Summary
GME offices often describe their work as constant problem resolution—what many call “putting out fires.” Over time, this pattern can shift leadership responsibility from residency programs to the institutional level, particularly within structures designed to support institutional oversight. This Insight explores how a coaching philosophy, supported by intentional GME leadership development structures, can strengthen Program Directors and program leadership while preserving appropriate institutional oversight.
The Pattern Many GME Offices Recognize
In many Sponsoring Institutions, GME office leaders describe their work in similar terms: constant problem resolution—what many simply call “putting out fires.”
Program leadership teams bring forward difficult situations: struggling learners, faculty conflict, policy interpretation questions, accreditation concerns, and leadership challenges within the program. Over time, the GME office becomes the place where these complex situations ultimately land.
“Over time, the place where decisions are resolved becomes the place where leadership resides.”
When this pattern persists long enough, something subtle begins to shift. The place where problems are resolved becomes the place where leadership resides.
Most GME offices do not intend for this shift to occur. In many cases, the response grows out of a sincere desire to support programs and prevent problems from escalating. But when the institutional response consistently absorbs the weight of program-level decisions, program leadership in GME can slowly become dependent on that structure rather than strengthened by it.
When Support Quietly Becomes Carrying
GME offices play a critical role in maintaining institutional oversight and ensuring programs meet accreditation expectations. But there is an important distinction between supporting program leadership and carrying the leadership responsibilities of programs themselves.
Support becomes carrying when:
- The GME office routinely resolves problems that belong within program leadership
- Program Directors begin relying on the institutional office to make difficult decisions
- Institutional leaders spend increasing amounts of time managing issues that originate within programs
In these moments, the work of the GME office can begin to feel less like leadership development and more like constant problem containment.
A Coaching Philosophy for GME Leadership
One way institutions can rebalance this dynamic is by adopting a coaching philosophy toward program leadership.
Coaching does not remove difficult decisions from Program Directors or program leadership teams. Instead, it provides structure, guidance, and accountability so those leaders can carry their responsibilities more effectively.
In this model, the GME office remains a strategic partner rather than the place where every difficult situation ultimately lands.
This shift allows institutions to:
- Strengthen leadership capacity across programs
- Preserve the authority and ownership of program leaders
- Reduce the constant cycle of institutional problem resolution
Structure Matters: Coaching Supported by Institutional Design
Philosophy alone is rarely enough. Coaching approaches are most effective when they are supported by intentional leadership development structures.
Institutions that successfully strengthen program leadership often provide multiple layers of support, including:
- Role-based professional development
- Structured leadership learning opportunities
- Access to coaching and consultation when complex issues arise
To help GME offices reflect on where support may unintentionally shift into carrying, we’ve included a short Coaching vs Carrying Reflection Tool accompanying this Insight.
Partners® Learning Pathways and Passport resources were developed to support this kind of leadership ecosystem—providing role-specific development for Program Directors, Associate Program Directors, program coordinators, and GME office leaders.
In particularly complex seasons, Partners® Virtual Coaching by role offers a confidential space for leaders to structure decisions, reflect on challenges, and maintain ownership of their leadership responsibilities without feeling isolated.
Related Resource: Motivating Change in GME
Sustaining a coaching approach often requires helping program leaders navigate change effectively. Our webinar, Motivational Dialogue — Helping Facilitate Change, explores practical strategies forguiding leadership growth and strengthening engagement across programs.
Watch the webinar in the Partners® Passport OnDemand library.
Strengthening Leadership Without Absorbing It
Strong GME offices do not remove difficult decisions from program leadership. Instead, they create environments where leaders are equipped to make those decisions with clarity and confidence.
When institutions move from carrying to coaching, something important changes. Program leaders grow stronger in their roles, the institutional office can focus on strategic oversight, and leadership responsibility remains where it belongs—within the programs themselves.
The goal is not to reduce support. The goal is to ensure that support strengthens leadership rather than unintentionally replacing it.