Abstract
Visual Abstract.
As a Designated Institutional Official (DIO), no matter where you work, you are experiencing considerable change. I am experiencing considerable change at my institution as we prepare for an acquisition. This experience prompted me to reflect on how we may learn from—and along with—each other, to navigate challenges during turbulent times.
When I am at home, I begin each day the same way. I wake up at 5:00 am, complete the morning dog routine, grab my coffee, and sit on the couch reviewing the prior day’s events and planning for the day ahead. In the winter, there is a fire in the fireplace. The “Spa” station plays on Pandora. It’s comfortable, grounding, and dependable.
On this day in January 2024, I had much on my mind. Eleven days prior, our health system board had signed a Letter of Intent to be acquired by a subsidiary of a venture capital firm. As part of this deal, we would transition to a for-profit entity. The past several days had been mentally and emotionally exhausting, as I worked to understand the implications of this acquisition and absorbed the questions, concerns, and feelings of the residents, fellows, faculty, coordinators, and program directors for whom I was responsible. I use the word “absorb” intentionally. It is optimal to maintain some degree of emotional distance especially during challenging times. Nine years into this role, I still struggle with it. I’d been on an intense emotional ride.
This morning, my thoughts went to my dad who had passed away 7 years prior. He was a neonatologist who studied parental anticipatory grief in the 1970s, then collaborated with my stepmom on her dissertation about the subject years later.1,2 When parental grief scores were plotted on a graph over time, a curvilinear “roller coaster” appeared. “I bet this experience looks like a roller coaster,” I mused. “I should study it.”
Starting that day and every day since, I have given myself a well-being score. Using a scale from 1 (feeling low) to 10 (feeling great), I documented a number along with any pertinent details. My criteria were nothing more than a gestalt. This could be described as my own, admittedly, low-tech screening tool, not unlike the well-being screening tools we are required to provide access to for our learners.
The Figure is my well-being graph, starting January 29, 2024, 11 days after the acquisition announcement, through January 29, 2025, one year later. Some days, I had 2 scores, with the day starting out fine and then taking a dive, or vice versa. I plotted both points.
Figure.
Change in Well-Being as a Function of Time
Note: The line in the graph represents daily well-being scores that are plotted as a function of time over the span of one year.
Key Takeaways
When I saw the graph for the first time, I thought, “chaos” especially at the year’s beginning and end. The jagged line looked like the year felt. Of course, the data points represented more than just the impact of work. As does everyone, I exist in a family with its own dynamics, in a world with its dynamics, and in a body with a mind that certainly presents its own “dynamics!”
My mean score was 6.8. The 10s occurred during vacation, during the Accreditation Council for Graduate Medical Education (ACGME) Annual Educational Conference, the day I walked my first marathon, after a crucial conversation with a leader during which I expressed myself well and felt heard, and the day we joined my husband as he left the emergency department after working his final shift. My first 1 score of the year occurred around a frustrating email communication and my second occurred during an intense non-work-related experience.
The depth and breadth of issues we manage as DIOs is immense. I have known this for years. Still, to see this work and how it influenced my well-being was startling.
It is clear to me that I feel deeply what is happening in my environment, whether that is my paid job, my volunteer efforts, or my home and family life.
Some behaviors are associated with the good days, and others are more likely to accompany the low days. These are things like sleep quality and quantity, exercise, and the quality of food that I ate. It is worthwhile to identify these and try to do more of the “good day behaviors” and less of the “low day behaviors” to, ideally, create a more even ride.
Principles Guiding Me Through This Challenging Year
Listen. Do not take communication for granted. Do not assume that people know the latest information. Hold meetings, go to others’ meetings, open your door, be visible, and listen. People might go outside the organization to express frustration. They are more likely to do this if they do not feel heard inside the organization.
Get facts. When change is looming, we create stories that are informed by media, friends, family, and our own beliefs. Listen to these stories, then share facts. If you don’t have them, get them.
Use your networks. I am completely new to the idea of running graduate medical education (GME) in a for-profit model. So, I reached out to DIOs who work in this model and asked questions. Our GME community is amazing. This is particularly important for those who might identify as introverts, as I do. Fight the temptation to withdraw into yourself. Seek out support in your colleagues and friends.
Communicate more. You’ve held your meetings; you’ve done your listening tour. Don’t leave it there. Follow up. You care about these people and their concerns. Show it by showing up and following through.
Communicate with key stakeholders, such as medical school partners, residency/fellowship applicants, and key participating site partners. Be proactive. In the case of a major change, like an acquisition, inform the ACGME and share your monitoring plan.
Monitor the change with your Graduate Medical Education Committee. Make this a standing item for your meetings. Create a space to discuss concerns and share updates. Document key discussion points in your minutes.
Own your expertise. You are the GME expert at your institution. Make sure you get the information you need and that your voice is heard.
Offer solutions. If you want to be seen as a strategic partner, you need to behave like one. Don’t stop at “this can’t work.” Identify what could work. And…
Accept that you won’t always get your way. This is a toughie! Some things are just the way they are, and you are not going to change them. Unless they are a violation of your ethics, your values, or ACGME requirements, accept them and move on. Help others accept them too.
Own your missteps and encourage others to own theirs. Somebody will miss something, say the wrong thing, do the wrong thing. Extend yourself and others grace. Offer an apology when one is needed to remove a barrier and restore trust.
Be open to new possibilities. With any change, there is going to be opportunity. Your residents and fellows are graduating into a world of rapid change and many unknowns. They are watching how you manage this. Give them a positive example.
Take care of yourself.
Conclusions
Beyond the reflections provided in this discussion, a broader body of literature exists that offers excellent insights into managing change in GME and on experiential learning theory.3,4 While we await the close of the acquisition at my institution, I will continue monitoring my well-being and preparing for the future. I will continue to lean on this GME community for education and support and will share learnings along the way.
References
- 1.Benfield DG, Leib SA, Reuter J. Grief response of parents after referral of the critically ill newborn to a regional center. N Engl J Med. 1976;294(18):975–978. doi: 10.1056/NEJM197604292941803. doi: [DOI] [PubMed] [Google Scholar]
- 2.Benfield CG. University of Akron, College of Education; 1995. Comparing the anticipatory grief response of mothers and fathers in a neonatal intensive care setting. Dissertation. [Google Scholar]
- 3.Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. 2nd ed. Pearson Education; 2015. [Google Scholar]
- 4.Sudak DM, Du W, Arellano P, Zimberg M. In: Graduate Medical Education in Psychiatry. Macaluso M, Houston LJ, Kinzie JM, Cowley DS, editors. Springer; 2022. Managing change within a residency program. [Google Scholar]