National Institute for Program Director Development: Providing Foundations and Connections for 30 Years

The first graduation of the fellows of the Association of Family Medicine Residency Directors’ (AFMRD) National Institute for Program Director Development (NIPDD) occurred in June of 1995. Thirty years and 1,356 graduates later, NIPDD is still going strong and is often identified as a key factor in family medicine residency director preparation and retention. While NIPDD has grown from 40 fellows to 70 fellows per class, and the curriculum has evolved along with the dynamic graduate medical education environment, the underlying principles and goals have remained constant. Some other medical specialties have subsequently developed NIPDD-like initiatives, but the specialty of family medicine remains unique in its community-based orientation. Family medicine program directors are the most likely to find themselves in a single residency setting, where they are faced with managing their residencies without positional peers.¹ The connections, concepts, and details taught by NIPDD may have particular value for those in this community-based environment.

Over the past 30 years, the impact of NIPDD has been studied and analyzed. Early studies showed high levels of learner satisfaction and large majorities of program director graduates linked it to lower stress levels.¹ Other studies have reported higher resident board certification pass rates for graduates of programs with a director who completed NIPDD.² Interestingly, research results have varied regarding the link between NIPDD and increased program director tenure.^1-3 However, one recent study did find that program directors with tenures longer than 3 years were significantly more likely to have completed NIPDD, and only left their positions because the program was stable and it was the “right time.”⁴ Both in formal studies and informal course evaluations, NIPDD graduates have consistently identified “the opportunity for networking with other program directors and the training in residency finance” as some of the most valuable components of the experience.¹

As originally envisioned, NIPDD course design, curriculum development, teaching, and advising is delegated to the NIPDD Academic Council.¹ As the number of fellows has increased, so has the size of the Academic Council. Make-up of the Academic Council has fluctuated over the past 30 years, but current Academic Council members must be NIPDD graduates and have current or recent experience as a family medicine program director. Additionally, many Academic Council members have held other organizational leadership positions, as well as regional and national educational roles. Although founded with direct input from many academic family medicine organizations, NIPDD is now a program of the AFMRD and is fully funded and self-sustaining through fellow tuition fees. The Chair of the NIPDD Academic Council reports directly to the AFMRD Board of Directors.

While the curriculum has evolved since the launch of NIPDD in 1994, the foundation upon which it was built remains. The curriculum consists of 3 sessions: 2 intense 3-day sessions and 1 session combined with the Residency Leadership Summit. The sessions consist of short didactic lectures with increasing opportunities to work in small groups for discussion, mentorship, and professional networking. Small groups also have exercises to reinforce the key topics. The fellowship also includes longitudinal projects in residency finance, program improvement, and program value that are experiential and useful in each fellow’s program. Over the last several years, programs and program directors have had to respond to major changes in the ACGME and the ABFM. Although NIPDD has responded to these changes, the core domains that the Academic Council teach remain much the same as when NIPDD was founded. There are 5 core domains: accreditation oversight, managing people, fiscal responsibility and management, vision and stewardship, and professional fidelity. To be effective and build stable and thriving programs, program directors must understand and respond to accreditation changes and handle complex interpersonal interactions. The hidden curriculum of NIPDD is the networking and peer mentorship that builds trusting relationships and future guidance when needed.

The past 30 years have witnessed many changes in the graduate medical education environment, but many of the underlying challenges of running a family medicine residency remain remarkably similar. New program directors still need NIPDD to solidify key knowledge details and build a professional network of peers. While NIPDD content and teaching modalities have adapted and evolved, the core concepts are foundational and constant. The demand for NIPDD continues to rise as many new programs receive accreditation. To meet the increasing need, in addition to maintaining the high quality of NIPDD, the AFMRD is preparing to launch a new leadership development program geared toward other leaders in the family medicine graduate medical education environment.

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