Every Chief Resident wants his or her year to be the best it can be. The best for the program, best for patients, best for the residents, and best for the Chief. One of the most effective ways to set  the highest standards for your own program is to learn from what others have done before.

In a recent Leadership Forum for Chief Residents in Ophthalmology, Wesley Millican, President of CareerPhysician, led a round-table discussion on defining best practices for Chief Residents in the learning and teaching environment of an ophthalmology program.

“Think for a moment about the best things – and the worst things – your Chief Resident did last year,” he said. “We’ll make a list of the positives and the negatives and then put together an outline of what your best practices should be.”

The Chiefs had no trouble coming up with examples from their individual programs.

Here’s What Worked…

“A good Chief will lead by example and set clear expectations,” said one participant. “A leader should be approachable, not distant.”

“It’s also important to be a diplomat,” said another. “The Chief needs to strike a balance between the needs of the program and the residents, while keeping the focus on the needs of the program as a whole. The Chief must have a good working relationship with senior management.”

“Organizational skills are critical to keeping people on track,” said another participant. “A Chief should be consistent and objective.”

A number of forum participants agreed that starting the year off with a detailed, intense orientation program, specifically geared to first year residents, is essential to the success of a program.

“There should be a mandatory social event to kick things off, like a barbecue for residents and their families,“ said one. “That’s how teamwork begins.”

The group agreed that shared social experiences were beneficial to the program as a whole and that a good Chief Resident will build social events into the schedule throughout the year. “It helps later, when problems come up, to know more about the people you’re working with,” said one.

Participants listed a number of specific actions their prior Chief had taken that they felt were extremely helpful. These included:

  • the creation of online schedules,
  • distribution of PDAs to every resident,
  • a “call back list” of what to bring with you in different emergency situations,
  • a small laminated, pocket-sized  “survival guide” with all the phone numbers and contact information a new resident needs,
  • a map of the hospital with all the room numbers.

“My Chief last year helped new residents get off to a positive start. He observed resident’s initial cases and helped with consults for first-years. He also checked in regularly with all of the residents to see if there were any problems,” one person said.

Another group member said that his prior Chief arranged to use volunteer patients (who were actually free from disease) for practice exams during orientation for first-year residents. The volunteers agreed to provide the residents with detailed feedback.

Everyone agreed that it is essential for a Chief to involve the residents in decision-making and not to be threatened by the input process. “You still need to make it clear that the decision is yours,” said one participant. “But once the decision is made, you must also be able to delegate responsibility.”

A good Chief should also possess top-notch medical knowledge, be a good teacher, and a strong leader.

“My last Chief assigned us 80-100 pages of reading every week,” said one person. “There was a quiz every week, written and graded by a different resident. We also had skill sessions scheduled regularly. It really kept us on our toes and we learned a lot together.”

The group also felt that a good Chief sets the ethical and behavior standards for the whole program. “My Chief always focused on the issue, not the person,” said one.

One of the most popular suggestions to come out of the session was the concept of a Resident’s Orientation Handbook. Everything a first-year resident needs to know can be included in the Handbook. And, it’s a valuable legacy that one Chief Resident can leave to his or her successor.

…And What Didn’t Work

The discussion group was equally ready with a list of negatives from their experiences with prior Chief Residents.

“My Chief had a serious case of  ‘senior fever’,” said one. “He was just losing touch. He was complacent, apathetic and neglectful.  It was not an attitude I found to be conducive to a positive learning environment.”

“Our last Chief was just not responsive,” said another. “He didn’t really take any time to get to know the residents – he never interacted with anyone else.”

“My Chief tended to make things personal and play favorites. It seemed pretty clear that he didn’t feel accountable to anyone. He didn’t discuss issues with residents before making a decision and then developed and enacted policies which benefitted himself first.”

“It’s a problem if the Chief fails to understand the nature of power and authority or has no awareness of hierarchy.”

“We had no organized social events last year, so there was no sense of collegiality. We never got a chance to get to know one another as people outside of the pressure cooker of work.”

Learning from Others

Feedback following the interactive session with Millican was very positive.  The participants felt that hearing each other talk and appreciating the experiences they held in common was very healthy.
Clearly, taking the time  to inventory and list the positive and the negative aspects of their experiences with former Chief Residents put many issues into sharper focus for the group.  There was a broad consensus, as they prepared to enter their own year as Chief Resident,  – this opportunity to share each other’s experiences would provide invaluable help as they each define their own best practices.

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.