Program Content and Organization

Once the goals and objectives of the program and rotations have been established, it is important to construct a training sequence that is rational.  It is the Program Director’s responsibility, along with the RPC, to advocate for residency assignments that are based on educational needs, not simply service.

The service-to-education ratio is the critical balance and reflects the 'real' educational philosophy of a program and a department.  It can be a challenge for the Program Director to defend a balance that supports education; criteria need to be established for resident assignment and justified.  In this, Program Directors need the support of the department and Head.  It may help to take a fresh look at traditional assignments and ask:

What is dictating this resident assignment – service needs or educational needs?

Is the sequence of rotations rational for each resident?  Is the sequence responsive to each resident’s training needs and career goals?

It is also essential that every program, by design, permit the resident to have increasing responsibility for patient care.  This should be reflected in the objectives.  

For each rotation, the Program Director needs to designate a supervisor with whom you can liaise about scheduling and discuss resident progress and evaluation.

Other structural concerns:

In planning rotations, the Program Director needs to consider whether the program permits:
  • Electives (these must be possible and appropriate)
  • Community-based rotations (is the supervision adequate and are the objectives clear?)
  • An appropriate inpatient/outpatient mix
  • Access to academic activities and research
Finally, the Program Director needs to review the training template, both from the department's perspective (have the service issues been addressed?) and from each resident’s perspective (how does his/her chronological training map look?).