Time to Reengineer the Internal Medicine Chief Residency

Abstract

The results of the study by Garg and colleagues 1 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. 1Although Garg et al 1 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 steppingstone 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.Additionally, with medical school indebtedness steadily increasing, any year that delays entry into a position that is compensated as a practicing board-certified physician carries a high economic cost.Peers of chief residents are often hired into hospitalist positions with greater flexibility and compensation. Thus, ensuring that the types of exemplary physicians typically chosen for chief resident roles find the role to be value-added demands that we consider reengineering the year as a launching pad to leadership.

Performance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the Profession

“…[51][52][53] This study's findings support the potential of such strategies but not inferences about their effectiveness, which will require further research to elucidate. That being said, the widespread belief that chief residents are instrumental in physician training 28,30,54 suggests returns to redeploying physician excellence.…”

Responsibilities of Internal Medicine Chief Residents in the Modern Era: A National Survey

“…Similarly, administrative duties such as resident scheduling and food delivery remain common. The CR role has evolved educationally, yet administrative burdens may detract from opportunities for career development ( 2 , 4 , 6 ).…”

“…Routine incorporation of protected time for scholarship could lay the groundwork for an academic career ( 17 ). Capitalizing on the opportunity to pursue these paths may be challenged by increasing administrative responsibilities ( 2 , 6 , 18 ).…”

“…To our knowledge, organizational CR-specific seminars build general skills for chief residency, but few programs focus on IM CRs’ professional growth longitudinally ( 19 , 20 ). Dedicated mentoring committees have been suggested to promote career advancement ( 6 ). Deliberately nurturing personal and professional growth is imperative to mitigate the potential for increasing CR responsibilities over time.…”

Chief Residency—More Than Just Teaching and Scheduling

“…In addition, they serve on committees to advance patient safety initiatives and work alongside residency program and institutional leadership to innovate and implement change. During these activities, they act as junior faculty leaders and receive close 1-on-1 mentorship from faculty who are typically leaders in hospital or educational operations . These experiences likely improve chief residents’ ability to communicate, collaborate, and maintain relationships—all of which are germane to excellent patient care.…”