Coleadership Among Chief Residents: Exploration of Experiences Across Specialties

The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review

PHENOMENON

Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature.

APPROACH

We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies.

FINDINGS

We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency.

INSIGHTS

After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.

Effectiveness of a leadership conference for chief residents in dermatology

The position of chief resident involves increased leadership, mentorship, and management responsibilities. There is no standardized procedure in which dermatology chief residents are trained and prepared for their final year of residency. In 2008, an annual Dermatology Chief Academy conference was initiated in which incoming chief residents were given formal leadership training for their new role. At the 2020 conference, residents completed a survey regarding their expectations and experience of this conference. After the conference, residents felt significantly better prepared for their new role as chief residents, handling conflicts, and effective leadership. A formal leadership conference for incoming chief residents is vital for improving the success of a residency program.

Characterization of Internal Medicine Chief Resident Administrative, Educational, and Clinical Experiences

IMPORTANCE

The internal medicine (IM) chief residency is a position of leadership and honor common in IM programs, but the goals, responsibilities, and experiences of those who undertake it can be highly variable. Studies assessing the experience and impressions of the chief resident (CR) position from the viewpoint of the IM CRs are lacking.

OBJECTIVE

To describe the structure, responsibilities, and perceptions of the IM CR role across IM residency programs.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, simple descriptive electronic survey for current CRs was administered between April and June 2018 across US IM residency programs accredited by US Accreditation Council for Graduate Medical Education. A 2-step nonrandom sampling approach was used: first, snowball sampling was performed using the authors' professional networks, and second, the survey was sent to the Association of Program Directors in Internal Medicine (APDIM) CR listserv. Data analysis was performed from June 2020 to August 2020.

EXPOSURES

Participation as a CR for an IM residency program in the 2017 to 2018 academic year.

MAIN OUTCOMES AND MEASURES

Descriptive CR personal and program characteristics and CR perceptions of administrative, clinical, and leadership experiences.

RESULTS

Among 169 unique responses, 77 participants (46%) were female and 89 (53%) were White. The response rate was 57% (70 of 122 surveys) in the snowball sample and 12% (99 of 842 surveys) in the APDIM listserv. The 2 sampled groups were combined for analysis. Most respondents (125 CRs [74%]) were from academic or university-based programs. Common across CR responses was responsibility for administrative tasks, clinical work, and educational efforts. Most CRs (111 of 157 respondents [71%]) reported being the primary schedulers for the residency program. Clinical work differed widely across respondents. Only 70 of 156 respondents (45%) reported having an academic title associated with the CR role. CRs reported inconsistent evaluation throughout the year, with high percentages reporting never receiving feedback on teaching (34 respondents [23%]), clinical abilities (67 respondents [45%]), or leadership abilities (60 respondents [40%]). Most CRs (107 respondents [69%]) agreed that they find work as a CR fulfilling and 117 (74%) agreed they would do chief residency again.

CONCLUSIONS AND RELEVANCE

Despite its ubiquity in training programs across the US, the IM CR experience is very different across programs. Recommendations are provided to consider for improvement of the CR experience, including structured feedback opportunities, maximizing educational and clinical experiences, and standardizing policies.

Developing Committed Resident Leaders: A Survey of the Administrative Chief Resident Experience in Surgical Fields

OBJECTIVE

Administrative chief residents (ACRs) are integral to residency programs, however little research has been done on the experiences, training, and support of ACRs in surgical fields. The objective of this study was to define the challenges and experiences of surgical ACRs and identify support needed to make them successful.

DESIGN

A Qualtrics survey was electronically distributed to participants. Response styles included multiple choice questions, yes/no, Likert scales, and short answers. Question topics included demographics, ACR duties, support, and experiences.

SETTING

Obstetrics & Gynecology and General Surgery residency programs in the United States.

PARTICIPANTS

Current and past administrative chief residents (2019-2020; 2018-2019) and program directors from Obstetrics & Gynecology and General Surgery residency programs.

RESULTS

Seventy-nine surveys were completed by 48 (61%) ACRs and 31 (39%) program directors. The majority (52%) were from academic programs with a median of 6 residents and 2 ACRs per year. On a 10-point Likert scale, mean perceived support from faculty, program director, administration, and other residents was 7.0, 8.8, 6.7, and 7.7 respectively; however, mean stress level was also perceived to be high. Regarding preparation for the role, 56% of administrative chief residents do not receive a job description, 41% do not have a formal handoff process, 42% do not have formal leadership training, and only 61% agreed or strongly agreed that the administrative chief role was clear prior to starting. Common challenges reported by ACR's are limited preparation and training, conflict resolution, and workload management. Many ACRs felt they would benefit from formal leadership training and protected time.

CONCLUSIONS

These results summarize the experiences of ACRs in surgical residencies. Best practices and formal training in identified challenge areas should be added to residency curriculum and used to develop toolkits to support ACRs nationwide.

Effectiveness of a Leadership Development Course for Chief Residents: A Longitudinal Evaluation

BACKGROUND

Nonclinical skills (eg, self-regulation, team leadership, conflict resolution) are essential for success as a chief resident (CR). The literature on programs teaching these skills reports few if any effectiveness outcomes.

OBJECTIVE

We reported the outcomes of a leadership course for CRs using participants' self-reported outcomes and assessments from their program directors (PDs).

METHODS

A 2-day curriculum focused on emotional intelligence competencies, including self-awareness, self-management, social awareness, and relationship management. We used a logic model to align 2017-2018 curriculum with targeted outcomes. Questionnaires before and after the course assessed short-term and intermediate outcomes for the participants and PD interviews evaluated observed changes in CRs' performance attributable to the course.

RESULTS

A total of 74 residents participated in the course, and 65% and 59% responded to the post-course and follow-up questionnaires, respectively. Over 95% of respondents indicated developing leadership knowledge and skills and connecting with new CRs in the post-course questionnaire. During follow-up, CRs reported applying concepts learned during chief residency, using tools to address conflict, engaging in quality and patient safety projects, and continuing to interact with other participants. The relationships between reported outcomes and participants' gender/prior leadership training were not significant (P > .05), with small to medium effect sizes (0.01-0.32). All 14 PDs offered positive appraisal of the CRs, but we could not specifically attribute this growth to the course.

CONCLUSIONS

Participation in this CR leadership development course was associated with enhancement and application of leadership competencies in immediate and intermediate time frames.