“Example is not the main thing in influencing others, it is the only thing.”-Albert Schweitzer

At a recent Leadership Forum for Chief Residents in Ophthalmology, Dr. Karl Golnik met with a group of newly-appointed Chief Residents. Dr. Golnik is the Ophthalmology Program Director at the University of Cincinnati.

“What are your responsibilities as Chief Resident?” Dr. Golnik asked the group.

“Well, I’m supposed to be a leader, a team manager, and a teacher,” offered one of the new Chiefs.

“Yes, but we’re also physicians. And we’re still learners ourselves, too,” said another.

“Plus, we’re expected to be negotiators, counselors, mediators, and social directors on top of all of that,” added a third Chief.

Learning how to wear all these hats gracefully and competently is a challenge that every new Chief Resident faces coming into the job. During the workshop, Dr. Golnik examined these roles and analyzed what it takes to be successful at each of them.

Chief Resident as Leader
“The key to being a leader is to act like a leader,” said Dr. Golnik. He offered the following suggestions:
•    plan and coordinate activities
•    communicate clearly
•    clarify your expectations
•    be consistent
•    learn to use situational leadership styles

“Situational leadership means that you, as Chief, should adapt your style depending on the level of readiness of each individual resident,” said Dr. Golnik. This leadership style was originally described by Hershey & Blanchard in Management of Organizational Behavior (1988).

With first-year or “low-readiness” residents or fellows, you exert leadership by simply telling them what to do, according to Dr. Golnik.  As residents gain skill and experience, however, they may no longer respond well to being ordered around so directly. When you recognize that a resident has reached this point, switch from telling them what to do to asking them to participate in a task. By the third year, as residents reach a high level of skill and confidence, it’s time to simply delegate tasks to them and expect that they will complete them successfully.

Of course, the burden is on you, as the Chief, to get to know each of your residents on a personal level and track how they’re progressing through the program. While you should be careful not to ask for more than a resident is yet capable of doing, don’t be afraid to stretch them and encourage them to take on more responsibility.

Chief Resident as Team Manager
There are several critical components to being a good team manager, according to Dr. Golnik.

Be organized. This is the most essential skill you’ll need in your role as Team Manager. Find the tools that are the most useful to you –  your PC, spreadsheets, databases, calendars, email lists, PDAs – learn how to use them effectively and get everything into your plan for the year.

Set goals. Make a written list of the goals you have for yourself and for your program. You really can change your program for the better as Chief Resident by setting this example for others.
Supervision. How much is enough? Enough to know whether any problems exist. It’s up to you as Chief to recognize potential problems early and intervene before a crisis develops.

Be approachable. Take your role as Chief seriously. Residents often complain that their Chief has “senior fever” and is just not interested or involved. Treat everyone with respect and be a good listener.

Give feedback. Remember that residents cannot read your mind. If you have feedback or information for them, give it to them in a timely, clear, and constructive manner.

Chief Resident as Teacher or Advisor
“Why is it important for you, as Chief Resident, to be a teacher?” Dr. Golnik asked the Chiefs. “First of all, it’s part of the job. In addition, the residents will appreciate it and be happy to cooperate. In the long run, teaching will make your life easier and make you and your program look good.”

Teach by example. Whether you realize it or not, you are a role model for the other residents and their continuing medical education. Set high standards for everything you do and you will be establishing your expectations for the entire program.

Short lectures. Schedule brief lectures on tightly-focused appropriate subjects on a routine basis. Work on your lecture skills, make it lively, and keep your students engaged.

Microteaching. Learn to recognize “that teachable moment” during the course of your daily work with the residents. When you notice that a resident is making a mistake or doesn’t understand how to do something, you have a golden opportunity to take a minute or two to teach that skill.

Dr. Golnik offered the following scenario as a perfect opportunity for what he calls ”microteaching”. A new resident briefly presents a patient: she is a 34-year-old woman complaining of blurry vision, OD and pain with eye movement.

Follow these five steps to successful microteaching:
•    commitment – “What do you think is going on?”
•    clarify reasoning – “Why do you think that?”
•    teach general rules – amplify on the DDx of optic neuritis
•    positive specific feedback – “You did a good job eliciting pertinent historical facts.“
•    correct mistakes – “The pupil exam is critical; you should have shown me the pupils before dilating.”
Take care to avoid negative or belittling statements such as: “I can’t believe you got into this program.”

Feedback. Feedback is critical to the learning process. If residents don’t know how they’re doing, they’ll have a difficult time improving. However, most people find feedback difficult to give.

In order for feedback to be successful, it must be ongoing and reactive, specific, and not always negative. Focus on changeable behavior, not on the person. Remember that your delivery of feedback sets the tone for future learning and other interactions.

Dr. Golnik suggests using the concept of the “feedback sandwich” – if you have negative feedback to impart, sandwich it between two layers of positive feedback.

Favorable Learning Climate. Your own enthusiasm is the best way to foster a positive and nurturing learning environment. Set aside time to be available to the residents. Show courtesy and respect to everyone and encourage interaction in teaching situations. Make it clear that you don’t know everything, and that you’re willing to learn too.

Problems with Faculty and Administration
Many Chief Residents find themselves in the position of mediating friction between the residents and Attending Physicians.

Residents sometimes complain about a “Problem Attending” who doesn’t teach, takes their cases, is rude and obnoxious, is always late and always right, and who provides no feedback.

“What do you think is the best way to handle this problem?” Dr. Golnik asked the Chief Residents.

“I might start with tactful hints,” said one Chief. “If that didn’t work, I’d try to have a direct discussion with the Attending in private.”

“If that approach doesn’t solve the problem, I might have to take it to the Program Director,” said another Chief. “In an extreme case, maybe even to the Chairman.”

There can even be such a thing as a “Problem Program Director” according to Dr. Golnik. Perhaps the individual has been in the job too long and has become disinterested. Or she is too new and hasn’t quite grasped the full extent of the position’s responsibilities. The Program Director may not listen to anything the residents have to say, or may be unwilling or unable to act.

In a situation like this, you should first initiate a direct discussion with the Program Director about the problem. Be prepared to back up everything you say with documentation. If money is being wasted or needs to be spent, have your financial data ready to submit. If you decide later that you need to approach the Chairman, you will need to have all your supporting documentation and data available.

During the question and answer session following the workshop, one of the Chief Residents asked Dr. Golnik how to assert leadership without offending the Program Director.

As a Program Director himself, Golnik laughed. “I would absolutely love to have a Chief Resident exert leadership in our program,” he said. “It would have a positive and permanent effect on our program.”

About the Author:

Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.