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Every year anesthesiology residencies across the country go through the exciting process of selecting one or more Chief Residents. Unlike surgical residencies, in which usually every senior resident automatically becomes chief, senior anesthesia residents are usually voted into this coveted position. The selection process varies among programs. At my home institution, all CA-2 (soon-to-be CA-3) residents are eligible to become chief. The staff and residents vote via an anonymous e-survey and the person with the majority of votes is elected chief.
I learned that I would be this year’s chief resident during a busy February morning. I was called for an impromptu meeting with my program director, the vice-chair of education, and the education manager. I must have had a puzzled look (and a hint of worry) on my face, because immediately after I closed the door behind me my PD said smiling “let me just say it, you are not in trouble,” and she went on to deliver the news. Of course, I was incredibly excited and honored to be chosen among my talented cohort. My PD said this would be a “challenging but rewarding” year -- if I chose to accept the role. Then my mind filled with questions: what would my job be (besides making the schedule)? Would I have time to do it? And does anyone decline being chief?
Turns out most newly minted anesthesia chief residents have similar questions. I know because I met dozens of them at the Society for Education in Anesthesia (SEA) Leadership Program, which was held in May in Denver, CO. In order to demystify what being chief resident entails, I decided to share some pearls I learned from the SEA workshops, as well as from exceptional leaders in our specialty whom I deeply admire. I hope this information helps you execute your current and/or future leadership roles.
1. Decide the type of leader you want to be
There are two types of leaders, those who want to serve people, and those who want a title. If you choose to be chief, I suggest you choose the former. Not only will it be more rewarding, but it will bring you clarity. When I’m having difficult conversations with program leaders about decisions that affect residents, remembering that I am representing forty plus people whom I care about has given me the courage to speak up and has made all the difference.
2. Understand your role
Your program should have a Job Description for chief residents, which will likely ask you to be a leader (promote clinical excellence, service, collaboration, scholarship), educator (teach interns, medical students), liaison (be in numerous committees), and very likely, to make the schedule. At the very core, your primary role will be to serve both, the residents and the leaders of the program. This can be a difficult position to be in, because each side might have unique interests and you will find yourself caught in the middle. Which leads me to the next point.
3. Don’t work alone
Identify other resident leaders in your program - for example, residents involved in advocacy or committees - and work with them to make decisions. Ideally, you would have a team of diverse minds who think differently and can help you recognize blind spots. Dr. Jeffrey Kirsch, Emeritus Chair of the Anesthesia Department at OHSU and one my all-time favorite leaders, once told me that the way to get buying in from people is to include them in the decision-making process. So, create an advisory board. They will help you come up with much better solutions and likely result in increased resident and program leaders’ satisfaction.
4. Represent the consensus
Find out what matters to the majority of the residents. Remember that you and your co-chiefs are probably like-minded people willing to work longer hours, take on extra assignments, etc. You might not have an accurate picture if you limit yourself to discussions with your close circle of peers. Some residents will not feel comfortable approaching you or disclosing information to you. So it is useful to identify influential residents in your program and approach them to get their input – they might know of concerns that others don’t feel comfortable discussing publicly.
5. Not everyone will like you or approve of you
Some people will resent your decisions, be unhappy with a situation, or simply not like you. That’s not pleasant, but don’t let it stress you. As long as you are fair (don’t play favorites), transparent (communicate frequently, and honestly), and have thought-out reasons for your decisions, people will respect you. So, focus on your core values, create concrete goals, and work with your co-chiefs and advisory board to come through with results.
6. Making the call schedule will be your most valued role
Creating the schedule will be, by far, your most important job. Why? Because it is the most tangible way you will impact resident morale and quality of life. For this reason, it is absolutely critical that you prioritize the resident schedule. Publish it in a timely fashion, have a system to track the number of calls, and be able to easily identify who is getting overworked. You should be able to review a resident’s schedule and show them how their call burden compares to others, with concrete numbers. Importantly: do not volunteer to take every call. You will get burned out and nobody benefits from an exhausted leader. Meet frequently with your call committee to discuss call and duty hours, review call assignments and call distribution, and assess overall fairness. In short, keep the process transparent.
7. Establish boundaries
In my opinion, 3 of the most important boundaries to develop early on are:
(1) Keep confidentiality: don’t discuss resident issues with co-residents or outside parties unless you are concerned about their safety, in which case you should report it to your PD at once.
(2) Stop the urge to solve every problem: your colleagues will come to you with an assortment of concerns and complaints. Your job is not to solve every problem (that would be a heavy burden to carry) but to listen and provide support. Realize that sometimes your colleagues just want to vent and are not looking for you to solve their problem. But if they want you to intervene, discuss it with the appropriate party (i.e. the PD) who can provide a definitive solution.
(3) Set time limits – decide on a time to deal with “chief” stuff, and don’t allow it to spill into your personal or educational life. This is most relevant to emails and text messages.
Being chief resident has been as challenging as my predecessors forecasted but the growth, sense of duty, and ability to create change have been immensely rewarding. The non-clinical days are too short to address all the needs and, I confess, I occasionally violate my “time limit” boundary. But having been in this position for over 4 months, I am getting the hang of things. And of course, I don’t work alone!
There are innumerable books and articles written about leadership, and the SEA Leadership Program for new chief residents, which I highly recommend every chief to attend. I am still wondering if anyone rejects being chief. Clearly, I did not, and I hope you don’t either if you get the choice.
Go beyond this article and listen to Residents in a Room, a podcast series for residents, by residents. In episodes 6, 7 and 8, Chief Residents from Northwestern University and Rush University Medical Center give sage advice and tips for pursuing leadership development.
Date of Publication: Fall 2019
