A Job Within a Job: Residency Rotation Director

In conjunction with the PEMFellows.com Blog I’ve authored a post on what it means to be a Residency Rotation Director, a role that I inhabit at Cincinnati Children’s Hospital Medical Center.

At the risk of getting analogical, there are many hats in the haberdashery of a Clinical Educator. Many institutions specify that faculty do more than provide clinical care. Though the classic triple threat triumvirate of clinical, research, and education serve as guideposts for how we should spend our time it is important to recognize that within these categories there are quite a few roles and positions that faculty can choose to occupy. One of those roles is the residency rotation director.

Near the end of my first year as a faculty physician I assumed this role within the Division of Emergency Medicine at Cincinnati Children’s Hospital Medical Center. My career interests education focused, and I felt that this would allow me to gain valuable experience in a position of leadership. I also saw a need to refine our curriculum and overhaul the evaluation process for our residents on the Emergency Medicine rotation. This role has come to define my niche within my Division and I’m now seen as “The Resident Guy” and have been able to get involved in a number of valuable initiatives.

What do they do?

The rotation director is a liaison between the residency program leadership (program directors), the departmental faculty and the residents themselves. Their specific duties may include rotation orientation, curriculum development, evaluation, conflict mediation, scheduling, mentoring and more. It can be challenging to balance these many duties with a busy clinical schedule. Staying organized and making good use of one’s administrative assistant’s talents are essential. The role comes with a bit of baggage in terms of scheduling meetings, and thus developing overall goals in accordance with Emergency Medicine and Residency leadership is incredibly important in making sure that your time is goal-oriented and well spent.

How do you become one?

Ask. Seriously, that’s it. The ACGME specifies that each residency rotation have a faculty member who is responsible for the oversight of the aforementioned tasks. First, you can find out who is responsible for this role in your department. As faculty you are responsible for charting your career path. If you are interested in a career in education or leadership this can be a great way to get your feet wet. When interviewing for a faculty position, it can be helpful to consider whose job you want. Not that you’re looking to depose anyone – but more specifically who has a role that you’d like to have in the future, and what do you need to do to learn more about it and get involved. Make it clear that you’d like to be next in line for the role, and talk openly and honestly with your interviewer and arrange to meet with the current rotation director.

Tell me more about the specific responsibilities?

Curriculum Development

This role entails determining not only the schedule for lectures and other learning opportunities, but also making sure that your residents are learning what they are supposed to be learning. Familiarize yourself with the rotation goals and objectives as specified by the residency program as well as the American Board of Pediatrics content specifications. Make sure that the residents are learning during and after their shifts. For me this involves both canvassing them for feedback in person and collecting structured feedback after our educational sessions. You might also think about including online modules or websites into your curriculum. You could start your own, or direct them to blogs such as PEMBlog.com and PedEMmorsels.com.

Our residents have eight hours of protected time per month for learning during which I was able to secure attending coverage. Our educational sessions include a mix of didactic lectures, hands on procedure training and in situ simulations. I am responsible for the overarching content, and recruit faculty contributors based on their interests and areas of expertise. I attend all of the lectures and serve as the Master of Ceremonies and color commentator.

Evaluations

Milestones, milestones, milestones… Since all programs now have to evaluate using the Pediatric Milestones familiarize yourself with not only the original criteria, but also your institution’s plan for evaluation. The Pediatric Milestones represent no less than a paradigmatic shift in how residents are evaluated. They are based on a continuum of clinical behaviors that develop throughout training. For example, senior residents should be able to make autonomous decisions for straightforward problems. If they don’t know how to manage an asthmatic for instance, you should be concerned that they have not developed sufficiently mature illness scripts. Other residents may struggle specifically with prioritization or dealing with consultants. You can learn more about the Milestones here.

Many institutions use a system such as MedHub or New Innovations for evaluation and thus the infrastructure may already be in place. Not only will you have jurisdiction over how the residents are evaluated, but you will also be responsible for assuring that faculty complete their evaluations on time. Many institutions have evaluation completion compliance built into their faculty roles and responsibilities. You’ll be responsible for reviewing the resident evaluations and developing a plan to intervene when residents are having particular difficulties during the rotation. My main goal is to make sure that the summative rotation evaluations impact the residents in a meaningful fashion.

Conflict mediation

There are times when residents have issues that impact patient safety, satisfaction or the care team in general. In addition to investigating the situation and discussing the issues with all involved parties, you may also be responsible for mediation. This can be a challenging yet rewarding part of the job and it really contributes to the professional development of your trainees.

Do I have to join any committees? I love committee meetings!

Your institution will have a Curriculum Competency Committee (name subject to variance of course). This committee is a group comprised of residency leadership (program directors and chief residents) as well as the individual faculty residency rotation directors. During regular sessions you will discuss important issues germane to the residency program at large, and biannually meet to discuss the progress of every resident in accordance of the pediatric milestones across all of their rotations. It would not surprise you to learn that residents that struggle in the high volume, fast paced ED might also struggle in the ICU, but conversely could thrive in a primary care clinic. The next time that resident returns to the emergency department, have a plan for their ongoing evaluation and improvement.

Any other benefits?

Sure! If you are interested in educational research there may be no better local pipeline than the role of rotation director. You’ll have extensive contact with program leadership, who can serve as mentors as well as residents themselves. My role also allowed me to partner with other similarly focused Pediatric Emergency Medicine educators and we published our resident education focused work last year in Academic Emergency Medicine. As previously noted, your time is valuable. This role often comes with protected time (time “bought down” from clinical responsibilities). It is important to know and/or estimate how many hours per week you spend on the role. I have had to consider the following when making my case for protected time: