Dear New Chief Resident,
Yesterday I worked my last shift as a resident. There have been small moments when it has “hit me” that this residency adventure is over and I have shed a few tears already, but honestly I think overall it is still sinking in. I’m looking forward to our week of graduation events to celebrate with my co-resident friends that have become like family.
As the residency chapter is closing, it’s also the end of my year as a chief resident. I was initially indecisive on whether or not I wanted to run for chief resident, and now looking back I am so glad that I did. It was an extremely challenging year, but the good significantly outweighs the bad. Being a chief resident is a lot of extra work, and on top of the usual work our program was threatened with closure unexpectedly which added an extreme amount of stress and heartache. Thankfully, our program was saved thanks to countless community members both within and outside of healthcare. That whole journey will probably be a blog post for another day.
For this post, I would like to share advice for new chief residents and share some reflections from my own chief year.
(For my non-physician readers) Every residency program has chief residents each year. For Emergency Medicine, it is not an additional year of training but just added responsibilities during our final year of residency. For some other specialties, a chief resident will be working an additional year. The roles of chief resident vary program-to-program, but generally entails acting as a liaison between the residents and the faculty, creating resident schedules, acting as the main resident-representative wherever needed, and various other administrative tasks. Our program selects chief residents by having all of the residents and faculty cast a vote for their top three choices, and the three (or four) residents who receive the most votes are typically then appointed as chiefs by our program director.
Being a chief resident is a huge responsibility
At my program, and I’m sure many others, there is an immense amount of trust and autonomy in the chief residents from both the residents and the faculty. I didn’t realize the amount of autonomy or the number of tasks that chief residents had until I was doing the work.
Your words and actions as a chief are magnified significantly; take that seriously. I’ll never forget my first week as a chief resident when I was working on an ultrasound rotation in the ED and every rotating medical student knew my name before I had met them. I was confused by this until I realized that as a “chief”, the students were definitely paying extra attention to me and my actions, and my attitude. As I processed the way medical students and interns were looking at me, looking up to me as an example, as a leader, I internalized that as a huge responsibility as a representative of my program, and as a representative and advocate for my residents.
There are always tough days, and I’m definitely an external processor and need to talk about hard things with trusted friends and loved ones in order to get through them. That being said, as a chief, be mindful of who is around when you need to vent, and know that your negativity can be just as powerful as your positivity. Lean on your co-chiefs as much as you can; they’re often the only people who know the full extent of the challenges you’re facing, so face them together. And on the flip side, don’t be shy with your positive feedback and in sharing the wins. Your positive influence can go a long way in fostering an amazing culture.
Be cohesive with your co-chiefs.
You will have differences in opinion, you will work with co-chiefs who have different communication and leadership styles from your own, and there will be challenges in that. But, have those difficult conversations privately. In front of your residents, be a cohesive unit and have each other’s backs.
On being “middle management”
People will often compare the position of chief resident to being in middle management. You have more responsibilities and power than your residents, but you’re still far from a faculty member. Navigating this middle position can be difficult. In my opinion however, your number one priority should always be your residents. Residents are an extremely at-risk group, and your job as chief above everything else is to advocate for what your residents need, even if it necessitates difficult conversations with the faculty members that are also your friends.
Everything in writing (text or email) should be as neutral and professional as possible.
Residents at times will take their scheduling mishaps personally and react accordingly towards you as a chief. However, you should try your best not to react in a defensive manner and exacerbate the situation. It’s part of our job to remain as neutral as possible. If you’re unsure if you’re treating a resident fairly, ask yourself whether you would respond differently if it were your close friend versus a resident you’re less close with. If so, then check yourself for more neutral responses and actions.
Not everything will require an immediate action from you.
There can be a lot of power in just listening, sharing the information with your co-chiefs, and observing for a while when smaller issues arise. If you’re always immediately reacting, you will often find that you acted too quickly and too early without truly assessing the bigger picture or the long-term pattern of what’s going on.
Give people the benefit of the doubt. Even if you’re wrong, it’ll help you be happier.
You never know what’s going on in people’s lives, so try not to judge people’s lack of responses or other shortcomings until you’ve at least checked in with them to see if there’s other adversities you didn’t know about.
It can be easy and is natural to get discouraged when residents aren’t responding or signing up for events. But, keep in mind that it’s not personal so try not to internalize it.
I think leadership positions can become a lot of self-fulfilling prophecies.
If you treat people with exasperation, expecting them to (continue to) let you down and not reply and not be excited, then they definitely will do just that. Along that same line, if you get burnt out from previous lack of responses to the point where you don’t even offer the opportunities to people anymore, again you will be doing things alone. You never know what seasons of life people are in. Maybe that resident that never replied to any of your requests previously was having a serious personal adversity in their life. Once that is settled, maybe they’ll be excited and enthusiastic, if you only give them the opportunity.
If you lead by example, remain excited and involved, and treat them with the expectation that they will also be excited and involved, you at least have the opportunity to be happily surprised. It is hard not to get burnt out when you maintain this high level of expectation of people. So honestly the trick is to sometimes just appear to expect people to participate…but if they don’t, you have your back up plan ready or you were expecting to do it yourself anyways so your own happiness is still protected.
Respect your residents’ privacy.
People will share very personal details about their lives with you. You’ll be amongst the first to know about new babies on the way, deaths in people’s families, and unfortunately as life goes, many other adversities that your residents will face. Respect their privacy, honor the trust that your residents placed in you as a chief and as a friend. Even if you can’t fix an issue, just being there for them, just listening and providing a truly confidential ear, can be extremely powerful in helping people get through difficult moments. That being said, be honest with your residents when you need to escalate things to someone else. And if they’re not ready for that, in my opinion, you shouldn’t take away their autonomy and force them into sharing things before they’re ready with the exception of being concerned for someone’s safety.
…
Being a chief resident has truly been one of the biggest honors of my life.
I am so grateful to have gotten to work closely with my faculty who have become lifelong mentors and friends. And I am so grateful for my co-residents for supporting me, for having faith in me, for making me feel so “seen” as a leader and as a physician, and for just being such amazing humans and ER docs in general. It has truly been an honor to lead as one of your chiefs this year.