LETTER
Perceptions of Chief Medical Residency
Robert G. Bing-You
1 May 1993 | Volume 118 Issue 9 | Page 750
TO THE EDITOR:
Previous authors have suggested that chief medical residents (CMRs) perceive the position as being burdened with administrative duties [1] and as lacking prestige [2]. Because they are teachers [3] and role models for medical students, unhappy CMRs may have a negative influence on students' views of internal medicine. To assess CMRs' perceptions of chief residency, I sent a questionnaire using Likert-type scales (1 = strongly agree, 5 = strongly disagree) in May 1992 to 64 previous and current CMRs from eight internal medicine residency programs in New England.
Forty-five CMRs (70%) responded. Eleven respondents were current CMRs and 34 had been CMRs within the past 6 years. Seventy-one percent were men. The mean age during the CMR year was 31 ± 3 years. Only 3 CMRs had additional postgraduate degrees. All CMRs entered chief residency immediately after finishing residency. Sixty-four percent went on to fellowships after chief residency, 16% entered private practice, and 20% joined either university faculty or hospital-based practices.
Most CMRs (82%) had no job description, and 22% felt inadequately prepared for their responsibilities (that is, answering strongly agree or agree on the questionnaire). Thirty-three percent indicated that "there were many unrealistic expectations" placed on them. Most (74%) felt they had adequate management and administrative skills (49% of respondents had attended conferences on "how to be a chief resident" before or during chief residency). Only 18% indicated that taking a year to be CMR was a financial burden, but 34% said that they would not readily be a CMR again if taken back to "pre-CMR" days. Fifteen percent of CMRs in this survey did not enjoy being chief resident.
This small pilot study suggests that while most CMRs approve of their experience, a small number have strong negative perceptions. Similar results were described 11 years ago [4]. A larger, prospective study is necessary to validate these findings and to better define what factors influence these perceptions and what remedies might be appropriate [5]. In view of the declining interest in internal medicine, we cannot afford to allow such an important role in our training programs to be an unpleasant job even for a minority.
1. Bomalaski JS, Martin GJ. The chief medical residency in the 1980s. Am J Med. 1983; 74:737-40.
2. Parrino TA, Steel K. The medical chief residency and its relation to academic sections of general medicine. Am J Med. 1983; 75:839-42.
3. Bing-You RG, Sproul M. Medical students' perceptions of themselves and residents as teachers. Med Teach. 1992; 14:25-30.
4. Greenland P. The chief residency (Letter). Ann Intern Med. 1981; 95:239.
5. Schneiderman H. Rules for surviving a chief medical residency. Conn Med. 189; 53:45-6.
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