José M. Villalón-Gómez, MD, MPH is program director for the Family Medicine Residency Program, Emory University School of Medicine. In this episode Jose talks about how his passion for education started as early as high school and how his mentors encouraged him to remain curious and try new things. As an educator and leader, he sees his roles as helping the future generations of physicians or learners and society in general. Some of his words of wisdom include: "I think this kind of position / role, we have to perceive it and treat it as a marathon. It's not a sprint. If you take it as a sprint or short race, you're going to get fatigue, you're going to get tired. That's where the burnout comes in. So you have to come in with a marathon runner perspective of find your pace, find your tempo, so then you can be an effective leader." and "I think that's one of the beauties of education is that knowledge is constantly changing and growing, and you have to really expose yourself and get out of your comfort zone to be an effective teacher. Because you're going to be teaching younger generations that are in a different mindset than the framework that you use to learn. So you have to adapt to those. And I think that's one of the reasons I enjoy teaching is it keeps your heart young despite your body getting old."

Resources

• Society of Teachers of Family Medicine (STFM)
• AFMRD : Association of Family Medicine Residecy Directors
• Residency Leadership Summit | AAFP

Hello listeners, welcome to Educational Landscapes: Lessons from Leaders. On today's episode, we are going to learn from Jose Villalon-Gomez. Welcome to the show, Jose.

Thank you, Ulemu. It's a pleasure to be part of this conversation and this project. So excited to be here and welcome to the listeners too.

Thank you. Thank you. To get us going, what is your educational leadership title or titles?

Yeah, so I serve as the program director for the Emory Family Medicine Residency Program for the past six years. And basically, we're in charge of running the educational experience of our future family physicians here at Emory, and across the city of Atlanta, and the different systems that we serve.

Wonderful. So thinking about working with these family medicine residents, what do you have to do in your role with them?

Yeah, so the structure of the program is a three-year experience for the residents. They finish medical school after their four years of their medical degree, either in allopathic or osteopathic medicine. And then to become a family physician, they have to complete an additional three years of residency clinical experience before they are board eligible to become board certified in family medicine.

So we have to provide experience to all the residents, but our program is 30 residents in total, so 10 residents per academic year. And the scope of our specialty is basically to train residents from birth to death. It's kind of our specialty. We take care of obstetric patients, prenatal care, pediatrics, young adults, adolescents. And of course the geriatrics all the way to the end of life. So the scope of the clinical practice process, all ages and all family generations, and it's one of the things that we have to expose our residents as part of their training.

That has always, I think, blown my mind when it comes to family medicine, the breadth that is covered, which I know we're going to be talking more about you and what you do. But I am curious, given that breadth, how do you work out what to cover in those three years?

Yeah, and that's something that has become more challenging as medicine and science has become more specialized and there's more knowledge on medicine and the different specialties of what's the scope of our practice, how much as family physicians we're expected to know. So it's becoming challenging in the sense of what to cover in three years of training, and how to be efficient, and be comprehensive enough that our residents are ready to practice primary care once they go to the real world.

So it's something that we have to innovate throughout the years as the specialty have grown. We became a board back in the '60s, and the specialty has been growing since then. The concept of the generalist has always been in history. It's just that we didn't make it a specialty and a specific training until the '70s.

So we continue to innovate, try to be creative of how to continue to be up-to-date on the medical knowledge and the new techniques and knowledge in medicine, and how to implement it to the primary care world. But I think it also takes a lot of collaboration with our colleagues on the specialties and how to facilitate that transition between how far can we take care of our patients, and then we have to pass the care to the specialist when it's out of our scope. So it's something that it takes experience and training for the residents to get comfortable in that sense, and for us as educators of how to develop those skills and trainings.

Thank you. Thank you. So given this breadth that you are supporting your residents to get through, what skills do you use in your role as an educational leader?

Yeah. So I think at this point in education, I think most of our faculty, I try to model that. That structure is, we basically see them as adult learners. So we have to meet the trainee at where they're at on their knowledge, on their comfort zone, also on their style of learning. And I think as adult learners, and we the faculty, myself as director, how do we manage the environment to make it as productive as we can from a learning perspective, to explore their potential of those trainees, and to help them find their path to success, and to improve their knowledge, and become the best physicians they can be?

I think it's a little bit more challenging as you move in the educational spectrum from younger learners, to undergrad, to then undergrad medical education. Now at this point, graduate medical education. A lot of the trainees already have developed their learning style, and we have to try to find a ways to compliment that, in a way that it's an effective process that you can do in three years. I think some come with skills that are a little more defined and are more developed, and they can then find their path, which is minimal guidance. And there's some other trainees, which I think are a little more challenging because of their learning experiences and their learning style that need a little more coaching when they're in residency. And as a lead on the program, a director, we have to develop the structure to support those trainees so they can be successful.

I think our goal and me as a director is to make sure that everyone succeeds. I think they've made it this far on their training and their education, that I think they can get it done. Sometimes, we just have to be creative on the way you do it.

Yeah, so important. I love as you talk about supporting and really meeting them where they are and being flexible, so that you can really support where they start and where you need them to go.

Yeah. And I think that's something that as an educator, also gives me a lot of room for growth, because some of their learning styles might not be the same learning style that I have. And I think that's what makes the job fun, is that you have to innovate within your own environment so you can make it a productive, and an educational and safe environment for the trainees.

Wonderful, wonderful. So I recognize that you mentioned early on that you've been in the role as director for about five, six years. So I would love to hear more, what was your journey that led to this current role?

So I think education has always been a passion of mine, even since high school, actually. I think my first job overall was as a math tutor to junior high students when I was in high school. And then as I went through my undergrad studies in biology, chemistry, I participated in a program that tried to help the community in a way of how an undergrad student can help the community and be impactful in their university settings.

So my project at the time actually, I put together an educational website for students around malaria, and the different transmission and treatment models. My undergrad honor thesis was in malaria research. And then when I went through medical school and then residency, I had the opportunity to take the role of chief resident in my residency, which some of our responsibility was a lot of the didactics development and curriculum development.

And then when I started private practice back in 2009, I started working with medical students probably six months into my position. I started my practice down in Pensacola, Florida, and we were associated with the Florida State University School of Medicine... College of Medicine, sorry. And then we actually took third and four year medical students in our practice.

So that's what kind of got me back into education. And I lasted probably, I think it was about 18 months, 20 months in private practice before I decided to make the jump to academic medicine. And then my first job in academic medicine GME, graduate medical education was actually in a rural residency in Georgia, in Rome, Georgia at Floyd Medical Center. So that was my first position as core faculty, and that was in 2011, and I stayed in that position until 2017 when I then joined here at Emory. I came on board as an assistant program director for the residency in the summer of '17, and then had the opportunity to step up to the program director role in January of 2018.

So education has always been in the path of my career, my life, my interests. And I think it's something that I always learned as a child. My grandfather was a journalist, so the writing, and how to communicate, and how to transmit messages to other generations was always very present growing up. So that's how I see my role in education is, how can I help the future generation of physicians or learners and society in general? And that was kind of what brought me where I'm at.

And then, never really had a plan of, "I want to accomplish this by the stage of my career," or, "I want to get to this point by this point in my life." It's just big opportunities that have presented through that path, that I have taken the chance to try them, and to venture on them, and put the energy and the passion to foster them and to develop them. And this is where I'm at right now. And hopefully, I get the opportunity to keep doing it in this role or any other role related to education.

That is wonderful. Thank you so much, Jose.

Thank you.

As I listen, one of the things that I am very fascinated about, because I don't hear about this often, how was it that similarity or difference being in academic medicine in a rural setting versus in the heart of Atlanta?

Yeah, so I think that's something that as the opportunity presented... And I trained in New York City, so I trained in an inner city community kind of base in Queens, New York, Jamaica Hospital. So I was kind of used to the big city, inner city structure.

And then when this opportunity presented on the rural side, I saw it as an opportunity to diversify my experiences and try to see how family medicine is taught in what we call an unopposed environment, meaning that there's no other residencies in the hospital, and that basically, the residents run the show in the hospital. Because there's no specialist, there's no fellows.

So the experience was very enriching in the sense that it gave me perspective about the diversity of education and family medicine, that you can teach the specialty in so many different ways, and depending on the needs of the communities that we meet. I mean, we're such a big country with so many different landscapes across the nation. And I think it's one of the reasons that attracted me to family medicine was the diversity of the specialty and the diversity of the patients that you can treat.

So having that experience in the rural setting, in the community setting, being the only residency in the system, allowed me to bring a little more flexibility to my knowledge in medicine, and also in the ways that we teach, because we also don't have all the resources that academic centers have, with all the backing of the technological resources, specialists that are available to train. So we have to be creative on ways to bring some of that knowledge to those trainees.

And then moving back to the academic center, then it kind of gives me a perspective of, there's a lot of ways to teach and to train our physicians. And I try to bring some of that to my residents here at Emory to plant that seed of, "Hey, maybe one day you might have to do this in a center that you don't have all the resources. You have to be creative." And it doesn't mean that you have to be fully proficient in a procedure or a specific pathology, but just have some exposure.

So when you get to see the patient and you encounter that pathology, you at least know how to stabilize it, and triage it, and then get the help that you need. So I think again, it just brings that flexibility to the specialty and the learning experience, and I think it's just kind of fascinating.

Indeed. Indeed. Thank you. See, I was fascinated, which is why I wanted to know. So as you think about the work that you've done, and you mentioned you started as an assistant program director, then you're now the program director. What do you wish you knew before stepping into these types of leadership roles?

Yeah, that's always a question that I reflect on every so often. And I think when we look at these leadership roles in education or any enterprise, we always want to bring that vision, goals, that strategic planning and how to move forward the programs that you're going to be leading.

But I think the reality is that it's a mixed bag of troubleshooting emergencies and what we call putting out fires of situations, dilemmas, problems that arise, issues with trainees because they're not performing like they should.

And that could be very energy consuming mentally, spiritually, physically. And you have to have a balance so you can still push that strategic planning that you want to do, that vision and mission for your program or your enterprise, and don't feel that you are getting bogged down because of those emergency and day by day situations that you have to encounter, but you also have to put your agenda. So I think that's something that I wish I knew or was more aware about before taking on this role. So I think that's something that I learned pretty quickly as you start working on those tasks. But I think that was something that I always go back and be like, "I wish I knew that before," so I could mentally prepare for it.

Very important, very important. That mental preparation. We can imagine the future. Yes.

Yeah, because I think this kind of position role, we have to perceive it and treat it as a marathon. It's not a sprint. If you take it as a sprint or short race, you're going to get fatigue, you're going to get tired. That's where the burnout comes in. So you have to come in with a marathon runner perspective of find your pace, find your tempo, so then you can be an effective leader.

I love that. I love that. And I'm not even a runner.

It's never too late to start.

There we go. There we go. Motivation, motivation. And so recognizing, as you said, the different things that you have to do, the skills that you need to use, what continuing professional development do you do in order to keep up with the needs of your role?

And I think that's something that you as a leader need to have a lot of self reflection of your weaknesses, because we sometimes tend to fall into taking things for granted or feeling very pleasant on certain situations. So we just want to keep in that trajectory or mode.

So I think always reflecting, I try to do it every so many months of, "Hey, there's this area that maybe I need to get a little more training on," in the sense of either leadership development, or how to handle certain situations with trainees, or when it comes to new technologies in medicine that I just didn't get exposed, because they didn't exist when I was a resident or a trainee myself. So having that self reflection of, what are my weaknesses? What are my holes in my knowledge? If I don't know it, I can't teach it. I think that's something that also as an educator, you can't wing things, you can't make things up in the air, you can't, because learners will catch you, and they will know that you're not good at it. So I think reflecting on those weaknesses on the areas of improvement, then I try to either do some extra, continuing medical education, or participate in some networking events with other leaders in others in other programs around the country. And I think that's something that also as a leader, you have to be open to listen, what things are going on in other programs in the country or in other specialties, because can learn from all their experiences, the challenges they're going through. And I think it just comes down to be as a leader, you have to be humble. And like I said, know your weaknesses and have a plan to patch those holes so you can still be an effective educator and leader in your role.

Wonderful. So I'm curious, I know you have your different specialty organizations. So is that some of the places that you go to find the leadership and educational training, or are there other spaces that you tap into?

Yeah, so I think in family medicine for example, we have an association of family medicine program directors, that they host annual conferences at the same time as the American Academy of Family Physicians Leadership Summit for educators in the spring. We also tap in some of the family medicine societies for medical student teaching, that's the STFM.

So there's a lot of organizations that you can tap and use as a resource. And I think now with technology, most of them, they have listservs. So if you have a question, you can pose questions in listservs and also get feedback from those leaders.

I think it's also important that we are in education. Also, we are teaching our residents in the healthcare system. So you have to also develop partnerships with those healthcare administrators and tap in some of their groups, organizations, because their language is a little bit different. It's more management style, but you have to teach within that environment, so you have to be well versed on that as well.

So I think it goes back to the flexibility. Be curious. What are things that are available for you, and tap into them. I think now, it's also important not only to recognize the websites and the societies that are available, but the ones that are credible as well. Because in the internet, there's a lot of information that it's just not true. So you have to vet the resources that you use, so you can make informed decisions.

Thank you. So I'm loving, you're already giving advice. Be curious. Vet sites when you're trying to find information. What other advice would you give someone interested in doing the same type of leadership role that you have?

Yeah, I think just to be open for experiences that you're not comfortable doing. And I think this is something that I learned in my undergrad years from my advisor, which turned out to be the chair of the biology department of Case Western Reserve. And he always, I remember we used to meet with our advisor at least two to three times a year. And then he used to ask me, "Okay, so what classes did you pick for this semester?" And then we'll go through the list. And then he is like, "They're just boring. You need to try something more exciting."

So I think pushing me to try things that are of my comfort zone also allowed me to develop that instinct to explore things that I might not be comfortable doing, but expose me to a skill that it will become valuable down the road. And I think that's something that I have advice to anyone in education that eventually wants to take a leadership role or just be a lifelong teacher, is to expose themselves to new things.

I think that's one of the beauties of education is that knowledge is constantly changing and growing, and you have to really expose yourself and get out of your comfort zone to be an effective teacher. Because you're going to be teaching younger generations that are in a different mindset than the framework that you use to learn. So you have to adapt to those. And I think that's one of the reasons I enjoy teaching is it keeps your heart young despite your body getting old.

So very true.

Yep.

So very true. Thank you. Thank you. So as we've been talking and thinking about advice for those who would be interested in the same type of leadership role, I'd love to find out from you, how do you view succession planning?

Yeah. I think that's something, as a leader, you need to realize that your role is not for life. So this is not a monarch that you stay there until you die, or it's something that you're going to keep that position.

And as part of your leadership style and to be an effective leader, you have to start coaching and training your assistant directors, your associate directors, your core faculty to give them responsibility to start developing the skills that if they're interested on pursuing a leadership role, they can step into that role down the road.

I think as a leader, you are a more successful leader if you have a succession plan or you have developed a structure to support your colleagues to be able to take the role if you stepped out or if you get promoted. And not only give them responsibilities on the roles that you have, but also support them if they want to do any additional training, or any kind of continuing medical education, or workshops, or fellowships in education, or any other skill that they want to pursue that will help them support their residency. Because really, their success is your success. And then the success of all your teachers will eventually translate the success of the program. So I think it's something that you have to invest on working on and be very proactive about it, rather than reactive, so you're ready to pass that responsibility to whoever's ready.

I love that, especially as you're talking about the expertise of your teachers, and your leaders. It's that holistic image of how all of that ends up supporting the program. Thank you. So how do you go about supporting or expanding education in your profession or through your role?

So I think it kind of goes back to what we were talking about, succession and supporting your team. I think the success of our field, our specialty will depend on the success of those generations that are coming after my generation.

So my role as a director and teaching that generation is to make them and allow them to succeed in their fields so they can give back to the generations that are coming after them. So I think that's the ultimate goal when you're putting together strategic planning is, how do we keep the specialty and the field to keep progressing, to keep growing, to keep recruiting other medical students? And we have to develop an environment that is receptive and welcoming.

So putting that energy and develop the specialty to be a welcoming environment and something that they feel that they can help the society and their communities will help with recruitment, it will help with growth in the specialty. It's like you want to keep the species alive, so you have to invest in their growth and development so they're ready to tackle any challenges they will have as they are in the workforce, and also have the skills to train the generations that are coming after them.

Wonderful. Wonderful. And so building on this discussion about success and setting people up for success, can you tell us a bit more about what contributed to your biggest successes thus far?

I have to say that I think having strong mentors and having examples throughout my career of how do things right, and also learn from mentors and teachers that didn't do things so well, also taught me of the things that didn't work.

So I think something that I contributed to my success or to my accomplishment is to be very observant, and receptive, and discerning those experiences that I saw going through the different stages of my development, and my career, and education. Through mentors, through colleagues, coworkers. "Okay, this project worked. That project didn't work. What were the things that made it successful, or why was it not an effective project?"

I think keeping that openness and be always mindful of the things that were happening in front of me as I was going through my life experiences really helped me to gain perspective on those processes and experiences. And also, to understand of where are we heading as a profession, where is the field heading? What are the things that we need to tackle?

And also, I think my mindset of always being proactive rather than reactive doesn't always work, because not always your environment wants to stay with a proactive agenda. And I think we're living a society that many times, we're very reactive. Which makes it very challenging, because we are just part of a bigger environment and community that is affecting our experiences.

So that's the other thing, also learning to be patient, and to understand, and know when to pick your fights and your battles, and let other ones go and just, "All right, we'll deal with it later," kind of thing.

So I think having that kind of 360 perception, and understanding what's going on, and analyze the different outcomes of the projects that I have participated has allowed me to gain insight of things that I can try again or not try again. Because if you don't know your own history, you're committed to repeat it. So I think that's something that we keep seeing over and over.

Indeed, indeed. And I love that that builds on what you had spoken earlier about the importance of being reflective.

Yes.

Yeah.

And I think it's important to find time to do that, because sometimes, you get into this mode that you're just trying to keep going, going, going. And what is the new thing that we need to try? What is the new thing that we need to put together, to make this program successful?

I think many times, we just have to sit back, reflect, have a lot of discussions with the folks who are part of the project, who are part of the experience, to gain their insight. Because sometimes, their experiences and their perception of their experiences is not what you think. So gaining that insight would also help you to then formulate programs and projects that you want to do down the road.

Absolutely. So as we build on this a little more, since you are a lifelong learner, what would you say are your biggest growth opportunities right now?

I think that's something that I always look back and I think I struggle throughout my life, how to bring more imagination to projects. I think I have some friends and colleagues that they're always coming up with this amazing ideas, and I don't know if they just dream them. It's like their innovation and their imagination. It's like the never ending story, almost, kind of playbook. And I'm like, I just don't have that imagination. And I think realizing that makes me understand some of my weaknesses. And then, I can then complement with my colleagues that have those skills, to then help me develop some of those programs.

And I'm very project and goal oriented. So I develop activities that might feel a little bit dry or they're not as interactive, because I'm just very driven. And I think it's just that background in math, science. There was not a lot of liberal arts injected in there, which I think gives you some of that imagination. That's what my advisor always says, "Why don't you go and try this class? Why don't you go and try this?" Which were usually in the liberal arts.

So I think I realizing that weakness, which I think it's valid to point out, makes me be mindful of delegating some of those roles to maybe my chief residents that are a little more younger, more innovative. They try games. And there's a lot of gamification in education. There's a lot of flipped classroom, maybe more experiential classroom things. I'm more of just give me the lecture, I want the information, I digest it, then I apply it. But like I said, everyone has a different style, so we just have to adapt to it. So just tap on those colleagues and coworkers that have those skills, and then learn from them, and ride along.

Love it. Love it. So as you reflect on the work that you've done, what do you love most about your work and what you do?

I'd have to say seeing the residents grow from that first day that they start on July 1st every year. And then see their growth through three years of training and then that final product on June 30th after three years. And kind of experience with them, the challenges they go through, struggles that they experience, the life events that they go through, because their training doesn't happen in a vacuum. They have families, they have significant others, they have kids, some of them have babies in residency. Other ones have lost family members in residency. And all those things are part of your learning experience, and how you react to them shape the way that you develop as a physician.

So seeing that process. Be open to just listen rather than, not always give advice. It's always very fulfilling. And I think I learn a lot from it. I can see how they react and they grow, see their frustrations with some of the issues that we are going through. It could be their frustrations with patients. It could be frustrations with learning something. It could be frustrations with the system, frustration with the rules. I think all those things, and working through them to try to make it a productive and kind of a positive spin that you can learn from it. I think that makes the experience unique, that you cannot read that in a book. You cannot learn that in a class. I think the human experience adds another layer to this role, and I really enjoy it. It gives me a couple extra gray hairs every year, but that's just life. And then I think that gives you the wisdom and I enjoy it.

And I hope the trainees appreciate it. I think as the gap in the generation gets wider, we're getting older, they're coming in about the same age. It is my role to start closing that gap so I can stay current and effective. So that's what I enjoy the most.

I love that. I love that. And I'm just going to continue to build on this reflection since that's something you do. So as you reflect on your experiences to date, what would you say your passions are around education?

So I think that goes back to that sense of exploration and opening sometimes those Pandora boxes. So I think some of the passions that I always try to tap on is when I see a trainee extremely interested into something, I try to push them to open that box, and explore it, and try it, even if it's successful or not. But the learning that goes through that process, I think it's fascinating, and it will serve as a tool for them in the future.

And I see myself, and it's one of the passions of this role, I know I can't teach them everything they need to be a successful physician or a successful family physician. But I think it's my responsibility to teach them the tools so they can still be learners when they leave, and they keep innovating, and they keeping agents of change in society. So that's something that I'm very passionate about.

I think another area that has started to spark some interest is, how do we integrate some of this artificial intelligence into education, into science? How can we tap in that technology that could be very positive or it could be very negative depending on how you use it? So how can we tap in those technological tools to supplement the educational experience of the residents, but not substitute their path to learning? Because we could get very easily into, "Well, AI will be able to answer the magic question, the science question." But we still as a physician need to be human and need to understand the concept and the knowledge, so we can break the algorithm when there's an exception to the rule.

And I think we need to teach our future physicians of how to compliment their knowledge with technology, computing, artificial intelligence, without losing really the core knowledge and the desire to learn. Because we could get very complacent and just, "The computer will tell me is the answer, so I'm not going to learn it." So I think we still need to be very mindful of how to integrate those tools, and I think there's a lot of potential there. We just have to be smart about it.

Absolutely. Absolutely. I think as I've listened to these discussions about artificial intelligence and its potential, my mindset is AI with supervision should always be the way.

Yes. Yes, definitely. And I think we also have to curate the databases that they're using to pull the data. I've been reading and hearing a lot about this AI poisoning, which basically if the data out there in the data servers and the websites that the AI is pulling, I mean it's going to be all wrong. So we can really take this as a society into a very dark stage, and very worse, unless we really set some boundaries and be aware of what's true and what's the reality.

Indeed. Indeed. So important. So now to my last question. Recognizing 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?

Yeah, I think that's something that if you want to be a balanced leader, you have to model a balanced life. So I'm married. My wife is a physician. She's an emergency medicine physician. She's also faculty at Emory. We have two kids. So we make sure to find the family time to spend time together, because I think that's something that's important. That as a family, that's your support system. So it's important to nurture that as well.

I think on a personal level, I try to stay active through exercise on a regular basis, try to get good amount of sleep. That's a little bit more challenging, because you tend to think a lot at night.

And then as a hobby, I grow bonsai trees. So this is something that I've been doing for a while, and that's something that I enjoy that I think goes back to that nurturing of that small tree, and the growth, and how to take care of it. So that's something that I've been doing for a while.

Try to read on things that are outside of my field so I can keep some perspective. And also, some of that intellectual curiosity also stays there and kind of learn about things. So that's how I try to keep the balance. Involvement with the family, try to keep a mental, spiritual, and physical health through taking care of myself, and then some hobbies there on the side.

I love that. Thank you. Thank you. Thank you so much for your time today, Jose. Before I let you go, any last words of wisdom for aspiring educators or education leaders?

Yeah, Ulemu, it's been a pleasure to be part of the conversation. Something that I tell all my graduates every year is be sure to expose yourself to the unknown, because you will only learn from the things that you get exposed to in your experience. Stay empathetic to your communities and your society, and always be an advocate for the folks that you are representing, for the groups that you are supporting, and for those in medicine for your patients. So I think those kinds of themes, pillars, are always my North Star.

Wonderful, wise words to end off on. Thank you again, Jose.

Thank you, Ulemu. Always a pleasure. Nice seeing you.