Chief Medical Residents Research Articles

Abstract 17730: Facilitated Peer Mentoring: A Novel Model for Promoting Equitable and Inclusive Mentoring for Underrepresented Trainees in Academic Medicine

Introduction: Underrepresented minoritized(URM) cardiologists represent less than 8% of the US cardiology workforce. A positive role model, access to mentorship, and a diverse workforce influences the choice of cardiology as a subspecialty. Recognizing this, we established a novel facilitated peer-mentoring research group, the “Ogunniyi Research Group (ORG),” with the goal of creating a supportive and inclusive learning environment for trainees to develop cardiovascular research proficiencies. Methods: Our team consists of a lead mentor(cardiologist), 2 co-facilitators(cardiology fellows), and 4 resident-led teams of medical students and residents(Figure 1). Our mission is to advance cardiovascular health and equity through research, advocacy, and service; built on core pillars of mentorship, scholarship, leadership, community, and service. Mentees complete an individual development plan and meet regularly with the lead mentor to ensure milestones are met. Teams engage in research and quality improvement projects, which are reviewed at virtual monthly meetings. Quarterly academic medicine research seminars focus on building research skills. Results: 26 trainees participated during the 2021-22 and 2022-23 academic year. Most trainees (>95%) self-identified as Black, with equal sex representation. Major accomplishments include >16 abstracts presented at conferences, co-authorship on >10 publications, and several prestigious awards, grants, honors, and scholarships. 4 team members were selected as chief medical residents. To date, we have secured 100% residency and cardiology fellowship match rate. Conclusion: Our novel, multilevel, facilitated peer mentoring group has increased access to research and professional development opportunities, especially for URM trainees interested in cardiology. The ORG can serve as a model sustainable pathway for equitable mentorship, promoting diversity and inclusion in the cardiology workforce.

Performance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the Profession

Physicians' knowledge about each other's quality is central to clinical decision-making, but such information is not well understood and is rarely harnessed to identify exemplars for disseminating best practices or quality improvement. One exception is chief medical resident selection, which is typically based on interpersonal, teaching, and clinical skills. To compare care for patients of primary care physicians (PCPs) who were former chiefs with care for patients of nonchief PCPs. Using 2010 to 2018 Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data (response rate, 47.6%), Medicare claims for random 20% samples of fee-for-service beneficiaries, and medical board data from 4 large US states, we compared care for patients of former chief PCPs with care for patients of nonchief PCPs in the same practice using linear regression. Data were analyzed from August 2020 to January 2023. Receiving the plurality of primary care office visits from a former chief PCP. Composite of 12 patient experience items as primary outcome and 4 spending and utilization measures as secondary outcomes. The CAHPS samples included 4493 patients with former chief PCPs and 41 278 patients with nonchief PCPs. The 2 groups were similar in age (mean [SD], 73.1 [10.3] years vs 73.2 [10.3] years), sex (56.8% vs 56.8% female), race and ethnicity (1.2% vs 1.0% American Indian or Alaska Native, 1.3% vs 1.9% Asian or Pacific Islander, 4.8% vs. 5.6% Hispanic, 7.3% vs 6.6% non-Hispanic Black, and 81.5% vs. 80.0% non-Hispanic White), and other characteristics. The Medicare claims for random 20% samples included 289 728 patients with former chief PCPs and 2 954 120 patients with nonchief PCPs. Patients of former chief PCPs rated their care experiences significantly better than patients of nonchief PCPs (adjusted difference in composite, 1.6 percentage points; 95% CI, 0.4-2.8; effect size of 0.30 standard deviations (SD) of the physician-level distribution of performance; P = .01), including markedly higher ratings of physician-specific communication and interpersonal skills typically emphasized in chief selection. Differences were large for patients of racial and ethnic minority groups (1.16 SD), dual-eligible patients (0.81 SD), and those with less education (0.44 SD) but did not vary significantly across groups. Differences in spending and utilization were minimal overall. In this study, patients of PCPs who were former chief medical residents reported better care experiences than patients of other PCPs in the same practice, especially for physician-specific items. The study results suggest that the profession possesses information about physician quality, motivating the development and study of strategies for harnessing such information to select and repurpose exemplars for quality improvement.

A Resident-Led Virtual Journal Club to Educate Pediatric Residents About Coronavirus Disease 2019.

A Resident-Led Virtual Journal Club to Educate Pediatric Residents About Coronavirus Disease 2019.

Five Questions for Residency Leadership in the Time of COVID-19: Reflections of Chief Medical Residents From an Internal Medicine Program.

The COVID-19 pandemic has drastically affected the traditional methods residency programs use to train their residents. Chief residents serve a unique role as part of the residency leadership to foster the education and development of the residents. Given the rapid shift in demands on physicians in the face of the pandemic, the responsibilities of the chief residents have also shifted to help prepare the residents to meet these demands as frontline providers. There is not a precedent for how residency programs respond to this crisis while maintaining their primary role to develop and train physicians. The authors have identified 5 questions chief residents can ask to guide their program’s response to the demands of COVID-19 during this uncertain time in health care.

Fostering Meaning in Residency to Curb the Epidemic of Resident Burnout: Recommendations From Four Chief Medical Residents.

Burnout has become commonplace in residency training, affecting more than half of residents and having negative implications for both their well-being and their ability to care for patients. During the authors' year as chief medical residents at Brigham and Women's Hospital in 2017-2018, they became intimately familiar with the burnout epidemic in residency training. The authors argue that addressing resident burnout requires residency programs and teaching hospitals to focus not on the individual contributors to burnout but instead on fostering meaning within residency to help residents find purpose and professional satisfaction in their work. In this Perspective, they highlight 4 important elements of residency that provide meaning: patient care, intellectual engagement, respect, and community. Patient care, intellectual engagement, and community provide residents with a focus that is larger than themselves, while respect is necessary for a resident's sense of belonging. The authors provide examples from their own experiences and from the literature to suggest ways in which residency programs and teaching hospitals can strengthen each of these elements within residency and curb the epidemic of burnout.

House Staff Participation in Patient Safety Reporting: Identification of Predominant Barriers and Implementation of a Pilot Program.

Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, the Clinical Learning Environment Review site visit assesses residents' engagement in PSE reporting at each accredited academic institution. The objective of this study was to understand the common barriers to PSE reporting and design an intervention to increase the number of PSE reports by resident physicians. We surveyed 304 residents and fellows to assess attitudes toward the PSE reporting system and identify barriers to submitting online PSE reports. Based on this analysis of barriers, we piloted interventions with the internal medicine residency program and measured their effect on resident PSE reporting. Of the survey respondents, 58% had never submitted a PSE report. The most commonly identified barriers were too much time required to submit a report (38% of all respondents), lack of education on how or what to report (37%), lack of feedback or change after reporting (19%), and concern for repercussions or lack of anonymity (13%). Based on this analysis of barriers, we piloted interventions with the internal medicine residency program to educate residents about PSE reporting through a reminder message in their orientation e-mail, informational slides at the end of conferences that described what and how to report, a pocket card with reporting instructions, and leadership encouragement during walk rounds by chief medical residents and the program director. Compared with the 10 weeks before the start of the intervention, the number of PSE reports submitted by internal medicine residents more than doubled, from 16 to 37 reports (P < 0.01). This increase in resident PSE reporting was sustained for 20 weeks despite the interventions lasting only 8 weeks. A resident-driven intervention that fostered a culture of encouragement for PSE reporting through leadership support and targeted education increased the number of PSE reports submitted by internal medicine residents at our health system. Hospitals and health systems should seek to understand the common barriers to PSE reporting from this important group of direct patient care providers and administer structured educational programs to encourage their participation.

Journal Club 102: Enhancing Evidence-Based Medicine Learning Using a Virtual Journal Club

We developed a virtual journal club (VJC) for internal medicine residents and faculty as an alternative to the regularly scheduled journal clubs. We expected the VJC to increase journal club participation by overcoming time and geographic barriers to attendance resulting from duty hour limits and dispersion of residents across multiple clinical sites, and to enhance evidence-based medicine skills. The VJC is part of the department's intranet website and is managed by the chief medical residents. The VJC users read, review, and post comments on a blog-like feature. Each month, a senior resident prepares a critical appraisal of a recent article following the user guide format from the Journal of the American Medical Association1–,5 with the mentorship of a faculty member. Once the appraisal and a link to the original article are posted to the website, residents and faculty are notified by e-mail. Educational goals are determined depending on the type of article and are discussed in detail in the critical appraisal, with links to definitions and explanations in the file and on the website's main page. We monitored VJC website usage from July 2008 through November 2009, including the number of visits, comments on the blog, and downloads of articles and critical appraisals. To evaluate user perceptions of the VJC, we surveyed internal medicine residents (n = 116) and faculty (n = 31) on whether the VJC achieved its educational goals. Results showed VJC website visits of approximately 307 per month (range 31–570), blog comments of 10 per month, article downloads of 97 per month (range 20–140), and critical appraisal downloads of 114 per month (range 20–120). As typical for new technology, the VJC received an initial enthusiastic response. However, after 3 months, enthusiasm faded, and indicators of participation decreased. To achieve our goal of maintaining a successful VJC, starting in January 2009, we made the VJC a part of the academic hour, a block of protected time in the ambulatory clinic used for didactics. The VJC participation rates increased to approximately 100 downloads per month for articles and critical appraisals, and that rate was maintained for the remainder of the tracking period. Survey respondents from 27 residents and 5 faculty physicians showed that most agreed the VJC discussion was educationally valuable (84% agreed or strongly agreed), that the VJC helped keep them up to date with recent medical literature (78% agreed or strongly agreed), and that the VJC improved their critical appraisal skills (72% agreed or strongly agreed). Since incorporating the VJC into the ambulatory curriculum and dedicating specific time to review with the faculty, it has been very popular. Residents and faculty review articles before the educational session and spend the hour discussing the methodology, statistical concepts, and how to incorporate that knowledge into daily practice. Blog comments have been robust, with nearly every preceptor group commenting with each monthly session. Awarding continuing medical education credits to faculty who participate via the blog has helped with that. This virtual setting for education complements the traditional journal club in residency training and helps enhance the evidence-based medicine learning experience, which may lead to improvement in skills.

A Systems Approach to Morbidity and Mortality Conference

A Systems Approach to Morbidity and Mortality Conference Jason H. Szostek, MD, Mark L. Wieland, MD, MPH, Laura L. Loertscher, MD, MPH, Darlene R. Nelson, MD, Christopher M. Wittich, MD, PharmD, Furman S. McDonald, MD, MPH, Joseph C. Kolars, MD, Darcy A. Reed, MD, MPH From the Department of Medicine, Mayo Clinic, Rochester, Minn; Department of Medicine, Providence St Vincent Medical Center, Portland, Ore; Internal Medicine Residency Program, Mayo Clinic, Rochester, Minn; Department of Medicine, University of Michigan, Ann Arbor, Mich.

University of alabama school of medicine.

University of alabama school of medicine.

Teambuilding and leadership training in an internal medicine residency training program.

The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a "reef survival exercise" and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees' agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members' decisions, highlighting the importance and value of teamwork to attendees. Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further study is needed to assess the impact of this learning on actual clinical practice and the durability of these lessons.

Chief Medical Residents, Stanford (1960-1971)

Chief Medical Residents, Stanford (1960-1971)

Preservation of the Chief Medical Residency

Letters19 January 1999Preservation of the Chief Medical ResidencyRobert S. Crausman, MD, MMS and Yul D. Ejnes, MDRobert S. Crausman, MD, MMSBrown University School of Medicine; Pawtucket, RI 02850 (Crausman)Pawtucket, RI 02850 (Ejnes)Search for more papers by this author and Yul D. Ejnes, MDBrown University School of Medicine; Pawtucket, RI 02850 (Crausman)Pawtucket, RI 02850 (Ejnes)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-2-199901190-00028 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In 1997, we wrote to inform the Annals readership of a serious threat to the medical chief residency (1). At that time, Blue Cross of Rhode Island, our Medicare intermediary, informed our institution that their interpretation of the relevant sections of the Federal Register led them to conclude that chief medical residents in their fourth year of training were neither residents nor fellows for the purpose of graduate medical education funding. As such, they indicated that they were going to cease counting chief medical residents for graduate medical education reimbursement. For smaller training programs less able to ...

Training Too Many, Training Too Few

It was a Friday morning in June 1995, and my final day at the hospital where I had virtually lived for four years. I arrived there at 6AM, and by 10 I had visited my patients, joined in a meeting for quality improvement, and listened to the residents complain about coverage the previous night. As one of the departing chief medical residents, I was to deliver a graduation speech in the hospital's main auditorium. The ceremony was beginning in an hour, and I still had not translated all my ideas into words. There was much to say. I was among the first few exchange visitor international medical graduates (EVIMGs) to join the program and the first to have become a chief resident. I wanted my speech to capture the experiences that other EVIMGs and I had lived through during training. Despite our different backgrounds, we had confronted similar challenges

Feedback from chief residents about proposed revisions of the special requirements for internal medicine residencies.

To receive feedback from chief medical residents about what they and their residents would think of proposed revisions of the Special Requirements for Residency Programs in Internal Medicine. A 71-item questionnaire was mailed in the fall of 1991 to a chief resident at each of 426 U.S. internal medicine residencies. A five-point Likert scale, ranging from 1 (strongly agree) to 5 (strongly disagree), was used. In addition, the chief residents were asked for qualitative comments. The chief residents were requested to reflect residents' opinions when completing the questionnaire. 272 (64%) of the questionnaires were returned. The mean rating for all questions was 2.12, SD, 0.66. The 12 changes most strongly supported (means < or = 1-1.46) included enhanced training in interviewing, communication, and interpersonal skills and in physical examination skills; emphasis on residency as an educational experience and on general internal medicine in the design of core lectures and ambulatory care clinics; and a requirement for written parental leave policies. Areas of moderate to less strong agreement included requirements for faculty and resident research, and that residents report moonlighting experiences to their program directors. The chief residents supported most of the proposed revisions of the Special Requirements, including a new proposal for enhancing professionalism in residency. The data reinforce the need to make residency education consonant with the practice of medicine and the changing demographics of the profession as well as to address resident indebtedness.

A Bulletin Board Service for Residents

Excerpt To the Editor:The chief medical residents at Franklin Square Hospital Center have been operating a computer bulletin board (BBS) since March 1989. A recent research grant has permitted us t...

Evaluating clinical teaching in the medicine clerkship: relationship of instructor experience and training setting to ratings of teaching effectiveness.

A clinical teaching assessment form was used to evaluate the teaching by faculty and residents in the required third-year medicine clerkship over a two-year period. Data from 1,627 forms were analyzed for differences between groups of teachers at different experience levels and for comparison of teaching programs at different training sites. The level of involvement of instructor with student correlated with ratings by the students. Among groups of instructors, chief medical residents received the highest overall ratings. Faculty were rated higher than first-, second-, and third-year residents when degree of involvement of instructor with student was high. Ratings among faculty of different academic ranks were not significantly different. Analysis of data from different clinical settings showed that the teaching efforts by clinical faculty members in the ambulatory setting received the highest ratings from students. Although increased involvement of instructors with students or other factors may have led to the higher ratings in the ambulatory setting, the results are encouraging for the use of ambulatory teaching sites for the basic medicine clerkship.

The medical chief residency and its relation to academic sections of general medicine

The role and function of chief medical residents in academic programs were reexamined in light of the advent of departmental units of general internal medicine. Of 87 chief medical residents responding to a questionnaire, 74 worked in departments with active general internal medicine sections. There was much interaction between chief medical residents and general internal medicine faculty: 36 percent of chief medical residents participated formally in general internal medicine section activities, 54 percent shared teaching responsibilities with general internal medicine faculty, and 45 percent of chief medical residents interacted wtth general internal medicine faculty in administrative activities. Despite this Interaction, most basic administrative tasks were handled by chief medical residents alone. Forty-eight percent of chief medical residents thought the position had declined in prestige. Recent literature on the evolution of the chief residency in internal medicine and in other specialties is reviewed, and recommendations for capitalizing on the presence of general internal medicine faculty to make the position more rewarding are made.

The chief medical residency in the 1980s

A survey of university chief medical residents [l] indicated a moderate degree of dissatisfaction with the position and suggested that it was obsolescent. Several ways to change the position were proposed. Two surveys 10 years later did not confirm the obsolescence of chief residencies but rather confirmed the importance of the chief medical resident and stressed the need for periodic assessment of the chief residency position in order to maximize the impact of the chief medical resident on patient care and the educational aspects of the individual program [2,3]. We have examined some of the criticisms of the chief medical residency position, placed them in light of changes in internal medicine that have occurred during the last decade, and propose a number of specific improvements based on our experience at the major academic facility of Northwestern University Medical School.

The chief medical residency: a description and recommendations.

Individuals occupying the position of chief medical resident have the opportunity to influence significantly the quality and tenor of medical education and medical practice. To assess the status of the position, the authors surveyed chief medical residents completing their tenure in 1980. These residents distributed their time among administrative (41 percent), teaching (35 percent), patient care (21 percent), and research (3 percent) activities. They reported that their experience was quite positive. However, overall satisfaction was significantly negatively correlated with percentage of time spent performing administrative tasks. The percentage of time chief medical residents allocate to administration has increased during the past decade, while time spent teaching and delivering patient care has decreased. Based upon this survey, recommendations for improved utilization of the time and talents of these individuals are presented.

Consultations in internal medicine: a training program resource.

At the Milton S. Hershey Medical Center of the Pennsylvania State University an internal medicine consulting resident sees all medical consultation requests not directed to a specific subspecialty division. An audit of a nine-month experience on the consult service was compared with that of a general medicine ward service. The audit revealed that consulting residents were exposed to a quantitatively and qualitatively different spectrum of medical problems than were found on the ward service. The interdisciplinary aspects of the experience expand the consulting internist's fund of knowledge and complement outpatient exposure to other specialties, such as surgery and obstetrics-gynecology. Chief medical residents at 36 university medical centers were surveyed regarding the nature of the internal medicine consultation programs in their institutions. The survey indicated that half the programs were service oriented rather than educational and were not felt to be of profit to the medicine residents.