How to Become Chief Resident: Advice From a Former Chief

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June 3, 2024
If you’ve thought about taking on a leadership role in your program, and even wondered if you’d make a good chief resident, this post is for you! We’ll explain how to become chief resident, the process of running for chief, and how to determine if it’s something you may want to consider.

The Duties of a Chief Resident

Let’s begin by taking a closer look at what the position entails, so you can get a better sense of whether you’d like to one day become chief resident.

Some common responsibilities of a chief resident include: 

1. Leadership and Administrative Duties 

Chief residents often help manage the residency program, which includes doing schedules, organizing educational activities, and serving as a liaison between residents and faculty. These duties can vary depending upon the specialty, but they’re pretty common across the board. 

2. Teaching and Mentorship Roles 

Chief residents play a crucial role in acting as a role model for junior residents and even medical students, offering guidance, support, and formative feedback to help them progress in their respective roles.

Chiefs are often tasked with inviting didactic lecturers to enrich the training of their program and have other educational duties, such as hosting board exam review or in-training exam (ITE) preparation. 

3. Clinical Responsibilities 

In addition to their administrative and teaching duties, chief residents continue to engage in clinical work, often handling complex cases and serving as role models for clinical excellence.

Anyone considering running for chief resident should have a good handle on their clinical responsibilities if they plan to serve as chief.

4. Program Improvement 

Chief residents are involved in program development and improvement, contributing to the refinement of curricula and resident education policies.

They’re often tasked with supporting residency wellness as well and may maintain the program’s ACGME standards.

5. Conflict Resolution 

Another important role of chief residents is to assist in resolving conflicts among residents or between residents and faculty, ensuring a supportive and safe learning environment.

Whose turn is it to take the call pager? Who gets to have this Christmas holiday off and who gets Thanksgiving? These are often questions and sometimes quarrels that chiefs may be expected to resolve. 

In Summary…

Ultimately, the chief of a residency program wears many hats and has to be quick on their feet to handle the various situations they’ll encounter. Service is usually for a year and some chiefs are self-nominated, while others are elected by peers and/or faculty.

For example, a chief resident in surgery might primarily focus on managing surgical rotations, organizing technical training such as procedural and suture workshops, and supervising junior residents in the operating room. 

In contrast, a chief resident in internal medicine may spend time coordinating diverse clinical didactics sessions, overseeing patient care in both inpatient and outpatient settings, and emphasizing diagnostic reasoning and updated clinical guidelines.

Both roles involve significant administrative tasks, teaching responsibilities, program improvement efforts, conflict resolution, and are tailored to the specific demands of their specialties.


What Does it Take to Become Chief Resident?

So, that’s some of what you can expect to do as a chief resident. Now let’s take a look at another important topic: what makes for a good chief resident? As we’ll see, no matter which specialty you serve in, there are some qualities that many good chiefs share. 

Let me begin by mentioning that a successful chief displays self-awareness, engages in proactive learning, and is immersed in the clinical and nonclinical aspects of residency. 

If you feel like you may be lacking in some of these areas, there are a few concrete steps you can take that will prepare you for being the chief.

In my opinion, how to become chief resident really comes down to working on the following seven things: 

1. Leadership Skills

You can work on your leadership skills by taking initiative and volunteering for leadership roles within your residency program. For instance, a stepping stone to chief begins with leading a committee, organizing a social event, or managing a team research project or presentation.

After successfully completing that task, ask how you did! Seek feedback from peers, mentors, and attendings alike on various aspects of your training. Use this feedback to improve upon your approach as you observe and learn from established leaders within your program. 

2. Competence 

It goes without saying that you need to be competent in your current residency duties before you can make the leap for chief. Staying up-to-date with the latest advancements in your specialty by attending conferences, reading journals, and participating in educational sessions will keep you well-informed. 

3. Organization 

Sharpen your time management skills and keep track of responsibilities and deadlines while prioritizing tasks based on their importance. Staying organized will impress your peers and attendings, not to mention making the tough workload of residency seem more manageable. 

4. Mentorship

Teaching stands out to administration. Mentor and teach, whether it means giving a brief five-minute chalk talk during table-side rounds or presenting a research paper at a national conference.

Volunteer to teach at educational sessions, workshops, and on rounds to improve your teaching style, refresh your knowledge, and stand out as an educational leader to your peers and faculty. 

5. Teamwork 

Collaborate and figure out how to work with others to solve problems, keeping in mind that sharing perspectives can lead to more effective solutions. By fostering positive working relationships with your fellow residents, you demonstrate that you can work well within a team and support your colleagues.

6. Communication 

Practice open communication and remember to close the loop so that everyone is on the same page. 

7. Taking Responsibility 

Lastly, take responsibility for your actions and decisions—own up to your mistakes and learn from them. Be open to change and adaptable in the face of new challenges while maintaining a positive attitude and seek solutions rather than dwell on problems. 

By proactively developing these qualities throughout your residency, you can set yourself up to be viewed favorably by your peers and faculty, and be a strong candidate for the role of chief resident.

And “candidate” is the right word. Understanding how to become chief resident requires you to learn about more than what qualities you need to have (or develop) to become chief. This is, in a sense, a political office, which means you’ll have to place yourself in the running!


The Process of Running for Chief Resident

So, now let’s take a look at what the campaign for chief is typically like. 

The process of becoming a chief resident typically involves several steps, which can often vary by program and specialty. Here’s a general outline of the process:

1. Determine your eligibility. 

Typically, programs require that chief resident candidates be in their final year of residency or have demonstrated significant leadership potential (which can start as early as intern year). I mentioned above about volunteering for teaching opportunities, or offering to lead workshops or residency-led activities and events.

Prior to starting your final year of residency, inform your program director and residency coordinator of your interest in the chief resident position. This can be done through a formal letter of interest, email, or as a verbal mention during your evaluation and review meeting with your PD. 

2. Submit your application. 

Programs may require a formal application, including a CV, a letter of intent, and possibly even letters of recommendation from core faculty members. 

3. The committee makes a decision. 

Once the required documents are received, candidates may be interviewed by a selection committee, which often includes program directors, faculty members, and current chief residents. They will likely review your past performance evaluations, leadership experiences, and feedback from both peers and faculty will be considered.

In some programs, residents may vote for their preferred candidates, with the final decision made by the program director and selection committee. Once the selection is made, the new chief resident(s) are announced, often a few months before they assume their roles to allow for a transition period.


So, Should You Run for Chief Resident?

So, now you know how to become chief resident, what the position entails, and what you’ll gain from it professionally. But is it for you? 

In the end, of course, it’s your decision to make. All in all, spending your senior year as a chief resident is an amazing experience both personally and professionally. You get to spend time with your faculty and co-residents to tackle everyday and systemic issues that deeply affect you. It’s a rewarding experience and will help you grow closer to your colleagues. Not to mention this opportunity is a boon for your professional CV!

If you still need help deciding if this is the right path for you, check out my other post on this topic, “Should You Run for Chief Resident?

Hopefully, this insight into the chief resident position can give you some guidance as you learn more about the role or prepare to apply for it. Looking back, knowing what I know now, I certainly would do it again! Good luck on your resident leadership journey. 


Looking for more (free!) content to help you through residency and beyond? Check out these other posts on the Rosh Review blog!


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By Mike Ren, MD


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