A Survey of Neurosurgery Residency Program Coordinators: Their Roles, Responsibilities, and Perceived Value

Objective Residency program coordinators play an important role behind the scenes, in the function of residency and fellowship programs. In addition, coordinators have significantly heterogeneous job roles among institutions. The aim of this study was to evaluate the training, responsibilities, and contribution of residency program coordinators within the field of neurosurgery. Methods A 24-question survey was submitted to 133 program coordinators, and 78 responses (59% response rate) were received. Results The survey results showed that >80% of coordinators have been in their current position for ≥3 years. Coordinators identified at least 24 unique departmental responsibilities with an average of 85% of the time devoted to residency program management. Among coordinators, 82% reported no formal training, with 60% and 55% reporting inadequate training from their department and institution, respectively. Interestingly, 84% completely or partially agreed that their work is valued by residents, 91% by the program director(s), 78% by the department chair, 62% by other faculty, and 56% by other departmental staff. Lastly, 50% of coordinators reported that their department has not been receptive to receiving feedback on how to improve the roles of the position, with 80% reporting no career advancement track. Conclusion Residency program coordinators reported a wide range of experience and responsibilities within their respective departments. The majority reported limited training for their current position, and a significant number reported not feeling valued by members of their department, suggesting two areas for improvement. As coordinators continue to play a larger role in the management and accreditation of their departments, strategies to optimize their role may be important.


Introduction
Neurosurgery residency program coordinators play an important role in the organization and function of residency and fellowship programs. In addition to managing the daily operation of these programs, coordinators must manage Accreditation Council for Graduate Medical Education (ACGME) requirements for program accreditation in direct coordination with the program director(s), department chair, and other department staff [1][2][3]. First formalized in 2008, the Society of Neurosurgical Surgeons Coordinator's Group grew out of the increasingly formalized ACGME requirements for neurosurgery departments. Continued expansion of ACGME since its founding in 1981 has led to the increased complexity of accreditation requirements, site visits, and annual reviews.
Currently, the ACGME Next Accreditation System, formed in 2015, governs the process of residency and fellowship program management. The demand placed on residency program coordinators has increased over the last decade as the ACGME requirements and other regulatory governance in neurosurgery programs have become more complex [4][5]. These changes have resulted in an expansion of the program coordinator's role from a secretarial responsibility to a managerial position involved in budgeting, departmental operations, human resource (i.e., for residents and fellows), management, and regulatory affairs [4][5][6]. Furthermore, as neurosurgery residency programs have grown in size and complexity (to 115 ACGME-accredited programs in the U.S. with a total of 1479 residents [7]), the residency program directors and coordinators have greater responsibility to facilitate training and administrative tasks. The survey included nine questions assessing the demographics of residency program coordinators, two questions about current roles and responsibilities, 12 questions surrounding the value of work and contribution, and one final question allowing coordinators to provide any information about their job they would add in addition to the survey ( Table 1). Job responsibilities were assessed by asking coordinators to select which of 24 common roles and responsibilities they perform as part of their job, along with one blank answer space allowing participants to add any roles that were not listed. Value and contribution were surveyed through questions assessing the coordinators' subjective views on how the institution and department view their work as well as how individuals within the department value their contributions.

How many years have you worked in your current position?
Did you have formal training for your job as a program coordinator/administrator?

Residency program coordinator demographics
A total of 78 coordinators completed and returned the survey (59% response rate) (

Roles and responsibilities
More than 85% of the responding residency program coordinators reported that their job duties included coordinating with the Electronic Residency Application Service (ERAS), Graduate Medical Education (GME), and National Resident Matching Program (NRMP) offices; participating in interview scheduling; completing paperwork for ACGME accreditation; providing residency orientation; completing rotation scheduling; and attending resident-program director meetings ( Table 3). Fewer than 50% of coordinators reported that human resources or working as a coordinator for a clinician or faculty member was part of their duties.  Self-reported responsibilities listed under "other duties" included Continuing Medical Education (CME) coordination, scheduling visiting lecturers or professors, organization of medical student away and home rotations and shadowing, and other administrative tasks to include departmental budgeting, grants and awards, and departmental operations management.

Value and contribution
We assessed the self-perceived valuation indicated by program coordinators ( Table 4). Fewer than <20% of coordinators reported a career advancement track through their department. With regard to value and contribution, 63% of coordinators completely or partially agreed that their work is valued by their institution, 75% by their department, 78% by the department chair, 91% by the program director(s), 62% by other faculty, 61% by fellows, 84% by residents, and 56% by other staff. A total of 48.7% of coordinators reported that the institution has been responsive to feedback for improving their role or job and 50.0% report that their department has been responsive.

TABLE 4: Institutional validation of program coordinators
The self-reported valuation of coordinators was correlated among staff categories ( Table 5). That is, coordinators who somewhat or completely agreed that they felt valued by their institution or department reported the same valuation by the department chair, program director(s), and staff. Next, we evaluated the responses of coordinators that felt somewhat or completely undervalued was performed (

Discussion
The aim of this survey was to assess the experience, training, responsibilities, and contribution of neurosurgery residency program coordinators. To our knowledge, no such study has been carried out previously. The importance of such a survey is in the increasing role that coordinators play a role in managing neurosurgical staff, monitoring regulatory affairs for accreditation, maintaining budgets, and performing human resources tasks, all of which allow departments to function and directly impact patient care.
The response rate of 59% is consistent with surveys of program coordinators in other fields [1][2][3]. Overall, neurosurgery program coordinators are fairly experienced in their position, with >50% reporting working in their current position for ≥5 years. This experience is similar to program coordinators in other surgical subspecialties [2]. Additionally, neurosurgery coordinators normally manage one department, and the majority of coordinators manage less than three fellowship or residency programs.
Also consistent with other studies, residency program coordinators surveyed in our study reported inadequate training from both the institution and the department [1,3]. A barrier for training may result from the lack of a standardized definition of program coordinator responsibilities [9]. With different standards across specialties and some specialties only requiring that a coordinator simply be in place at a department, heterogeneity between coordinator roles will continue to exist [9]. Many coordinators, including those surveyed in our study, are responsible for managerial tasks not directly related to the residency/fellowships they manage [1][2][3]. As one coordinator highlighted in the response to our survey, handling departmental duties on top of managing the residency program felt like "extraneous" responsibilities. Coordinators reported that when these departmental responsibilities were relieved, they were much more effective in their role as residency program coordinator. Delineating work responsibilities at a departmental, institutional, and/or national level is warranted.
Workplace training and responsiveness to feedback were common threads that impacted the valuation of program coordinators. The lack of formal training, standardized qualifications and expectations, or standardized job descriptions leaves coordinators with responsibilities that take their focus away from residency program management, a demanding task in and of itself. Without formal training, coordinators can quickly become burned out from many tasks that they do not feel qualified to manage. Respondents to our survey with inadequate department or institutional training correlated with a greater likelihood of feeling undervalued by the institution, department, department chair, and program director(s). Coordinators were more likely to feel undervalued by the institution or department if either was less responsive to feedback. A longer career in the position predicted a greater likelihood of feeling valued by the program director(s), very likely correlating with lower coordinator turnover and a better working relationship between coordinators and directors. Interestingly, no specific factors could be identified to suggest coordinators were undervalued by other faculty, fellows, residents, or other staff. These findings suggest that mechanisms to improve the onsite training of coordinators, specific to their job descriptions, and direct interaction with institutional administrators and other program leaders would be important to increase perceived valuation. Likely, as seen with longer lengths of employment and greater valuation from program directors, improved self-valuation results in greater job retention, although this was not specifically queried in this survey.
Coordinators are also placed in a difficult and fast-paced educational environment, one that requires them to juggle working with residents and fellows, program directors, department chairs, and other faculty and staff. Our survey demonstrated that coordinators do not always feel valued by those with whom they work. Over 90% of coordinators completely or partially agreed to feeling valued by program directors with 84% reporting feeling valued by residents; however, the subjective perception of value decreased when coordinators were asked whether they agreed with feeling valued by the department chair, other faculty and staff, fellows, or the department and institution as a whole. In addition to this lack of perceived value, many departments in the field of neurosurgery do not offer a career advancement track for coordinators. This provides less incentive to receive certifications and additional training such as TAGME certification. Our data demonstrate that <15% of neurosurgery program coordinators are certified as such. If neurosurgery program coordinators are not properly valued and trained, the quality of residency program management may decrease at a time when residency program administration is becoming more complex.
The high turnover rate among program coordinators demonstrated in other studies may be related to the lack of respect that coordinators reported they receive from those within the department [1,3]. The complexity and heterogeneity of the role and lack of adequate training, coupled with a decreased perception of departmental value, places tremendous strain on a program coordinator. Half of the coordinators in this survey reported that their feedback to improve the position of program coordinator is often not regarded by the department or institution. This may lead to a perception that departments and institutions do not value the role of a program coordinator even if the ability to produce a policy change was limited. This could be addressed with a simple but formal mechanism to hear out coordinator questions and concerns.
The limitations of this study include a subjective method of assessing roles, responsibilities, and perceived departmental value. Not all coordinators responded to this survey, which may result in a selection bias with viewpoints shared by a vocal number of individuals rather than the total. Further studies should investigate the training of residency program coordinators as well as possible solutions for the increasing managerial tasks among coordinators, which distract from the time involved in managing residency and fellowship programs.

Conclusions
Neurosurgical residency program coordinators play an important role with regards to the function of the residency program and department, which impacts patients. Coordinators reported a wide range of experience and responsibilities within their department, with the majority reporting no formal or inadequate training for their current position. A significant number also reported not feeling valued by members of their department and nearly half agreed that departments and institutions are not receptive to their feedback about how to improve the role of coordinators. These findings directly impact the work product of the coordinators and serve as areas for improvement. As coordinators continue to play a large role in the management and accreditation of their departments, further exploration into strategies to optimize their training and role is warranted.

Additional Information Disclosures
Human subjects: Consent was obtained by all participants in this study. University of Utah Institutional Review Board issued approval NA. IRB approval not required because completion and return of survey is considered consent. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Julie Service, Amy Ekins declare(s) employment from University of Utah, Department of Neurosurgery. These authors are employed as residency and fellowship program coordinators, respectively. Randy Jensen declare(s) personal fees from Medtronic. Consultant. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.