Residents in a Room

Episode Number: 73

Episode Title: So You Want to Be a Chief Resident?

Recorded: February 2025

(SOUNDBITE OF MUSIC)

VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

You really need to have a reason why it's appealing to you, because it's a ton of work.

Kind of being that go between for fellow residents and then also department leadership.

It's hard to be in the middle of two sides, but I think it's also extremely educational.

That's leadership training in all its glory right there in a year.

DR. RYAN McMAHON:

Welcome to a Residents in a Room, the podcast for residents by residents. I'm your host for today's episode, Dr. Ryan McMahon. I'm a current CA2 at Vanderbilt University Medical Center. I am joined tonight by a impressive cadre of program directors who are going to talk to us today about what it takes to become a chief resident, how to make the most of the opportunity, and how to work well with the chief residents in your program. Before we get started, let's meet our guests today.

DR. RACHEL KACMAR:

Hi everybody. I'm Dr. Rachel Kacmar. I am the residency program director at the University of Colorado.

DR. AMANDA KLEIMAN:

Hi, I'm Amanda Kleiman. I'm the APD for curriculum and assessment at the University of Virginia.

DR. TUAN-HSING LOH:

And hello, everyone. I'm Dr. Tuan-Hsingh Loh. I am one of the assistant program directors for resident education at UT Health San Antonio.

DR. McMAHON:

Wonderful. Well, thank you all for being here today and being willing to share your knowledge with residents all around the country. Let's jump right into it and get started with just some of the basics. What is a chief resident or what you say is their main responsibilities? What is a typical time commitment at your program, and what does this role specifically look like at your institution?

DR. LOH:

For my program, we have three chief residents who are CA3s, and their roles essentially serves as a liaison between the residents and the And program director, and they actually serve in a number of capacities and roles are, you know, pretty diverse. One of the most important role they have is management of a lot of the residents call schedules and delegation of vacation, which can be quite contentious at times. And so certainly needs to be very, very good people person, have good organizational skills. But at the same time they also handle a good number of resident feedback that residents perhaps may want to remain more anonymous and not necessarily have, you know, things in specific writings, and they convey those feedback onto program leadership as well. And so the time commitments can be about one hour of work a day or less, depending on, you know, when in the year. It is certainly a little bit more when it comes to scheduling Starting vacation, organizing schedules and a little bit less when it's not in those type of situations.

DR. KACMAR:

Uh, we actually have six chief residents, and they are slightly different roles. So we have a fairly large program. So we have three chiefs that run kind of the administrative things, kind of what Dr. Loh was explaining in terms of scheduling. It is such a huge part of the job. And so I think being organized in that is a really big responsibility that goes along with being a chief. As Dr. Loh said, sometimes that can be a little contentious in terms of balancing out how schedules work and meeting both the desires of residents and the needed time off, but also the clinical and operational needs for the hospitals and really creating a partnership. I think chief residents, first and foremost, are representatives for their peers, but also representatives for the program. And they're leaders of both peers and of the program. And so it's a really big job.

Um, and so I think time commitment varies as well. Those administrative chiefs have fluctuating time commitments. That and when they're making a schedule for the next quarter might be pretty intense. Then there might be some lulls. We have a recruitment chief, and their time commitment is very, very heavy during interview season but a little bit less other times of the year. And so I think it varies depending on what exactly the role is and where the responsibilities go up and down over the course of the year.

DR. KLEIMAN:

We're pretty similar. We have four chiefs, and everyone has an administrative component that has to do with scheduling. We divvied up the roles and so we have similarly a recruitment chief. And we have a chief that is in charge of sort of the educational programming, a chief that is in charge of quality improvement and responding to issues with quality, and then a wellness chief as well. So they kind of have two different roles. One is sort of overarching in terms of administration and scheduling, and then each of them chose an additional role that they wanted. Similarly, I think depending upon what time of the year it is, some of those topics are a little bit more compact and the time commitment that they have. But it sort of fluctuates and they do work really well together, which is a key component of being a chief to kind of share the burden at different times where maybe someone has too many things to do.

DR. McMAHON:

Thank you all for sharing that. Um, specifically at your respective programs, how does one become a chief resident? Are they selected by their peers, or does the faculty in leadership positions specifically select some of the CA3 residents?

DR. KLEIMAN:

Ours is a peer vote, and we're actually in the process of voting right now. All of our residents cast a vote for the four people that they think would make the best chief. We do allow CA3 residents to remove their name from the election process, and then once we have the overall vote, that's taken first to our educational leadership team and then to the overall faculty to ratify the choices, some things that may come up in the ratification process are things like if they're in academic, good standing, reliability, things like that. But I don't think that we've ever not ratified a group selected by our resident body.

DR. KACMAR:

We have a similar process for the admin chiefs where first there's nominations and then if anyone nominated does not wish to proceed, then they can remove themselves from the voting slate. And then we have a full residency vote. And similarly we take that then to the departmental leadership. So all the we have four different clinical sites. So we take it to the site directors, the rotation directors, the residency program directors and and APDs. And I would agree that we, I don't think, have ever not gone with the popular vote for our recruitment chief, our key chief, and we actually have a chief for our intern class specifically, we get nominations and then we actually have the stakeholders do the the selection, mainly because there's some slightly different characteristics involved in that. And so we, we look at what the person's been involved with thus far. If they have special background, that would make them especially well suited, things that the the peers may or may not be aware of when it comes to filling those other chief roles outside the admin chiefs.

DR. LOH:

At my institution. It's a combination of residents and faculty votes, and when the results come back, the program leadership sits down with the potential candidates to kind of go through expectations and anticipated time commitments and other requirements to ensure that that's something that is indeed, you know, they're willing and okay to do. There are some component that, due to the time commitment of being chief, someone who may be an excellent leader, but whose grades are maybe a little bit borderline, we may sit down and kind of go through risk benefit of the roles of chief to really make sure that indeed, that's something that they think they'll be able to handle and not to take away from their ultimate primary responsibility, which is to be successful in going through residency and becoming a staff anesthesiologist at the end.

DR. McMAHON:

Um, I know you all had kind of touched on it a little bit earlier, but if we could kind of go back and talk a little bit about what you guys think makes a good chief resident, and if you've seen specific attributes, characteristics, habits over the past several years of being in leadership positions at your respective institutions, what's made these people successful or stand out more than other chiefs when you think back?

DR. KACMAR:

Obviously having qualities of leadership being able to be a representative for your peers. But I think a big part of it is being a good communicator. You have to interact with so many different people in different roles, certainly your peers, your residency cohort, but a lot of departmental and hospital leaders and I would say a lot of multidisciplinary communication. I know our chiefs interact with our app leads and do coordination with those groups as well. I think a couple other people have touched on the strong clinical performance and a reasonable medical knowledge performance, too, in terms of being able to pass tests. It is a big commitment. And and first and foremost, we want residents to graduate from residency and be able to be successful in practice. And so we don't want to ever take away from that by adding responsibility.

I think that good chief residents are well respected and that they are able to advocate and be an effective representative, but also be able to be objective because there are things that may not be going exactly how all the residents would prefer, but there might be a lot of things that are happening behind the scenes or other contributing factors that make something have to go down a certain pathway. And I guess the final thing I would add in is being very responsible, organized, being able to complete tasks, um, that are either self-imposed or externally imposed in a, in a timely basis.

DR. KLEIMAN:

Yeah, I would agree with Dr. Kacmar. I think that, you know, being engaged within your residency, knowing people's names, kind of having a finger on the pulse of what's going on. Uh, often gets you selected as a chief resident, but it also helps you, I think, to be a really successful chief resident. Uh, I think those who really excel, being a chief are fair; they're critical thinkers; they take up issue and kind of think through it and think of all the different possibilities of solutions and different points of view. I also agree communication is key, being really professional and corresponding in a in a professional and polite way, even when it's something that you feel really strongly about. Being a chief is difficult because of the fact that you're kind of split between these two worlds and being able to operate in both of them, and to be a representative for the residents, while also understanding that there are things that maybe are well out of the leadership team's control, is really important to being a good chief.

DR. LOH:

I want to just echo what's already been said. I think that those are very, very important traits to becoming a chief. One aspect of things from some of my prior chief residences that not everyone has to have, I guess, like every single attribute. A lot of times, because there are multiple chiefs, and certainly I think communication is something that's very, very important, organizational skills. But when the words of my current chief residents and one of them says that no, I'm an ideas person, the other person is an operations person where they work very, very well together to look at issues and then propose ideas and come up with solutions to solve them now, when they do work together. That may be the one extra bit that I want to add into what has already been said.

DR. McMAHON:

Thank you all for that answer. It was a perfect segue into the next question. I think it's kind of discussing the difficulty of the role of chief resident, as you had mentioned, kind of being that go between for fellow residents and then also department leadership, and wanted to talk specifically. Obviously, not all chief residents are great chief residents and talk a little bit of where you think you've seen some kind of stumble in that area of kind of walking that thin line of being an advocate for your residents, but also being probably more privy to understanding why department leadership makes some of the decisions they do that some of the residents may not agree with and may not understand.

DR. LOH:

Some of the things that I think makes the role of chief resident very difficult, on the one hand, is that it is a big responsibility. And I will say that very frequently, people get burned out pretty quickly after a few months of taking on the role. And it may be partially related that they have to handle a lot of their peers requests and sometimes even complaints. At the same time, they have a backstage look at some of the things and see some of the things that other people may not see, which give them an extra layer of understanding to department inner workings. Or, you know, maybe characters about about their fellow residents, then maybe other people don't get to see and at the same time, they have to stay very objective and very professional about the things they have to do and communicate things that are appropriate and not say anything that is not appropriate. And then that takes a lot of skills and, um, and a lot of discipline to stay in this role. I think one of the things that perhaps some people, maybe the expectations from the outset may not be as grounded in reality, and perhaps that contributes to some of the burnout that I've seen in some people in the past. And so that's one of the aspects of the difficulties that I see with some of my residents, chief residents.

DR. KACMAR:

I would agree with a lot of what Dr. Loh said. I think it's a very hard balance and I think it's a learning curve. It's something that you never really understand until you're in that role doing it, and then everyone makes mistakes. And so I think there's definitely some coaching involved and setting expectations before becoming chief. But then along the way, as program director, as APD's, we also act as a support system and try to help with the stumbles or help navigate that. I think one thing that that I've seen is letting things become personal rather than than being objective. There's a lot of business that goes into this. We talked about schedule making before. It's a big operation to manage, you know, 30 to 80 residents in all of the things that they have going on in their personal lives, all the requests, all the demands at times. Um, and it's unfortunately, you can't make everyone happy. And that can be really hard at times because you want to make people happy. They're your friends. That's one of the reasons that that you're a chief is that you get along with people and they trust you. But I think that's a big focus is just trying to be objective, trying to be consistent, be transparent, don't have special deals for people because that will come out and that will be not well received by the group as a whole.

DR. KLEIMAN:

And totally agree about really needing to both be professional and be serious, but not take it personally when you're angering some of your friends. And you know, I was a chief resident and I'm sure these other folks were also chief residents. And you want to make everyone happy, you're going to make everyone upset. I think that there's a natural tendency to give in to people that complain a lot, and I think that's a pitfall of being a chief resident is you really have to look out for the people that are always your yes people and always say that they'll do whatever you know is the least favorable thing, and you really have to protect those folks and be really objective when you're making assignments, when you're deciding who you know gets whatever they want or what they need. Um, and really kind of take an internal inventory of of who your go to people are, and making sure that you really take care of them is super important.

I think another thing that can be a little bit of a pitfall is people who decide to be a chief because someone told them that they would be good at it, or that they should do it. I think that it's one of those things where you really need to have a reason why it's appealing to you, because it's a ton of work. It can be very non everyday rewarding, not instantly gratifying job. And so I think you have to really have some motivation to, to do it for whatever your specific reason is and encourage people to to really think about it and, and not to do it just because your program director said you should.

DR. McMAHON:

I think that’s really wise and great pieces of advice. Adding on to that. We talked a little bit about some of the difficulties that individuals might have as chief. What are some of the reasons that you see individuals wanting to become chief? And also, what can some of the chiefs expect to get out of that year? What skills do you see that they gain? What benefits do you think that they walk from after taking on these additional academic and other responsibilities that normal residents would now experience?

DR. KACMAR:

I think you can flip some of the downsides into benefits. Honestly, it's hard to be in the middle of of two sides, but I think it's also extremely educational. And I think that for residents who are interested in future leadership opportunities, whether that's in an academic setting, in a program leadership setting, or in a private practice, you get amazing opportunities to learn about how things work, why things are scheduled, certain ways, what happens on the hospital side, what happens when you're working with different groups, trying to figure out who's covering what. Um, I think a I'll say a line from one of my APD's that: if you're a chief, you are essentially vetted for life, because no one gets to be a chief without being dedicated, easy to work with, have good interpersonal skills. It's kind of a, you're kind of in a little exclusive club that very few people get to be in, and you're going to be a desired person to come into a group and be a partner, because you're probably going to be a great partner. And then I think outside that I know our chiefs get some special opportunities to go to networking with School of Medicine leadership, with hospital leadership, work with other chief residents. You're going to gain skills in a lot of different aspects that aren't necessarily part of a traditional anesthesiology or other residency program.

DR. LOH:

I will agree with what what was said about, you know, the downside is also the the the upside. That's leadership training in all its glory right there in a year, being a liaison, you know, communicating, you know, between your your peers and leadership, making schedules and navigating through all of this. It's excellent practice for any future role of leadership that someone might end up in the future. And I think if someone has those aspirations, being chief can grant massive advantage and head start heading out of residency and into whatever field that you're heading to.

DR. KLEIMAN:

I think it's also an opportunity to sort of leave your mark on your program. I think for me, being a chief was a great opportunity to investigate some of the things that I had thought about when I was a junior resident and even a senior resident. And so you can make a lot of changes, especially if you have a program leadership that's behind you. And, you know, either figure out that those changes that you wanted to make worked or didn't work or were not possible, and you gain a lot of invaluable experience. But also, oftentimes your chief residents are involved in recruiting the next incoming class. And so that's sort of your legacy within the program. As a chief resident, is this lasting impact that you had on the kind of future generations in your program?

DR. McMAHON:

I think those are all awesome reasons to become a chief resident, and a lot of great benefits that you get out of being a chief resident. As this is a podcast for residents and just purely from a numbers game, most people listening to this probably will not become chief residents and may just be C1s, 2s and 3s going at their respective programs. What things do you wish that you could tell our residents in order to hopefully help build strong relationships between the residents and the co residents, or expectations that are not typically met from those residents what they think the chief resident should be doing for their program, or how they should be advocating for them.

DR. LOH:

I guess one advice that I think can be helpful are also the similar advice to give the chief residents, and sometimes not to take some of these things too personally. Because even though the chief residents do serve a very important role, there are still a lot of things that's way beyond their control. And a lot of times, even though they serve as a liaison, sometimes they are just messengers for some of the maybe the bigger decisions from maybe the department or institutions or some other higher ups that they have to convey to fellow residents that they may or may not have much involvement in. And it's also very, very hard sometimes to make everyone happy and have a little bit of grace for your fellow resident who is more stressed and trying to work for you can go a long ways. Just like communication is something that's very important for chief residents, I think it's also important for every resident. And an essential part of us being an anesthesiologist is communication and to have professional and appropriate communication about if you have concerns and how to address them, and how to bring it up in appropriate channels and appropriate manners, so that those concerns don't lead to any grudges or negative feelings that might impact your relationship with these people who are supposed to be your friends.

DR. KLEIMAN:

I think one thing is to not sort of pick the chief residents against one another. I think, you know, just because one of the chiefs told you no to something that you want, you know, try and always remain positive and really support your chief residents who are supporting you. I think when you think about what you know can or should go through a chief resident's day to day life things, ideas that you have for the program, ideas you have for education, ideas that you have for rotations. Things like that are great to go through the chief residents. We depend upon our chief residents to let us know about sort of what's going on within the residency. I think having an axe to grind or really being super critical, you know, of the program, that stuff probably needs to go through someone with a little bit more, both institutional knowledge as well as power. You have to kind of play nice in the sandbox and remember that these are your advocates, but they're also in the same boat as you are and are dealing with the same things. So remembering that these are your friends, these are your colleagues, these are people who are in the trenches with you. And trying to to be kind is really important. And preserving those relationships and allowing your chief residents to be successful.

DR. KACMAR:

I'll add a slightly different version of something you said earlier. I think that remembering that chief residents are also just human and they can make mistakes. And Dr. Loh said, you know, give, give people grace. I totally agree with that. Chiefs get stressed. They're trying to make people as happy as possible, and they know they cannot give everyone everything that they want. So if you see something that you think might not be right, just approach them in a in a calm way. They'll probably fix it for you. I think things that residents can do to help chiefs is if you do have ideas about things that could be improved, or new programs or new rotations, come at it in a collaborative way. Don't just give them the idea and expect them to have the bandwidth to run with it and make it happen. See how you can help you know if you can be the the leader to try to get that going, or to write something up, or to get some information about how something's done somewhere else that you're hoping to do at your program. I think that that collaboration really goes a long way in making things actually come to realization.

DR. McMAHON:

That’s great. Um, when do you think that residents should specifically turn to their chief residents for assistance with an issue versus directly approaching department leadership with a problem that they may be facing? Or, in other words, what specific items do you feel like chief residents are uniquely positioned to help with versus maybe better handled by individuals like you all in the department leadership?

DR. KACMAR:

Um, I think that day to day things are a great thing to start with chief residents. I think if a resident has a more personal or serious issue going on and they feel more comfortable talking to a chief as the first line kind of peer support, I think that that can be totally appropriate. But I think if it's a serious issue or something that they don't want to share with any peers, they should probably come directly to program leadership, whether that's an APD, the program director or another trusted program leader. I think if there's something that's happening with an attending, or if there's a conflict with another resident that can't be resolved just by having a conversation, that's also potentially a time to escalate. Trying to empower chiefs is is wonderful and support their decisions when it comes to scheduling and that sort of thing. But I think that there are times where they don't necessarily have to be involved in something that's happening with an individual resident.

DR. LOH:

I think that's very accurate. The Chiefs have their designated responsibility and roles. So certainly I think, for example, one of our chiefs is responsible for the ICU rotation schedule and call. And if there's any issues regarding that, then certainly they're the first person that you should bring any concerns or issues or mistakes to regarding the schedule. But certainly if there's anything that involves, you know, the faculty involves things beyond the chief's responsibilities that they don't necessarily have any power to control, then I think for those matters, then the program leadership is more appropriate, especially regarding things that might be sensitive and, you know, doesn't need more people knowing than it should.

DR. KLEIMAN:

I think that it's important--and this is perhaps more of a program issue than a chief resident issue--it's often not appropriate or possible for chief residents to be involved in anything that's more than sort of being a supportive peer and kind of displaying good professionalism and that sort of thing. You know, I think that you can try and be a mentor as a chief resident, but we specifically don't involve our chief residents in sort of reprimanding or dealing with deficiencies and that sort of thing. I think that's probably unfair for the chief residents to be involved in some of those disciplinary issues, because it's a huge conflict of interest, given that you're both sort of on the same level, despite the fact that your chief resident. So I think that those are sort of issues that that should probably be taken out of the chief space as opposed to kind of going through the Chiefs, but again, more of a programmatic thing than the actual role of the chief.

DR. McMAHON:

And with a lot of our listeners potentially being anesthesia interns or even CA1s or CA2s, um, any specific pieces of advice that you would give to any of those residents hoping to become chief during their CA3 year?

DR. LOH:

Being chief is, I think, you know, it is, we talked about a lot of the responsibility and the workload and things like that, but it is also a great honor to be able to serve your fellow residents, serve the department that you're in and make differences and meaningful differences, you know, in that role. And so if that's something that, you know, especially you're thinking about leadership positions in the future and whatnot, certainly as you talked about great practical experiences and learning along the way as well. On the one hand, you don't have to be afraid to be a chief if that's something that fits your career goals, and at the same time, you don't necessarily have the unrealistic expectations about the roles as well, but truly understand what it all entails and what kind of things, responsibilities, and what kind of bandwidth it requires of you to help you make that decision. And and in the meantime, you know, if you want to, that's something you're about to do. Learn everything that you can be in good standing, because that's certainly something that will be helpful when the time comes, and enjoy the ride. Because even though it's hard, you know, I think for other people that have been through, most of them are, you know, pretty exhausted. But many, many of them look back and think it's something that's, you know, really, really meaningful that they have done in residency.

DR. KLEIMAN:

I think as a junior resident, talk to your chief residents, figure out why they did it, what they liked about it, what they wish they could have changed. Um, observe the chief residents that you have while you're a junior resident and moving towards becoming a chief, potentially. Think about what traits those residents have and whether or not you share those traits. What are things that they did that you liked, that maybe you didn't like and you thought they could have done differently? Try and learn from them and really think, I think, critically about whether it's something that you want to do, whether it's worth it. Because I think if you are doing it for the right reasons, that it makes it that much more enjoyable.

DR. McMAHON:

I think those are all great pieces of advice. Well, Dr. Kacmar, Dr. Loh, and Dr. Kleinman, thank you all so much for taking time out of your busy days and being here to share your knowledge and experiences with the residents all over the country.

DR. KACMAR:

It was a pleasure. Thanks so much for having us.

DR. LOH:

Yeah, this was my pleasure and hopefully some of our experiences helps your listeners.

DR. KLEIMAN:

Yeah. Thanks so much for having all this on.

DR. McMAHON:

This has been Residents in a Room, the podcast for residents by residents. I'm Ryan McMahon and hope you all have a great rest of the day. Join us again soon! Thanks. Bye.

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VOICE OVER:

The ASA Resident Distinction Award is a great way to recognize residents for outstanding work. Consider encouraging your exceptional residents to apply. If you're a resident, take the leap and apply for yourself at asahq.org/rda.

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