Chief resident

[Chickenandwaffles]

Advertisement - Members don't see this ad

How much of an involvement in other residents' matters should chief residents have? I'm at a program that I will be leaving from where the chief, I feel, has excessive role in personal/confidential matters of other residents and I think it's inappropriate to say the least. For example, he has access to our evaluations. I find that's inappropriate. Everything he is told, even if in a confidential manner, gets back to the PD. We don't trust the chief for the most part, but would like to know what others think about this situation.

As I see it, the chief should be mostly administrative type, and involved as a liason between the PD/faculty and residents, not be involved/intertwined in every aspect of other residents' business.

 

[deleted480308]

My rule of thumb has always been, I don't tell anything to anyone at work unless I am ok with everyone at work knowing

my personal business is my personal business

 

[Chickenandwaffles]

My rule of thumb has always been, I don't tell anything to anyone at work unless I am ok with everyone at work knowing

my personal business is my personal business

Well I have learned that, but that's not really my point. My point is how much involvement in other residents' business should a chief have.

 

[BlondeDocteur]

It depends what specialty you're in. If you're in surgery, where the final-year residents are automatically called "chief," but they're still existing residents, then I think they should have very little say in matters of remediation, personal leaves of absence, or anything else personal that could affect the residency complement. They basically make schedules and run their services and that's it.

If you're in a field where a couple of final-year residents are designated chief, then a little more, but not much-- after all, they're still residents just like you.

However, if you're in medicine or another field where 'Chief Resident' is a title you hold AFTER you complete residency, where you're basically an instructor making almost-attending pay in exchange for significant admin duties, then quite a lot. Those people are basically extensions of the program director and since they're not residents like you, it's more kosher.

 

[Chickenandwaffles]

It depends what specialty you're in. If you're in surgery, where the final-year residents are automatically called "chief," but they're still existing residents, then I think they should have very little say in matters of remediation, personal leaves of absence, or anything else personal that could affect the residency complement. They basically make schedules and run their services and that's it.

If you're in a field where a couple of final-year residents are designated chief, then a little more, but not much-- after all, they're still residents just like you.

However, if you're in medicine or another field where 'Chief Resident' is a title you hold AFTER you complete residency, where you're basically an instructor making almost-attending pay in exchange for significant admin duties, then quite a lot. Those people are basically extensions of the program director and since they're not residents like you, it's more kosher.

No, I'm in none of those fields you mentioned but the chief is simply a last year resident, not someone who has graduated or anything like that. I don't feel it's appropriate personally. I feel evals, conversations with the PD, etc etc should be kept confidential. I don't have access to this person's personal file and while an upper classman, this person is still a resident. It really bothers me.

 

[BlondeDocteur]

I agree with you then. Petty tyrants.

 

[SouthernSurgeon]

It all depends. Our chiefs formally sit on the committee that says ( in essence) yay or nay as to whether residents are meeting the standards to be promoted. So yeah, they get to see evals as a part of that meeting, and they are pretty involved in making sure people are doing well clinically and not having some major interpersonal issues.

It doesn't really bother me. It's not like they are gossiping about my love life with the PD

 

[Chickenandwaffles]

It all depends. Our chiefs formally sit on the committee that says ( in essence) yay or nay as to whether residents are meeting the standards to be promoted. So yeah, they get to see evals as a part of that meeting, and they are pretty involved in making sure people are doing well clinically and not having some major interpersonal issues.

It doesn't really bother me. It's not like they are gossiping about my love life with the PD

Why would the chief sit on anything? The chief is another resident.

 

[BlondeDocteur]

Because the chief, being a resident, usually has his/her ear to the ground regarding how well a junior is performing. SouthernIM is in surgery (despite his user name) and they generally provide very useful information on that front, since surgical services are run with a skeleton crew and the chief will, in general, work with nearly all the juniors over the course of the year.

Should the still-a-resident chief know your in-training exam scores, the fact that you're getting divorced, any medical diagnoses you might have, etc? I don't think so, personally. But they certainly should be expected to function as the eyes & ears of the PD.

 

[Raryn]

Why would the chief sit on anything? The chief is another resident.

Depends on the specialty. In internal medicine, the chiefs are graduated residents who chose to stay on a fourth year as a kind of administrator/junior faculty member.

For example, the chiefs at our program even act as attendings on service periodically throughout the year.

 

[Chickenandwaffles]

Depends on the specialty. In internal medicine, the chiefs are graduated residents who chose to stay on a fourth year as a kind of administrator/junior faculty member.

For example, the chiefs at our program even act as attendings on service periodically throughout the year.

As I've stated, the chief in my specialty is simply a senior level resident, has not graduated or anything.

 

[Chickenandwaffles]

Depends on the specialty. In internal medicine, the chiefs are graduated residents who chose to stay on a fourth year as a kind of administrator/junior faculty member.

For example, the chiefs at our program even act as attendings on service periodically throughout the year.

It's different here.

 

[vhawk]

I can only speak for surgery, but the chief resident serves as sort of a liason between the faculty and the residents. As nice as it would be if every attending who had any concern with any individual resident dealt with it on a one-to-one basis, that is unrealistic. At the mid-year eval, or however your program does it, they are the voice of the residents, and they are in a unique position to comment on certain things, like a junior residents clinical competency. At large programs, junior residents could conceivably go several years without several attendings having any real idea what they are like on the floor, in patient management, etc.

An unavoidable part of that role for the chief resident is they are privy to information that perhaps you would rather they not know, things like in-service scores or evals.

 

[SouthernSurgeon]

Why would the chief sit on anything? The chief is another resident.

Because they have an administrative role within the program.

I don't understand why this is such a difficult concept for you

 

[schmitta1573]

I think the OPs problem is not necessarily with their administrative role, but how it is being handled. If this is true, I can see that. You have a peer who is in a leadership role and they have likely never been in such a position. Many handle it well, but it becomes an issue when they don't handle this role well and the attendings are unaware of their lack of leadership aptitude, inability to handle sensitive information, etc. Residents become leaders/chiefs by default, but the problem is many should not be. I could be wrong, but I assume this is really what the OP is struggling with.

 

[galactus]

I was chief resident in FM, and my role was to do admin stuff (call schedules, rotations, etc), as well as attend all faculty meetings and resident evaluation meetings with the core faculty. I was also elected by my peers, along with the other chief, to represent the residents as well as be eyes and ears to the PD. I had my resident's trust, and I was always about putting out fires so the PD does not have to deal with it. Obviously if things needed a PD level intervention I would go to him, but for the most part my co-chief and I were able to handle most issues.

Maybe because of an election process I had more trust with the residents/interns. IDK. Now I've seen programs where the chief is hand selected by the PD only, which I feel like can be an issue if the fellow residents do not trust him/her and feel like this chosen resident is merely a puppet to the PD. The other thing the OP mentioned is the most senior person being the chief. In that term I guess it's dependent on the person. Some people are great leaders, some aren't, but unfortunately the senior most person will be chief, and may not be good at the administrative side of things, confidentiality, communication, etc.

 

[Law2Doc]

Because they have an administrative role within the program.

I don't understand why this is such a difficult concept for you

Agreed. In many specialties/programs, the chief is elected from the ranks of residents but has an actual role in the program far beyond minor administrative tasks. It's a Role that's a mix between being a residnt advocate and a part of the administration with respect to resident matters. They attend meetings, have involvement in committees, recruiting, dealing with resident professional and academic issues and the like. They may be privy to a lot of program information the typical residnt doesn't. They aren't simply the guys who handle the schedule although that is certainly part of the job. This is program/specialty specific, but its really not uncommon for a chief resident to have a role very different than merely being another senior resident. In hierarchical specialties you really should regard them as your supervisor -- the sergeant in the room full of privates. Not a hard concept. But you have to get past this notion that they ought not have access to info about you because in many circumstances it's actually their "job" to know this. A lot of what you find "inappropriate" is actually pretty common, and the issues you describe stem from you not dealing with them as you would a supervisor rather than just another classmate.

 

[nlax30]

I'm currently chief at my community IM program. We're a little different in that it isn't a 4th chief year here, but a 3rd year voted on by the residents/faculty to be chief.

It probably depends a lot on the culture of the program but I sit in on the faculty meetings and am expected to handle a lot of the interpersonal issues that arise, whether it's among residents or hospital staff and residents.

I'm sure there are some things i don't know if someone went directly to the DME out of privacy, but for the most part, for better or for worse, I'm part of hierarchy when there's an issue so I'm usually involved to some degree. Trust me, some things I'd rather NOT know but I always take the position seriously and maintain confidentiality and try to remain professional. Definitely not something I take lightly.

 

[MedicineMan99]

The Chief(s) should mainly be concerned about scheduling matters and helping bring things to the faculty that the residents want the faculty to hear. Other than that, they are just one of the residents. If they act as anything more, then it's more of an ego thing. And something with which to pad your resume.

 

[Law2Doc]

The Chief(s) should mainly be concerned about scheduling matters and helping bring things to the faculty that the residents want the faculty to hear. Other than that, they are just one of the residents. If they act as anything more, then it's more of an ego thing. And something with which to pad your resume.

Again, in probably the majority of programs the job description is very much more expansive than that. Not purely a scheduling thing. Has nothing to do with "ego", and as the prior poster indicated, a lot of the time the chief would really rather not be as involved in other residents lives as the job forces them to be. If it were purely for resume padding they would stay out of it.

 

[shan564]

Nobody at work , including your PD, should be involved in your personal life if you don't want them to be. If you're underperforming at work, I think it's reasonable for either the chief or the PD/APD to ask you if everything is OK at home just to try to figure out how to help you get better at your job, but that's it.

That said, I do think that it's fair for the chief resident to be involved in evaluating us. Yes, the chief is another resident, but not "just another resident"... this person is literally my "chief." He/she outranks me. If he has access to my evaluations, that can only help me, because I expect that he'd use his "ear to the ground" to help improve the accuracy of the evaluations. And I know that the purpose of the evaluations is to help me be better, not to blow smoke up my butt, so I want my evaluations to include an accurate assessment of areas for improvement.

To the OP - this doesn't mean to suggest that your chief isn't overstepping. It sounds like this person has established a pattern of violating the trust of the junior residents, which defeats the purpose of having a senior resident as a liaison between the residents and the PD.

 

[QofQuimica]

I think the problem for the OP is that s/he doesn't trust this chief.

OP, if that's what your gut instinct is telling you, then that is probably wise. I didn't trust most of my chiefs with personal info either, and I avoided speaking to any of them about anything I didn't want the whole department to know about. (One chief I disliked to the point of avoiding any non-work-related conversation with them entirely.)

Concerning your evals, odds are good that all of your peers (and maybe even your juniors) know where you shake out in terms of how good of a resident people consider you to be anyway. You need to accept the fact that your colleagues are watching you and judging you, including your fellow residents. As long as you're not getting dragged into the PD's office for meetings or otherwise being disciplined by your program, best to let the righteous indignation part of it go. Maybe put that energy into ensuring that your program selects better chiefs for next year if possible. :-/

 

[gutonc]

I can't believe we're still discussing this. Let's break this down.

Some people are nosy a - hole douchebags who don't mind their own business.

All chief residents are people.

By the transitive property therefore, some chief residents will be nosy a - hole douchebags who don't mind their own business.

Head down, do your work, move on, the end.

 

[Law2Doc]

I can't believe we're still discussing this. Let's break this down.

Some people are nosy a - hole douchebags who don't mind their own business.

All chief residents are people.

By the transitive property therefore, some chief residents will be nosy a - hole douchebags who don't mind their own business.

Head down, do your work, move on, the end.

While this is true, these streets are two ways, and "a-hole douchebags " as you so eloquently put it, can be seen traveling in either direction. There are plenty of people who don't understand the role the chief serves (often by designation rather than desire) and as such, some will see them as overstepping their bounds even where they really aren't. Ergo by the opposite transitive property the chief might not be nosy and might actually be doing their job. Go figure.

 

[Chickenandwaffles]

While this is true, these streets are two ways, and "a-hole douchebags " as you so eloquently put it, can be seen traveling in either direction. There are plenty of people who don't understand the role the chief serves (often by designation rather than desire) and as such, some will see them as overstepping their bounds even where they really aren't. Ergo by the opposite transitive property the chief might not be nosy and might actually be doing their job. Go figure.

As gutonc put it best, why are we talking about this still?

 

[shan564]

I can't believe we're still discussing this. Let's break this down.

Some people are nosy a - hole douchebags who don't mind their own business.

All chief residents are people.

By the transitive property therefore, some chief residents will be nosy a - hole douchebags who don't mind their own business.

Head down, do your work, move on, the end.

The math nerd in me has to point out that, although this conclusion is appropriate, this is an illogical use of the transitive property. Here's an example of why:

Some people have no medical training.
All chief residents are people.
By the transitive property, some chief residents have no medical training.

Transitive property is that if A is related to B and B is related to C, then A is related to C. You can replace "is related to" with any mathematical relation that is equivalent, but you have to use the same relation each time... for instance, if A > B and B > C, then A > C. If every member of group A is a member of group B and every member of group B is a member of group C, then A is a member of group C.

In your statement, some members of the group "people" (A) are also members of the group "nosy a-hole douchebags" (B) and all members of "chief residents" (C) are members of the group "people" (A). This doesn't fit with the transitive property.

I will pre-empt the perfectly reasonable response that this entire post is completely irrelevant to the purpose of the thread, especially since I agree with gutonc's premise and conclusion. The only reason why I typed this whole thing out is because (1) I like talking about math/logic and because (2) well-meaning but incorrect logical conclusions due to an oversimplification of a more complex idea in the process of trying to make a quick point are a pet peeve of mine. That's how Hitler came to power.

Also, I hate emoticons, so I will not punctuate this post with a smiley face to clarify that this is mostly meant to be a jovial comment. I hope nobody thinks that I'm actually comparing anybody to Hitler.

 

[shan564]

Also, the reason why we're still talking about it is:

People on SDN share many opinions
This topic sparks many opinions
This topic is located on SDN
By no direct mathematical or logical property, this topic will cause many people to share opinions.

 

[Law2Doc]

As gutonc put it best, why are we talking about this still?

Well, gutonc actually revived a discussion that was winding down by taking one side of the argument and claiming it was logically superior. So I'd say he put it "worst", not best. He gets no gold star tossing gasoline onto the fire while saying "why is it so warm in here".

 

[Perrotfish]

I think to some extent the OP's problem is that the difficulty of having a colleague get promoted to being your boss, which isn't really a problem unique to medicine, but is worse than usual in medicine because residents tend to share more with each other than normal coworkers.

Chief is a weird position. Residents don't have as much solidarity as you might think they would, but in my experience they do at least share a very vocal distain for all things in residency. The endless documentation. The pointlessly long abusive hours. The attendings. You also learn more than a little bit about how different residents actively shirk the system, and the problems in their lives that are keeping them from caring about doing better.

Then you're chief, and you know all of this these things told to you in confidence by other residents as a co-resident, and you're still getting told more stuff in confidence because they still think of you as resident, and what do you do with it? After all you're supposed to be the boss now, the system's designated cheerleader/organizer. You're now held responsible for not just yourself but also everyone else's behavior. Say for example that you know PGY-2 Schmuckatelli is having other people sign in to morning report for him because he told you when you were a PGY-3. Do you bust him, or ignore it because you learned it as a resident? Do you ignore it indefinitely, even though you're seeing it every day, because it was a preexisting confidence? What do you do when other people stop showing up because they see Schmuckatelli getting away with it?

What about personal problems? You have a friend who comes to you and tells you he's been late all the time because he's about to get divorced and is getting depressed, but he doesn't want to see anyone or change anything. Do you keep that a secret? If it is a secret, do you bust him for being late and ignore what you know he's going through? If not how do you look like you're not playing favorites? Do you make excuses for him? Do you try to reschedule them for lighter rotations so they can deal with things? What about when people ask why you're doing what you're doing? Its hard to think of a way you could handle this where someone wouldn't think you handled it wrong.

Then there's just the question of attitude. What about when people just come to you to complain to you about the same crap they've been complaining about for the last 2-5 years? Do you take the party line ("well I hear your frustrations but actually those forms are really useful tools to improve our model of education") and risk sounding like a dingus? Do you continue talking badly about the system, like you were a resident, and risk that they might take it as tacit approval for bad behavior?

Again, its not a problem unique to medicine. Every 19 year old lance corporal has to deal with the magical moment when one of his buddies suddenly becomes his boss. I'm not sure there's a good solution for how you want that person to act. Honestly all you can hope for is someone who is consistent, who lets you know exactly how they're going to act early and then sticks to that. The only objectively bad way to be chief is to be a different kind of chief on different days. Or worse, with different people.

 

[Doctor Bob]

That's how Hitler came to power.

Also, I hate emoticons, so I will not punctuate this post with a smiley face to clarify that this is mostly meant to be a jovial comment. I hope nobody thinks that I'm actually comparing anybody to Hitler.

Hehehe.... Godwin's Law.

 

[Cellpathology]

LOL @ all the people defending the role of chief residents

 

[Shikima]

Hehehe.... Godwin's Law.

Unbelievable! I've now come to see it on SDN!

 

[Shikima]

Again, its not a problem unique to medicine. Every 19 year old lance corporal has to deal with the magical moment when one of his buddies suddenly becomes his boss.

Terminal Lance anyone?