Lessons from Philip Shayne, MD
Philip Shayne, MD is the Associate Dean for Graduate Medical Education and ACGME Designated Institutional Official at Emory University School of Medicine. In this episode, Philip talks about his journey from residency through private practice back into academic settings. He talks about recognizing early on that he wasn't as interested in research and instead pursued educational leadership roles, starting with Emergency Medicine program director, as an alternate path in academia. During his time at Emory, with support from his leaders, he has had multiple opportunities to lead locally and nationally which helped prepare him for his current leadership roles. His words of wisdom include "you need to find opportunities where you can influence a group of people, so you might make an educational or procedural or something like that. You've got to really love the job.", "There are a lot of people who think, "I have all this experience, but I've never done that," and they're more than competent to do the job. You really just need the aptitude and the love for the position." and "You've got to love what you do."
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Transcript
Hello listeners, welcome to Educational Landscapes, Lessons from Leaders. On today's episode, we are going to learn from Philip Shayne. Welcome to the show, Philip.
Philip Shayne:Thank you, Ulemu.
Ulemu Luhanga:To begin, what is your educational leadership title or titles?
Philip Shayne:My official titles are Associate Dean for Graduate Medical Education, and ACGME Designated Institutional Official.
Ulemu Luhanga:Okay. Oh, that's good to know. I always thought the O was Officer. What do you do in this role?
Philip Shayne:I manage all of the residency, the post-MD training programs. We have 120 ACGME accredited programs, which makes us about the 11th or 12th largest in the country, out of 800. We also have about 80 non-accredited programs that are often experimental programs, but they're so innovative, they haven't become accredited programs yet, and they have different ... They have a lack of rules that we have to provide more structure for, but those are fairly sophisticated learners. Also, we get international learners who don't qualify for fellowship in some of those non-accredited fellowships, so there's lots of different types of fellowship. We also have a podiatry program, which is not ACGME accredited, and we have an oral facialmaxillary surgery program, which is a dentist accredited program. I have to know different types of accreditation.
Ulemu Luhanga:I hear that. That is a lot, and so I'm now curious, what skills do you use to enable you to navigate all of that?
Philip Shayne:Well, I'm a consultant. Every one of these programs has an excellent program director who runs the program, and they're smart and they, for the most part, love their residents and fellows and take a lot of pride in their program and do great work. I make things easy for them and I help them with their problems, but I'm sort of the grandparent of the residents.
Ulemu Luhanga:I see that. I like that. There's the directors as the parents, and then you are a layer above that, as grandparent. Okay.
Philip Shayne:Right, and so I get to send them to the program directors when they misbehave.
Ulemu Luhanga:You get to be the nice grandparent, remaining?
Philip Shayne:Sometimes yes, sometimes no.
Ulemu Luhanga:Okay. Okay. I am curious, because I'm sure you didn't just start off as a DIO. What was your journey educationally, and even in terms of leadership roles, that led to this current role?
Philip Shayne:Well, the short answer is, I was the residency director for emergency medicine for 17 years, which was long enough to have experienced a majority of the problems that you can experience in running a residency. I graduated 300 plus residents, so I had credibility and experience, and that job was the honor of my lifetime and the best thing that ever happened. You can only just do it for so long because it's exhausting, and so when this opportunity to move up in the ranks at Emory presented itself, it was time for me to let somebody younger and more nimble take over, and somebody who maybe was more willing to improvise on things that I had failed at, let them take over, and I could take on this new role using the skills, and all my failures became assets all of a sudden.
Philip Shayne:Also, Emory gave me great support. I got involved in the program director organization for Emergency Medicine. I became the president of it. I was on the review committee for the ACGME, and I was the chair of it, all of which took a lot of time that I was supported by Emory, that my chairs always really appreciated demonstrations of leadership. I got national leadership and experience on Emory time, which then came back to serve me really well when I took on this role, because I had been on the other side of accreditation of programs and dealing with residents.
Ulemu Luhanga:Thank you. I'm curious, I'm always curious about when it comes to taking on leadership roles. Is that something that you aimed for as you were going through med school and residency, or is that something that kind of evolved over time?
Philip Shayne:It evolved over time. In high school, I was the editor of the yearbook, and that was a miserable experience. I got a lot of responsibility, no help. I was nauseous, anxious, and thankfully put out a yearbook. I didn't do anything in college. I had zero leadership because I was so scarred by it. I went through residency. I was not chief resident or anything significant. I went out in the community for a year and suddenly felt like I was missing something. I missed the camaraderie of academics, but I knew I had done some research that I hadn't enjoyed. It wasn't my thing, so when I showed up at Emory a couple of years out of residency, having been in private practice, I knew I wanted to do academics. I didn't really know what the options were.
Philip Shayne:I wanted to stay away from research, so I told them I wanted to be the program director because I knew that that was sort of hanging out with the residents and not research. Two years later I was the program director, just because I was the one who always showed up, and I had no business being the program director at that time. This was a much better experience with leadership, and there were some lows, but it was really great to be able to create the values and objectives of the program and recruit residents based on your values, hear the values reflected by the people working and see people realize their potential, and feel like ... I always found the end of the academic year, June, to be the best time, because I see the graduating residents who are so competent and I see the ones who are orienting to be interns, who are so scared and un-useful. You get to really get a sense of what your product is, and it's really pragmatic.
Philip Shayne:You graduate from medical school smart, and you leave residency useful, and you get to see that accumulation of competence, and with competence comes confidence, and you really see people grow up and realize their potential, which is a lot. We have a three-year emergency medicine program. To think that in three years you learn how to stand by yourself in an emergency room and accept any responsibility that rolls through the door, it's great to see people become confident.
Ulemu Luhanga:That is amazing, especially when I think about all ... The emergency room is a space where you don't know what is going to walk through the door.
Philip Shayne:Right. Yeah, you have to speak all the languages, all the languages of the hospital, and it's scary for residents, but by the end, they have this confidence that you feel like you contributed to. If they're good doctors and nice people and they've maintained a shred of the idealism that they brought in, you feel like you've done a good job, and that's ultimately my legacy.
Ulemu Luhanga:Absolutely. Thank you. I love that arc that you had, of an experience that left you a little unsure, and then eventually took on these leadership roles within academic medicine. What do you wish you knew before stepping into those types of roles?
Philip Shayne:Oh, gosh. If I knew, I probably wouldn't have done it, so it's often good to be a little vague about what exactly it entailed. I probably would've been more deliberate. It took me a lot of years to understand the value of cultivating your leadership style, and I may have even thought it was fake when I started up, but there's a balance, and people need to trust you and have faith in you. I had this idea, I had this sense when I started that I was too nice, and so I needed to be strict, because those who are loved by everybody are respected by none. I think that was a fortune cookie I got once, or maybe it was from The Art of War. I don't know, but I thought if I tried to be everybody's friend, they would all take advantage of me and nobody would respect me and I couldn't get anything done, so I started off by being really strict, and they respected that. It came at a time when things were a little wild down at Grady, which is where emergency medicine is housed, and they needed some structure and professionalism.
Philip Shayne:Over the years as I relaxed into the role, it really became easier, because they really didn't want to disappoint me. They knew that I really deep down loved them, and they would do so much not to disappoint me that my life became a lot easier. They don't know how much you know, until they know how much you care, or they don't care how much you know until they know how much you care, really became the better saying. I found that that works really well. You're not going to be a good leader unless you care for the people you're working for, and you need to be able to express ... Which reminds me, tomorrow is Jianli's 15th anniversary. I need to get something for her.
Ulemu Luhanga:There we go. I think, when you talked about that and the people, would you say the people you're referring to, the attendings who are part of the department as well as the learners, or did you find as program director you had to focus on one group more than the other?
Philip Shayne:I thought you had to focus on the residents, but it's like you automatically become the educational person for the department, and all of the faculty expect you to, because you're the residency director, to know how to teach and to find what to teach. My chair immediately started sending me faculty who needed help with their teaching skills, and anytime somebody got a negative evaluation, as if I was the expert. That's a strange type of leadership, right? That's not an explicit leadership. Maybe it is, but these were my peers, and I'm young, and they're teaching me shift by shift at my practice, still, and I'm supposed to be ... I tried to hold up a mirror and show them how they were perceived by their constituencies, and what they wanted to keep and what they wanted to maybe change out. That was always a tough one for me, but slowly, they all became younger and I became older, and then it became more natural for me to give them advice, and it worked better.
Ulemu Luhanga:Okay. Okay. Thank you for that context. Given, as you said, with all of those kind of things, the expectations of you in that kind of role, what continuing professional development do you do in order to keep up with the needs of the various roles?
Philip Shayne:It's very traditional. The major organizations that run these things ... There's a new organization just for people in my position, DIOs, the 800 of us that run the 800 different hospital systems across the country, but the ACGME, which is the main accreditation body for residencies, has a conference. There you meet your peers, and your peers become the network where you can, without judgment, get information if you weren't paying attention or didn't understand, or have a new instance. The learning always comes really through the actions, and somebody can tell me something a few times, but once I've experienced that resident issue, I know how to deal with it. It's always a pragmatic learning approach that works the best.
Ulemu Luhanga:Okay, thank you. What advice would you give someone interested in doing the same type of leadership roles that you've been in?
Philip Shayne:Well, there aren't a lot of places to go with the skillset you get with being a program director. There's only one position of mine, and there's an assistant position, and so you need to find opportunities where you can influence a group of people, so you might make an educational or procedural or something like that. You've got to really love the job. You have to be sort of a real nerd for this type of activity to appreciate it. I'm doing HR and looking up arcane rules. For me, it's about making life easier for the program directors by getting my feet wet in sort of the drudgery of professions. There's some sad instances where we have disciplinary action, and then you really wonder why you do it, but they're there to make it palatable for the program directors who are doing the great work of training all these residents, and we have 1500 residents, and I think it's 250, 300, going out into the community or the next job every year. That's a big legacy, and we want every single one of them to represent Emory well and take excellent care of their patients, and that's how we define our legacy.
Ulemu Luhanga:Absolutely. Thank you. Given, as you said, kind of the challenge of, there's limited roles for program directors and even DIOs, how do you view succession planning?
Philip Shayne:Well, so I view succession planning as to who's going to take over from me when I'm no longer deemed fit, or ready to move on. I'm not worried about where I'm going to go next. We divided the job into two and made an assistant and an associate, so that when Maria Aaron, who was the associate dean when I was the assistant dean and did a fantastic job, when she decided that she wanted to move on, I was ready. I had been in the office and she and I shared everything, and so I moved into her role and we did a search for the assistant dean. Now the assistant dean has been selected as the presumed successor, and I involve her on everything as a way to ensure that if I get hit by the Grady bus, that she can seamlessly step into my office. I think that it's a huge disservice not to have something really practical like that in mind, and if you don't have somebody already designated, you need to be sure there are people who understand your office so that they can step in seamlessly in what's probably a traumatic event.
Ulemu Luhanga:Thank you. Taking a step below DIO, when it comes to program directors, are there assistant program directors often, in order to have a similar succession plan?
Philip Shayne:Sure. Every department has a lot of educators, and they may express leadership through being part of the residency. You could be director of simulation or director of ultrasound or director of radiology or director of podcasts. I don't know. There's the clerkship director, which is equivalent leadership, and the assistant. There's fellowship directors, various fellowships. There's this big messy pot full of educators, and you need to have some way of supporting all of them in your department, but it means that when the program director job comes up, there are a lot of people that are competent to do it, and there are more people than they realize. There are a lot of people who think, "I have all this experience, but I've never done that," and they're more than competent to do the job. You really just need the aptitude and the love for the position.
Ulemu Luhanga:Yeah. Thank you. As you think about your experiences to date, what has been one of your greatest successes thus far?
Philip Shayne:Well, I mean, my greatest success I think is the legacy of 350, 400 graduates of the program that are out in the community. I'm not a very emotional guy. I'm sort of stiff and stern, and I always refused to hug residents. I did it once and my wife said, "Well, how do you know that she wanted to be hugged by you?" That terrified me, that people would ... I never, so I'm always a little bit off-ish, especially in the ER, which is, we're a little bit more casual maybe than some specialties. There's a lot of back-slapping and hugging and stuff like that. I never did it, and at graduation one year, all of a sudden the whole class rushed me and hugged me as a group of 18. I had this picture of me in the middle of, again, this massive hug. That was sort of the moment I felt like I had done it right, to earn that spontaneous expression of appreciation. I don't know if that's what you meant, but I like the story. Makes me feel good.
Ulemu Luhanga:Yes. That's beautiful. Thank you. I'm picturing ... I would love to see that photo someday. That's so-
Philip Shayne:Also, the last two years I did it, each resident put together a page in an album of whatever they wanted, to say thank you. I have these two albums with ... They're in my office, I'd be happy to show them to you. It's also an expression of affection that is really almost overwhelming to me, to have been that influential.
Ulemu Luhanga:Absolutely. Oh, that is a beautiful success. I'm curious, as they go out into the community, do you have a lot of them that stay and continue at Emory, or it's all over the place?
Philip Shayne:Yeah, so last year or two years ago, my first graduate that I had recruited as an intern attained full professorship. I think we have four professors now in the department that I recruited as medical students. I would say about half, a little less than half of our department are graduates of the program. We've always tried not to be too inbred, but if you look at the city of Atlanta, they're all our people.
Ulemu Luhanga:Oh, that's awesome.
Philip Shayne:I brought my wife into an outside hospital when she wasn't feeling really well, and everyone there was a former resident, so I feel like we've had a really good impact on Atlanta and some of the others, Savannah, Mercer. Sorry, Macon. A few have gone down to very deep south, so I mean-
Ulemu Luhanga:Nice.
Philip Shayne:The state had an impact.
Ulemu Luhanga:That's wonderful. Thank you. As you think about your role, and you're in education, what would you say your biggest growth opportunities are right now?
Philip Shayne:You can always do a better job reading people and understanding why they did what they did. When we have to discipline people, there's usually some problem that we're not getting to. I try and deal with these things through compassion, but they're often ... The system makes it a controversy, or a fight, and so I think my biggest growth is to really make these nurturing opportunities and not disciplinary opportunities, and how to, which is easy to say when you're not the program director, you're sitting on the outside. It'd be really nice if we could give our residents the support they need so they don't act out. There's an act of unprofessionalism at 3:00 in the morning, they probably were exhausted, and who knows what's going on in their personal life? Yeah, it was inappropriate, but let's make the system better so that we don't try them so hard.
Ulemu Luhanga:Thank you. What would you say, just in continuing this, reflecting on what you've done so far, what do you love most about your work and what you do?
Philip Shayne:Oh, my colleagues. I've always loved that at Emory, whether it's in the ER or the GME office. We have people dedicated to the job and the vision of the organization, and people are really good at Emory. I've found that they just have excellent ethics, good vision, want to do the right thing, and we get along well. It makes the job a joy, and so you know what it's like to walk into the GME office. It's usually a bit noisy and somebody's having a party somewhere, and it's just great to be part of that.
Ulemu Luhanga:Absolutely. I've got the last two core questions, and the first one is, reflecting on your experiences to date, what would you say your passions around education are right now, or where is your educational philosophy at?
Philip Shayne:My passion is supervised experience. I think that that's what makes the world move. I think that's the magic about GME, is that you're no longer in a classroom, and the residents always want more didactics, but what they don't understand is that the teacher is your patient, and it's being allowed to treat them with the proper supervision that gives you all the skills that you need. If we could treat all education like that, I think especially for adults, it would be much better. You need to be able to fail, and that's what's tough in medicine, is it's really hard to fail. We're slowly bringing simulation up to the point where it can take that place and allow you the opportunity to fail better, but we have to be able to have our hands on it.
Ulemu Luhanga:Thank you. Last but not least, because you are more than what you do, what are some things you do outside of work to help you maintain joy in life and practice?
Philip Shayne:Well, I love coming home to my wife and kids, although my kids got big and left. They still come around sometimes. I like to work out, and I ride and run with some of my colleagues in emergency medicine. I like to eat, and Atlanta's become a really great food destination, as you know. I'm somewhat insufferable on the subject of restaurants, if we get talking about it, and travel. I'm not sure I'm as vigorous a traveler as you are, but I love traveling, and as we were discussing earlier, it's about getting to know a place, not about what you see, but understanding what it's like to live there. That's really exciting to me.
Ulemu Luhanga:Thank you so much, Philip. We have really appreciated your time. Before I let you go, any last words of wisdom for aspiring educators or education leaders?
Philip Shayne:You've got to love what you do.
Ulemu Luhanga:I love that, so nice and succinct, and captures, I feel like, your message throughout. Thank you again for your time.
Philip Shayne:You're a really good interviewer.
Ulemu Luhanga:Thank you.
