So You Wanna Be Chief (Resident!?)

For Internal Medicine residents, a crossroads creeps up mid-way through their second year of residency. What is next? Fellowship? Hospital Medicine? Primary Care? Or, the vaguest option of all, a chief year. I remember meeting our five chief residents during my intern orientation. I was confused on why they would spend a year after completion of residency training to be a “Chief.” If you already knew you wanted to be in primary care, fellowship, or hospital medicine, what was the benefit of doing a chief year?

At the time, I did not recognize the different roles of the Chief Medical Resident (CMR), or as some call us, “the middle manager.” As a chief resident, you are in a unique position serving as a liaison between residents, faculty, and administration. From an educational standpoint, you have the opportunity to improve residency curricula, lead resident reports, present journal clubs (bonus—you get to pick journals you are interested in since you’re the chief!), and educate medical students. One of my favorite roles has been as the attending physician on inpatient wards when you lead a team of your former co-residents. Plus, you already know the EMR and how the hospital works, giving you an advantage over new teaching attendings! You round with the residents using various styles and get to experience patient care from a new lens. And the best part is you actually make the final decision!

One of the most fun parts of chief year is advocating for your residents. You cheer them on, promote their needs and celebrate their successes. Because the residents trained with you and had a relationship with you before you were “the chief”, they are often more willing to open up to you. This is also one of the most difficulty parts of chief year—it challenges your boundaries and teaches you the importance of professional versus personal relationships. Pretty quickly into your chief year, you realize that everyone is not like you—there are many different ways to approach a situation, make a decision and communicate. It is challenging to lead people who are different than you are, but navigating so many perspectives and personalities is Leadership 101. You learn that every story has at least three sides and that you need to incorporate all perspectives to figure out the next steps.

In addition to residents, you also have to navigate administration and hospital leadership. This opens your eyes to the business and politics of academic medicine (both good and bad). As a CMR, you may not have the power to make all the changes you want, but you do have a strong voice to advocate for change; you have the privilege to see how decisions are made behind the scenes.
By the end of a chief year, each CMR will have the opportunity to become a better educator, lead a Medicine team, mentor, advocate for residents and network with administration and faculty. Chief year provides a unique time to hone in on and to develop new skills in addition to those learned during residency. These skills are highly desirable when pursuing academic medicine, fellowship or any other career pathway after residency.

Even with all the opportunities it brings, a chief year is only as good as you make it. Do chief year if you want to be a leader and want the challenge of a very unique position. Changes will occur during your chief year that are out of your control. There will be frustrating days, but you have a tremendous opportunity to make a great impact. A powerful piece of advice I got when starting my chief year was “have a specific goal for yourself and co-chiefs and foster a good relationship with your co-chiefs and program directors.” It is easy to get bogged down in endless meetings, overflowing emails, scheduling requests, negativity, and tedious tasks. Formalizing a goal early gives you a vision to steer toward. In my chief group, we wanted to improve residency morale and quality of noon-conferences. Personally, I wanted to implement a high-value care curriculum. These goals, in addition to the strong comradery in our chief group, empowered me to see beyond the nitty-gritty tasks of chief year to the greater experience.
My chief year has been an incredible experience in great part to my co-chiefs. Together we have learned:

You can’t say “yes” to every request no matter how good of friends you are or how much you respect the faculty member.
The necessity of keeping a real calendar of daily meetings (because now you do more than take care of patients).
How to tackle never-ending exploding inboxes (and if you’ve never felt popular by email, no worries, as a CMR, you will be TOO popular).
What it’s like to have free time and scheduling flexibility (you actually have time to work out at normal hours)!

As my chief year draws to a close, I’m feeling a bit sad and nostalgic. This year has been filled with surprises. I have had the honor of seeing my former interns grow into confident senior residents and attended on the same wards I spent my first day of internship. I gained insight to various leadership styles, improved my conflict management skills, and developed relationships with faculty and administration. The most common question I receive when I say I am a chief resident is, “What is a chief resident?” The second is, “Would you do it again?” I am proud to say I would absolutely do it again. I am grateful to have had amazing co-chiefs: we are known as “DRG” (David, Rachna, Garrett). Our best memories from this year are our weekly breakfasts around St. Louis. I am grateful for phenomenal mentorship from our program leadership, especially from our program director, Dr. Buckhold. If you loved your residency program, if you want to give back to the program that made you a confident physician and develop leadership skills, a chief year may be for you.

Posted by Rachna Rawal on Apr 25, 2019 10:21 PM America/New_York