moment to consider your personal reaction to this data. In addition, the unpredictable nature of our work can lead to longer hours, work done at  home, and increased stress and fatigue. This all has the potential to create chaos in our lives and disrupt our work-life integration.  As program directors, we have many unique responsibilities when compared to our colleagues. These include teaching, role modeling both in the clinical setting and in the leadership  settings, curriculum planning, curriculum implementation and monitoring, assessment of our fellows, administration of the program, recruiting of future fellows, supervising  and mentoring our trainees, and finally, divisional leadership. With all of these responsibilities, time management and delegating are critical for  program directors in order to minimize that chaos in our lives and keep our jobs as gratifying and as enjoyable as possible.  I consider time management as a skill that can be both learned and mastered. Fortunately, there are many great resources available to new program directors.  These are two particularly helpful books that I personally found useful as I transitioned into my program director role five years ago.  I strongly recommend that all program directors explore several books and resources in order to discover the techniques and the concepts that work well for each individual.  It's also important to occasionally take a step back and take a look at the big picture. Understanding your values, your priorities, and your goals can help new program directors  frame their tasks. Having a conversation with your division chief or your department chair about your own institutional priorities is strongly recommended.  This is a complex process which should involve one's own reflection on their core values  and beliefs, their identity, goals, aspirations, their roles, responsibilities, and what motivates them.  Creating a personal mission statement is one tool that can really articulate these priorities through careful reflection.  Defined personal priorities can really help to align one's personal and professional goals with great fulfillment.  There are many benefits of allocating available time and energy based on one's personal priorities.  Most importantly, it promotes one's control over their life, which might lead to more satisfaction and productivity in their life.  Locke and Latham were both psychologists who published some fascinating work on goal-setting theory nearly three decades ago.  Their data suggested that the more specific and that the more difficult the goals were, the better task performances were produced.  In other words, we are most successful when we work on tasks that are both very specific in intent and also somewhat hard to complete.  Locke and Latham then went on to describe five principles of goal-setting, clarity, challenge, commitment, feedback, and the complexity of the tasks.  I have found that considering these five elements of goals can be very useful as I plan my priorities for the upcoming academic year, for example.  Writing down one's goals and then considering them in this framework can be a very powerful organizational tool.  Managing daily workflow is perhaps the biggest challenge for all of us. This assumes a systematic approach to productivity, a set of behaviors that begin with ideas and  ultimately result in a finished product. Good workflow management incorporates several elements, setting prioritized goals, effectively  allocating time, and respecting cognitive limits. I find it helpful to think about each task in terms of its urgency and its importance.  Few examples, a crisis with one of your fellows, that would be something that's both important and urgent.  Finishing up the ACGME's annual program update, that's clearly something that's important, but hopefully not urgent if you're addressing that task early enough.  Yet another invitation by email to complete a survey, that would be something I would consider not important and not urgent.  David Allen described five states for mastering one's workflow, collecting, processing the information, organizing the tasks, reviewing to-do lists, and then doing.  And notice that doing is the final step once all of the other steps have been completed. Learning to say no can be very difficult.  Often we are naturally inclined to say yes to most things, and it can be hard to know what to say no to.  It's important to have a good working knowledge of your priorities and regularly reflect as they may change over time.  For example, when you are moving on to another phase of your career, things may change significantly. Discerning what to delegate to others and what to tackle yourself is critical.  Importantly, obtain clear expectations from your leadership. Have a conversation with your direct report and have a frank discussion about their expectations of you.  This can be very helpful in deciding what to do next and what to delegate. Once you have developed your priorities, goals, and tasks, it is extremely helpful to think  about your tendencies regarding your productivity and your focus. For me, the morning is by far the best time for me to address tasks that require a high cognitive load.  Writing or reviewing papers and prioritizing goals are good examples of things I do first thing in the morning.  I save my more mundane and automatic tasks for later in the day, particularly after a busy clinic, for example.  It's also very important to actually schedule yourself with blocks of time to work on these tasks. Ideally, at times of days when you tend to be most effective.  What about multitasking? Unfortunately, it is not difficult to identify time wasters. Blocks of time intentionally or unintentionally spent on non-goal related tasks.  Eliminating time wasters can create more time to allocate towards prioritized goals and associated tasks.  Identifying time wasters often require scrutiny of your personal habits and practices. For example, socializing at work is fun, but it can be a major problem for one's productivity.  Multitasking is a common and often insidious threat to productivity. After some reflection, I realized that my email alerts on my computer and my phone led  to nearly continuous distractions and often to multitasking. Closing down my email, literally hiding my phone from myself, and removing my email alerts  increased my productivity significantly. There will always be unexpected add-on tasks such as new opportunities and urgent family  matters, but it's important that we consider preparing a time management emergency plan for times when the unexpected hijacks our existing plans.  Also consider how to renegotiate your priorities and how to reallocate time on the fly when needed. What about delegating? Delegating is critical.  It is absolutely necessary to get all of the work done that we have as busy program directors and busy clinicians. We can't do it all ourselves.  In addition, it's important to provide others with opportunities to develop professionally. Think about your resources.  If you have an associate program director, they are a wonderful resource, often underutilized. Think about your program managers and people that are in your administration.  Think about key faculty that are interested in careers in medical education and leadership. And then importantly, think about the stakeholders in your training program.  They are often some of the most helpful and most insightful when thinking about tasks important to your program.  Most importantly, ensure that each person that is doing this work gets the credit that they deserve for their contributions and their accomplishments in order to provide them with  fulfillment, inspiration, and further their professional development. Finally, succession planning is an often overlooked but very important role for any program director.  It's important to think about this early. Again, this is a great opportunity to mentor and help develop the careers of other promising junior faculty at our institutions.  Often, this can lead to collaboration and inspire a new shared vision for your program.  When thinking about the people for these roles, it is critical to step back and try to recognize  potential unconscious bias, soliciting the input from your trusted colleagues and from a variety of diverse people is essential.  Eight years ago, when I was named associate program director, our program's program director  at the time and our chair made the decision that I would succeed him in two to three years. From that point forward, I was very fortunate.  My program director copied me on every email that he received and wrote that was in relationship to our program.  We had regular meetings where he discussed his scheduling tools, his goal setting process, and his priorities. He has continued to mentor me throughout.  I can't think of a better situation. I think about that example when I'm planning my own succession planning in our program.  It's important to think about this thoughtfully and prospectively and put your program as the highest priority. In summary, time management is a learned skill.  It's important that we step back through reflection and structure to really think about how we  can most effectively manage our time in order to provide us with fulfillment both professionally and also personally.  It's critical that we develop systems to prioritize and manage workflow. It's critical that we learn when to say no and when to delegate.  And finally, actively think about succession but enjoy your job along the way. Being a program director is a privilege and an incredibly rewarding profession.  Thank you for your time.

Video Summary

In this video, Dr. John McPherson discusses three important skills for program directors: time management, delegation, and succession planning. He emphasizes the unique responsibilities of program directors, which include teaching, curriculum planning, assessment, and leadership. Dr. McPherson suggests that prioritizing goals, allocating time effectively, and respecting cognitive limits are keys to managing daily workflow. He also highlights the importance of saying no and delegating tasks to others. Additionally, he advises program directors to actively plan for succession and mentor junior faculty. Ultimately, Dr. McPherson encourages program directors to enjoy their role and find fulfillment in their work.

Asset Caption

References:

1. Allen, D. Getting things done: The art of stress-free productivity. Penguin; 2002.

2. Covey, SR. The 7 Habits of Highly Effective People. Franklin Covey; 1989.

3. Locke EA, Latham GP. A Theory of Goal Setting and Task Performance. Prentice Hall; 1990.

4. Mark, G., Gudith, D., & Klocke, U. (2008). The cost of interrupted work: More speed and stress. In Proceeding of the twenty-sixth annual SIGCHI conference on human factors in computing systems association for computing machinery, April 5–10, 2008, Florence, Italy.

5. Pangaro, L. Leadership Careers in Medical Education. ACP Press; 2010.

6. Pitre C, et al. Physician time management. MedEdPORTAL. 2018;14:10681.

7. Rogers R, Monsell S. (1995). Costs of a Predictable Switch Between Simple Cognitive Tasks. Journal of Experimental Psychology: General. 124. 207-231.

8. Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch of Intern Med. 2012; 172(18): 1377-1385.

9. Williams, FK. (Ed). The Toolkit Series: A Textbook for Internal Medicine Education Programs. Alliance for Academic Internal Medicine; 2017.

Keywords

program directors

time management

delegation

succession planning

mentoring junior faculty