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

Abstract

IMPORTANCEThe 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. OBJECTIVETo 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.

Time to Reengineer the Internal Medicine Chief Residency

“…Chief residents do not apply for a position through the National Residency Matching Program but instead are picked midway through their residency through an often opaque process. There is no formal curriculum and there are no milestone assessments, although the Garg et al 1 study shows that many do receive feedback on elements of their role. No board certification opportunity exists for successful completion of the year.…”

“…Their administrative role carries the responsibility of ensuring that there is an adequate patient care workforce for the hospitals and clinics. 1 They are often privy to and expected to manage confidential performance issues, personal problems, and conflicts among postgraduate year 1 to 3 residents, medical students, and occasionally faculty. They oversee compliance with accreditation rules, develop and implement curriculum, provide wellness and health support for learners, and engage in continuous quality improvement for educational programs as well as clinical care delivery programs.…”

“…The results of the study by Garg and colleagues shine a light on a legacy practice of internal medicine (IM) residencies across the country: the honorific chief resident year, typically served after completion of the formal residency program. Although the majority of chief residents surveyed would repeat their chief residency year again, respondents reported serving as primary program schedulers, and substantial numbers reported little feedback on teaching, clinical skills, or leadership skills …”

“…Although Garg et al focused primarily on chief residents from academic centers, the chief residency year is a recognition of exemplary performance and is often considered to be a stepping-stone to an academic career. The ambiguity of the role and lack of formal credentials for these future leaders is a lost opportunity both for the learners themselves and the institutions in which they work.…”

El jefe de residentes: una experiencia en un hospital universitario de Uruguay

“…Often these obligations are not standardized. Therefore, the goals, responsibilities, and experiences of those who undertake this challenge can be highly variable, depending on the different institutional traditions, the allocation of resources, and the needs and expectations of each program (8).…”