Katie Monroe, PhD, MMSc, CAA is Academic Program Director, Anesthesiologist Assistant program. In this episode, Katie reflects on how supporting people (students, faculty, & staff) is key to successful education leadership and how the journey to education leadership is not always clearly laid out.

Resources

• Kern Fellowship in Interprofessional Leadership
• Commission on Accreditation of Allied Health Education Program (CAAHEP)
• Master of Medical Science Program in Anesthesiology

Hello listeners, welcome to Educational Landscapes: Lessons From Leaders. On today's episode, we are going to learn from Katie Monroe. Welcome to the show, Katie.

Thank you. Thank you for having me.

Most welcome. To get us going, what is your education leadership title or titles right now?

I am the academic program director of the Anesthesiologist Assistant Program, which is one of the five health professions programs that's within the School of Medicine. Probably one of the lesser known programs, actually.

So, since it's lesser known, can you tell us a bit more about it?

Sure. The analogy that I will give to folks is nurse practitioner is to physician assistant what certified registered nurse anesthetist, or CRNA, is to anesthesiologist assistant. So, we're a physician extender in anesthesiology. We work in the operating rooms, we work on the anesthesia care team, and I lead the training program for students who are interested in that health profession here at Emory.

Awesome, thank you. Thinking about your leadership role, what do you do in this role?

Well, I do a little bit of everything actually. Ultimately, I'm responsible for the educational outcomes and the students' experience in the Anesthesiologist Assistant Program. That really does involve all kinds of things. At the high level, I'm involved in the planning, in the implementation of our curriculum, which is seven semesters long. I'm responsible for all the external reporting. So, we report out to the School of Medicine, to the university. We report out to our programmatic accreditor, so we have to maintain accreditation through CAAHEP, which is the Commission on Accreditation of Allied Health Education Programs. We have to demonstrate that we're meeting the standards of accreditation for anesthesiologist assistant education. I'm responsible for all of that kind of reporting externally.

Then I'm also responsible for our internal workings. I mean, ultimately, within the program, the buck kind of stops with me. If students or if faculty or if staff have concerns, then I am involved in understanding them and in addressing them. I'm accountable for the admissions process. I'm accountable for the budget, that our program stays on track with our budget. I'm accountable too, like I said with students, if students have an issue with the curriculum or would have something with the organization, then they come to me about that. A lot of things can fall into that category of the internal workings.

I also teach, I lead small groups. I chair our Admissions Committee, which means that I review and I interview candidates who are interested in coming into the AA Program. I work with faculty, I mentor faculty, I counsel students. If a student is struggling, I might not be the first line necessarily, but I'm made aware pretty early on in the process and I often get involved rather quickly actually if issues don't resolve. Then I also still work clinically. So, I have scheduled time each week at Children's Healthcare of Atlanta at Egleston, and I'm a staff anesthetist there. It's actually pretty cool. I have my assignment for the day and I go and I take care of my patients. That's a pretty straightforward day for me usually.

Wow, that is a lot of different things under your role. Thinking about that, what skills do you use in order to get all of this work done?

Probably a little bit of everything. I mean, there are a lot of things I think that you have to do to just keep all the balls in the air. I mean, that's really kind of my job as the program director. I have to be organized. I have to have good organizational skills, communication skills, definitely time management skills. Sometimes, I'm the one setting the timetables for everybody else and having to hold folks accountable to them. But I also have to be very self-directed on that one, because I'm setting the timetables. If something is off of my radar, then that means it's off of everybody else's radar, too, and that can be a little bit scary.

I think those are definitely skills that many people have to use regardless of their job. But it's interesting how they come to bear in this role, because it's not something that you necessarily have formal training in. It's more like you get experience along the way. There's just no one place where you would go to have everything listed that you need to have to do this job. I'm really fortunate that I work with a talented team, so I don't have to be good at everything. And that is just, I think, probably one of the best parts about my job. But I do try to keep all of the balls in the air and just try to make sure that everybody is on top of the things that they are accountable for, because we want to make sure that things don't get missed and we want to make sure that we're providing a good learning environment and a good experience for the students.

That's wonderful and so important, that student experience.

Absolutely. It's so much more than just the content knowledge. You know?

Absolutely. Absolutely. What was your journey that led to this current education leadership role?

If you had asked me 20 years ago, I would never in a million years have told you that I would be doing this. When I started my career as an anesthesiologist assistant, I really, I thought I would go into clinical practice, probably in an academic center, because I really liked doing big cases and patients who had a lot of comorbidities, and I liked challenging sorts of things.

But I'll tell you, life has a way of throwing curveballs. I am a graduate of the Emory AA Program, and I was a good student. I was at the top of my class when I finished. When I first entered the workforce, I started my first job, I split clinical time between Emory University Hospital and Egleston. So, I was in the system, so to speak. I was within the Emory system, even though I was on, at the time, it actually was the Emory Clinic was the employer, but it became Emory Healthcare within a year or so of my working.

So, I was in the system, and a few years after I had been out in clinical practice, one of the longtime instructors of the program was leaving. So, the AA Program leadership at the time asked me if I could step in and help out. I really thought I was doing it till the end of the semester and that they were going to be finding someone who was going to be more long-term. 21 years later, here I am. Again, just funny how things go and life sometimes gets you when you least expect it.

I started out as a course instructor and I really liked it. I really liked working with students. I actually liked putting together, preparing lectures, topics and discussion points around topics. Over the years, I just got more involved in the educational mission. I was asked to be the associate program director in 2011, and I don't know that I really realized it at the time, but it was part of the succession planning of the then program director to pull me into that role.

Because even when you're a course instructor, you don't know a lot of the things that happen in the administrative aspects of this job. So, I give a lot of credit to him, my predecessor, the program director who brought me in as associate program director, he was a really great mentor and he encouraged me to pursue a PhD in educational leadership. I did not like that idea, actually. I did not like it at all. I had sworn that I was going to be done with school when I finished my master's degree, but I begrudgingly took his advice.

I cannot say that it was fun going to school at night and working during the day, because I was still working full-time. But I am really glad that I did it, because I learned an awful lot and I met some really great people who have roles at different institutions, who I can reach out to with questions or thoughts, and I gained a lot from it. It was a great thing, but, at the time, it just seemed one more thing that you have to get through. Retrospectively, it worked out better. It was tough though. It was a hard three years. It was kind of a blur actually.

I can just imagine. I am always so in amazement of those who do full-time work and then they're juggling whatever type of program. It's like trying to remind yourself that at the end, it will be worth it. But during it, it's like, "Oh."

Absolutely. I've had faculty members since, who say, "Should I do this? Should I do this?" And I say, "Yes, you should do it, but you should also know that this advice won't sound like good advice until you're done with it. Because, in the moment, it's hard."

Absolutely. They can't say you did not warn them.

Correct. You want to be realistic in your advice giving. Right?

Absolutely. As you reflect 21 years so far in your interesting journey that has led to your current role, what do you wish you knew before stepping into this role?

Oh, that's a great question. When I think about stepping into the role of a program director, and I've been in that role for about probably seven and a half years now is about my length of time. I think I might have liked to know that I might never feel completely prepared for it. Just by the nature of the succession planning that my predecessor did, I think I had the benefit of a really long ramp up time, a really long lead up to the role and good preparation for it. But when the time came, I was still reluctant. I just thought, "I'm not ready for that." I guess I didn't think I knew everything that I would need to know. Maybe I didn't have enough experience to be qualified. I don't really know. Maybe that's just imposter syndrome and it kind of gets us all at some point in our career.

But when I look back, I think I was as prepared as I possibly could have been, and even still, I mean, I could have tried to prepare all day long and there still would've been curveballs. I mean, no one was predicting a global pandemic when I took this role in 2015 and there's nothing that I could have done to prepare, there was no preparation for that. But even without something like that, that hit everybody on this worldwide scale, there have been other things. I mean, the most recent class that we graduated lost two members of the class to unexpected death during their time in the program. And there's no preparing for that. I mean, in both cases, they were separate circumstances, they were unforeseen, they were not related to each other, they were not related to the program or the work that the students were doing. But I wasn't prepared for it.

I was navigating my own sense of loss and my own sense of sadness and also trying to support the students and the faculty and staff who were also just blindsided by it. There have been some really difficult moments. I would say, at this point, seven and a half years in, I still strive to be as prepared as possible, as knowledgeable as possible. But I've also, I think, learned to really lean into what resources I can leverage, what resources are there to help our program when we need it? Because it really is pretty tough to do it all yourself. Because you just can't be a self-contained unit, and there's no need to be, we're part of this amazing institution and School of Medicine that has a lot of things that we want our students to use. So, I have to remind myself sometimes that we really just need to reach out for that help.

I really appreciate that idea that no program director is an island. You are part of a system.

Correct.

So, tapping into those resources.

Yeah.

That's great. What continuing professional development do you do to keep up with the needs of your role?

Well, I have to do CMEs, continuing medical education credits, just to maintain my license and my certificate for practice. I definitely do continuing education work in anesthesiology, and I also help with planning and preparation of professional development activities for other program directors. So, I'm on the executive committee of the Association of AA Educational Programs. So, I help with organization of those, and I also participate in them, because there's usually some good information around that.

Again, as a student, you probably don't have a lot of ideas of what goes on in the planning and delivery of a curriculum. Even as a course instructor, you probably don't have a lot of ideas. The ways that you can get more information, oftentimes it comes from colleagues who are in similar positions at other institutions or colleagues who are directors of other programs within your own institution. It's a little bit sort of a different nature.

Also, I'm currently participating in the Kern Fellowship here at Emory, and I have found those sessions to be really helpful to practice skills that I actually do need and use more often that I thought I might, and that I've not really had any formal training around. Because there's a lot of this stuff, being a program director, that there's just not a lot of formal training around, that's specific to... I mean, obviously, you can do a PhD in educational leadership that helps with a lot of things about an institution and navigating institution, but there's a lot of stuff that you're also learning about things that are specific to AA Program education.

Great. Thinking of what you just said there about the Kern Fellowship, what kind of skills have you been learning that have been new and you're like, "Oh, that's really useful"?

Things related to having difficult conversations. It is so valuable to practice and have to role play. I'm normally very shy or reluctant to do role-playing kinds of things, but I have to give so much credit to this curriculum and to the leaders of the program that really bring us in and ensure us that it's a safe space and then let us... You're going on your instincts as how to respond in some certain things, but then you can also have the benefit of it playing out in this fictitious scenario.

Then, to think, "Oh, I could have said that better," or, "When I said that, this person heard that." That's really useful because when else do you get that kind of feedback? Probably, reflection on the session is one of the most valuable aspects of it. We'll have this thing and I'm like, "Wow, that was really uncomfortable," or, "I felt really unsure of what I was going to say next or how I was going to handle that." And I'm thinking about it two days later and that's really probably where you really get the bang for your buck in the growth on that one. I don't know. I haven't studied that empirically, but that's my sense.

Oh, that's powerful. The power of reflective practice.

Yeah, sure.

Great. What advice would you give to someone interested in doing the same type of leadership role that you're in?

I think I would say to collect all the experiences that you can, learn from anyone you can, who has been in a similar role, and then be open-minded to whatever might come your way. I would say, to anybody who's interested, that I have such a gratifying job, but there are some days that are hard and there are some days that are long and you have to... I guess, maybe some of that is in contrast to what my clinical work is, because with clinical work, it's like there's a start of an anesthetic, there's an end of an anesthetic. You know when you start, you know when you finish, and you know, when you finish, how it went. That's not always the same, I think, for this job, things can draw out over longer periods of time. Seeing the fruits of your labor can take months and even years versus hours to a day, sort of thing. So, it's a more delayed gratification sometimes.

You have to be willing to put in the work. You also have to be able to draw some boundaries, because there aren't necessarily those boundaries being drawn for you. So, you have to know when you're maxing out. And that can be a little bit tricky sometimes. I think most people who go into this program, basically people who would be interested in this kind of job, have been practicing anesthetists and they're type A people, very go get them, and you just have to know yourself, I think, to know when you're reaching your limits.

That is so important, especially given how much we hear about burnout.

Sure, sure.

Yeah.

Definitely.

Yeah. As you reflect on the career you've had thus far, how do you view succession planning?

It's very important. Yeah, knowing how valuable that long on-ramp was for me, I think it's really important. Because, as I've already said, there are a lot of aspects of my job as a program director that you just wouldn't have exposure to as a student going through the program or even as a course instructor. I mean, really it's not until you get more involved in the planning and the more long-range stuff, that you necessarily get yet any experience with it. It's also tricky, because it's not like there are... How do you prepare somebody for this role when you're still in it?

I know what was done for me and what I remain grateful for, for the experience that I was able to obtain. I try to pay that forward by really just inviting other people into the process based on instructors' areas of interests. I invite folks to join committees that they're interested in or things that are outside of the program that I think that folks might like. I think that's important, because it helps them to learn more about that process or that area. Things like admissions or accreditation or being the coordinator at the clinical site, so, be assigning the students or orienting the students.

There are a lot of things that we do that are really vital to the overall success of the program, and a lot of that is not learned through formal education and training. There's a lot of informal mentorship that I think is involved in that, and people tend to be more eager to do things that they're interested in. So, you try to mix and match people based on where the needs are, but also where they've expressed interest.

That's great. Great. Thinking about, as you said, the importance of people and successes for the program, what has been one of your greatest successes thus far?

That's a tough question, I think, because I believe that how we define success can change a little bit with the circumstances, that it can be a very situational sort of thing. I guess the most overarching definition for me is, did I do my best work? Did I see that issue through? And if I can answer yes, then that's a success. I think there are a lot of things that I've been proud of over the course of my career. I would say, in recent years that navigating COVID was one of our successes. When we graduated that first class after everybody had been on a clinical, after we had... We had to retool everything, almost all of our norms evaporated nearly overnight. We had to figure out how to move forward and how to get students into the workforce. And the workforce really needed them, healthcare needed people and the graduates needed to be prepared for what they were facing for the workforce that they were entering.

We are a clinical training program. It is really hard to have a clinical training program that's virtual, that's almost like an oxymoron. So, that wasn't an option. And we had to figure out how to get students back in safely and how to get them prepared for what was coming. I would say that that's probably one of the things. Last year, we had a accreditation site visit and it went really well. That was a good day at work, as much planning and preparation and work went into being ready for it. The exit interview with the site visitors was just so overwhelmingly positive that I thought to myself, "I feel seen, I feel validated. This is someone from outside who has no reason or motive for saying anything untrue, who's saying you're doing a great job." I was proud of that.

I work with a really talented team. I work with great people, and I'm very fortunate in that way. It's certain, I can't take all the credit for any of it, for COVID, or for our accreditation site visit, but those are definitely things, when I reflect back, I think, "We did well. We figured it out. We demonstrated what we needed to, people got what they needed out of the program, and we should celebrate that."

Absolutely. And a big congratulations for accreditation in the midst of a pandemic.

Thank you. Yes. The timing was perfect. It didn't hit right on the year, but it was as soon as we had just figured out how we were changing things or what we were doing moving forward. And it was like, "Oh, it's time for your site visit." It's like...

Oh gosh.

Not a sprint, but a marathon. It was adding an extra 5K at the end of a marathon, maybe that's a good analogy.

Oh, that's a lot for me, who doesn't like running.

Definitely.

All right, we're coming to our last few questions. Building on what you've been talking about, what, as you reflect, are or were your biggest growth opportunities thus far in your career?

I am not always good at delegating. I can still do better with delegating and then truly trusting that someone is going to do things as well as I would like or in a way that I would be happy with at the end. I still work on that. I still work on some of my ways to be the most direct that I can be in conversation. I think sometimes students need clear expectations, they need clear guidance. So, I don't want to beat around the bush necessarily. And some things are tricky to be very direct about, but I'm learning. That's one thing I will say with the Kern Fellowship, it's like, how do you say that more directly?

Mhmm.

So, it's good practice.

That's great. That's great. Thinking about, you've got this leadership role, and you've also mentioned that you practice clinically as well. As you think about those together, what do you love most about your work or what you do?

I like a lot of things about my work, the people, I would say, for both at the AA Program and clinically, I think the people who you work with really make it for you. I am fortunate to work with great people. I enjoy working with the students. I enjoy watching them grow. Graduation day is one of the best. Calling those names, watching the students walk across the stage and claim that diploma that they've worked so hard for. I mean, that is a good day. But I also love the day that it's a quiet week at the program office, and we have a little bit more time for lunch than we might otherwise. And some of the darnedest things come up at lunch conversation, people are laughing so hard that someone snorts or something like that. It's the people. It's always the people. I work with very, very smart people. I work with very engaged people, and that really makes it for me.

Oh, that's beautiful. Not that people can see, but the way your face lit up as you talked about people, it highlights just how much it motivates you and moves you.

Definitely.

Overall, reflecting on your experiences to date, what would you say your passions are in general around education?

Well, I think it's really a privilege to watch and hopefully to help people grow. I mean, students come into our program and it's a very rigorous program, and they learn a whole lot about anesthesia. They have to do the work, but I'm here to guide them along their journey and hopefully support them. Sometimes, be the bad cop who says, "Nope, you really got to do this right, you got to meet the mark." The students, not only are they learning about how to safely take care of patients, they're also learning how to become professionals in this field, what it means to be a professional or to demonstrate professional behavior as an anesthesiologist assistant.

It's a really transformative time for them, and I have a front row seat. I get to see it. I get to see it as it happens. Like I said, that's a real privilege. It's gratifying. I'd say that that's probably my biggest passion around it. We're always trying to build a better mousetrap. We're always trying to tinker with this and improve that and make this, more this or more that. But really it's about that growth that the student experiences from the time they come in to the time that you get into the workforce. We pack a lot into those 27 months.

That's powerful. Thank you. Last question. Recognizing you are more than your work, many aspects of life, what are some things you do outside of work to help you maintain joy in life and practice?

I would say my family life brings me a lot of joy, even when it's busy. I have a husband and I have two daughters. They make me laugh pretty well every day. I mean, I guess there's some days where I'm not laughing, but there's something that's pretty funny that happens every day. We're also close to parents on both sides. His family and my family have some local roots. And we also have some folks who are spread a little farther out. But family life is really fulfilling. Then I'm an avid reader. I'm an avid runner. I know you just mentioned with the marathon, I haven't run marathons in a long time, but even when I was in my best marathon shape, a 5K at the end of the marathon still seemed like a big ask.

Yes.

I would say that both running and reading, it's interesting. They're both kind of solitary sort of hobbies. I think some of that is because there's just so much interaction all day long. I think that those things can help me get out of my head sometimes. Just a little bit of almost in a meditative way, just a little bit of zen, either just from the rhythm of breathing when you're on a run, or because you're reading a story in a different world or a different context from your own. And that, it's good for me. Anyway, I would say that those things bring me a lot of joy.

That is wonderful. Those were my core questions for you, but as we wrap up, are there any last thoughts, words of wisdom that you would love to share with our listeners as you reflected on your journey to your current leadership role?

I don't think so. I appreciate the opportunity to talk with you. And even just some of the things that you asked me to think about, I think were really beneficial for me. I mean, I consider myself still probably mid-career. I mean, I don't have retirement in sight yet. So, some of the things I think that you want me to think about are what's next? And who knows, right? I mean, there are things that sometimes you do think you want to work towards, and then other things, opportunities that come your way that you just got to say, "Yeah, let's give it a try and see where that goes." I guess it made me a little curious, even just going through the exercise of thinking about some of the things you asked me to consider in preparation for our talking today.

That is wonderful, because as you talked about the growth of your students, it'll be interesting to see your own growth.

Totally. Absolutely. Yeah, you can't always recognize it when you're in it. Then even when you're through it, sometimes for yourself, it takes someone else saying something sometimes to be like, "Did I really do that?" Or, "Is that really me?" Again, we don't always recognize it in ourselves.

Absolutely. The power of reflection.

Totally.

Thank you again.

Thank you. Thanks for having me.

Absolutely.