The evolution of internal medicine chief residents

Chief resident dynamics

Chief residency is a prestigious and essential leadership position within residency programs. The position comes with teaching and supervisory responsibilities and often plays an essential role in resident recruitment and educational programming.

As residency programs have grown and evolved, so too has the chief resident (CR) position. There are variabilities in the composition and responsibilities of Internal Medicine CRs between institutions and there are limited data on CRs or their career paths.

Broad and diverse sample

To study the composition of CRs over time and their career paths following chief residency, UW investigators conducted a nationwide study spanning 22 academic medical centers. Findings were published this summer in the American Journal of Medicine. Lead author on the study is Dr. Tyler Albert, associate professor and senior author is Dr. Paul Cornia, professor (General Internal Medicine).

The authors studied a large cohort of former CRs from diverse academic internal medicine residency programs to describe trends in gender, types of CR positions, and subsequent career choices over a 20-year period. A registry was compiled of over two thousand CRs who served at their respective residency programs between 2001 and 2021.

“Ultimately, our goal is to understand how to position chief residency in internal medicine to not only support the educational and clinical missions of the residency programs and institutions, but to improve support for chief residents themselves,” said Albert.  

Evolutions over time

The study found that the number of chief resident positions increased by 38% over the last 20 years, and found significant improvement in gender parity, increasing from 39% female in 2001 to 52% in 2021.

The CR position also become more specialized over time, especially for larger residency programs. Ambulatory and quality improvement/patient safety (QI/PS) CR positions increased in prevalence to accompany general and inpatient positions that were mainstays at the beginning of the study period.

Looking at careers after chief residency, the study found that almost two thirds of CRs pursue subspecialty training and the remainder were evenly split between primary care and hospital medicine, the latter of which significantly increased over time.  More than half of the CRs remained in academic medicine, as compared to only 15% of internal medicine residency graduates overall, and the majority of CRs who remained did so at the institution at which they trained.

Insight

With this insight, the authors hope to improve the alignment between residency programs and the chief resident positions, enhancing the effectiveness and satisfaction of the chief residents themselves. As residency programs continue to grow and evolve, this information can be key in fostering a cohesive and supportive chief residency experience, ultimately benefiting the residents, their programs, and the institution