The Return of a Residency Program Director:
How I Found Passion in Medical Education
By: Dr. Gomez
Radiology Residents at University of Puerto Rico – 2011.
We’re expected to be ready when opportunity arrives, but sometimes, we’re not and it may feel like failure. But if you continue to chase excellence with kindness and hard work, opportunity will find a way back to you.
Almost a year ago, I was appointed as the Diagnostic Radiology residency program director (PD) at UT Health San Antonio. It took plenty of ingenuity from the Chair to make me understand that accepting the position was the right decision for both the residency program and me. I never quite bought it, but after several weeks of deep introspection, I reluctantly accepted the position. You may ask yourself the reason for such hesitation. After all, I am an academic radiologist and education should be one of my priorities. The answer, like education itself, is extremely complicated.
I first became a residency program director at the University of Puerto Rico (UPR) in 2008, right after finishing my MSK imaging fellowship. At that time, the Chair at the UPR was also acting as the program director and the Department was in desperate need of hiring a new faculty willing to assume the position of PD. I was very young and inexperienced and despite countless of warnings from many of my mentors to first grow as a radiologist, before assuming any leadership responsibilities, I accepted the position and became one of the youngest program directors in the nation. After all, I trained at the UPR radiology residency program and it has a special place in my heart. My tenure at UPR didn’t have a good start and in all reality never got any better after making one rookie mistake after the other. To say that accepting the position was a professional disaster would be an understatement. But I was lucky. Very lucky.
At UPR I had the benefit of working with the most outstanding, passionate and overachieving residents you could wish for. I also worked and learned from our long time associate program director, who had been working with the residency program for more than 20 years. She knew the ins and outs of graduate medical education and the ACGME to the very last detail. With their help, I was able to survive my first five years as a PD, including a full ACGME accreditation visit. Looking back, our residency program achieved great success those years – but it sure wasn’t a reflection of my individual efforts as a PD.
As would be expected for a young faculty, I didn’t know much about the politics of academic medicine. My ignorance got me in trouble really fast – with the Chair, the Dean and even with some of my colleagues. I wanted everyone to see medical education as the only priority in our institution, without any regards to the other components of academic medicine, like a healthy fiscal clinical enterprise and research. I got frustrated with the fact that education almost always took the back seat in academic medicine. After all, education is the one component that produces no income at all. In fact, most would agree that education is a money losing enterprise, at least in the short term. I became lost in my mission to provide quality education to our residents and became a rebel without a cause. The once positive passion turned into negativism and my enthusiasm became destructive. By the time I left UPR, I was burned out and completely tired of academic medicine and medical education. As I left the UPR radiology department for the last time, I promised myself to never again be involved in medical education. Life, as you might expect, had other plans.
When I started my job as an MSK radiologist at The University of Alabama at Birmingham (UAB), the Chair asked me about any aspirations as an academic radiologist and on ways she could help me achieve success at UAB. I was willing to contribute in any leadership position that would become available, except those related to education. Soon after that I became the section chief of the MSK section and director of MRI, both great opportunities that helped me grow as a radiologist and leader. While at UAB, I found myself unconsciously involved in resident education and giving my unasked opinion on how to make things better for the residency program. I also started to miss more and more my days at UPR and the great professional and personal bonds I’ve made with my prior residents. My academic life had become much less complicated and demanding, but also much less rewarding.
As luck may have it, there was a shift in leadership and the Chair asked me if I was willing to serve as an associate residency program director as part of a “temporary” educational team. I agreed and was thrown into medical education once again, although much less involved. I got the opportunity to contribute to the residency program without the full responsibility of being a PD. I gave my advice when asked, was able to mentor residents, interview medical students and share my prior experiences as a PD. Unfortunately and due to personal reasons, I had to leave UAB, but not before unconsciously erasing some of the discomfort I felt for medical education.
Three years ago, almost as a Deja vu, I found myself discussing with the Chair of UT Health San Antonio my aspirations as a leader and academic radiologist. Yet again, I offered myself for any available leadership position, except those related to medical education. Almost as if my academic career was in a loop, I once again became the MSK section chief and director of the UT Health SA imaging centers, both positions which I’ve enjoyed tremendously. But then, out of the blue, I was offered the position of program director. Initially, I respectfully declined the offer.
The Chair thoroughly explained the reasons she thought I would be the ideal candidate and asked me to take some time to think about it. I was rather confused and felt that it would be certain disaster to accept the position based on my prior experiences. To my surprise, all my mentors, friends and family thought it would be a great idea and precisely what both the residency program and I needed. I failed to see in myself what others clearly saw – a genuine passion to teach and to stand up for the education and wellbeing of our residents. Six years after vowing to forever stay away from medical education, I became the residency program director at UT Health SA.
One of my favorite drawings – doing overnight call with residents at UAB.
I’m passionate about medical education and I get to live my dream every day. Perhaps this time around I’m more experienced and equipped with better tools for the task, but the job remains as challenging as 10 years ago. Truth be told, the joy of medical education lies in the center of its hardship. Medicine is a difficult career, full of extreme challenges and inevitable setbacks. Long hours of intense physical and mental application, away from those closest to us. Nobody goes through medical education without at some point questioning their initial decision to become a physician. A struggle that requires constant attention from those in leadership positions.
At the administrative level, education will always live under the shadow of research and clinical work and is always dependent on their finances. The PD eternally lives in the intersection between the essence of what defines an academic institution and what makes it move forward in our ever-changing world. We are the gate keepers of our professions, always maintaining the delicate balance between assuring educational fairness and clinical competency. We are responsible for guiding young physicians on becoming competent and autonomous, while assuring the highest of standards in patient care. We get to enjoy the success of our residents, but also share the frustration of their academic hardships and personal discontentment. Guiding a resident through academic under performance while assuring safe patient care and fairness is the hardest task in medical education – but also the most rewarding.
2019 Radiology Residents Christmas party. UT Health San Antonio.
Last November, while attending the Radiological Society of North America (RSNA) annual convention I got to experience the epitome of what medical education is all about. While walking across a sky bridge I heard somebody yelling my name in the distance: “Dr. Gomez! Dr. Gomez!” I stopped in the middle of the crowded bridge to look back, and just then saw one of my former residents running towards me with immense joy. She hugged me and asked me how everything was going, which led to exchange of news about our respective lives. She then touched my shoulder and said:
“Dr. Gómez, I want to sincerely thank you for all that you contributed to my career. I wasn’t the best resident and residency was very confusing and frustrating for me. But today I’m a board-certified radiologist, caring for patients in my community and with the means to support my family. I left without ever saying how thankful I am for people like you that sacrifice much so others can be of service to our patients and community. So I just wanted to say, thank you.”
I was caught off guard and thanked her in return for the kind words knowing all the difficult times we shared when she struggled during residency. We talked some more and then parted ways. But as my former resident walked away, I just stood there among hundreds of people in motion, looking at her and loss in thought. She suddenly looked back with a genuine smile in her face and waved goodbye as she continued to disappear in the multitude. Almost as an act of magic, all became crystal clear to me – for all its hardships and shortcomings, education is what resonates in my heart, my true passion and what moves me to achieve greatness in others and myself. It was a cold November day as I looked around and saw the Chicago skyline in the background as a reflection of hope. Feeling complete and warm, I turned around and got lost in the crowd.
Dr. Gomez is the Diagnostic Radiology residency program director at UT Health San Antonio. Read more of Dr. Gomez’s writing on his blog: https://radioactivemusings.com
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