What I wish I knew before my chief year

1. What I wish I knew before my chief year A (non) Evidence-Based review

2. Who are your role models?

3. You all are entering an elite family of chief residents. Looking back at some famous former chief residents can be insightful and inspiring. Anyone know who this is?You all are entering an elite family of chief residents. Looking back at some famous former chief residents can be insightful and inspiring. Anyone know who this is?

7. Jason Seaver and Cliff HuxtableJason Seaver and Cliff Huxtable

9. In your group, brainstorm the following: What do you think are the 5 biggest challenges you�ll face (or have faced) as chief resident? How do you plan to address each one of these?

10. Be OK with things not being perfect all the time (e.g: not enough beds in the hospital): If problems: Faculty and Residents will come to you first You are NOT ultimately responsible for success/failure of the program Listen attentively, stay calm and cool, hear them out Give yourself time to think, process, explore the alternatives It�s OK to say �I don�t know the solution right now�� There will be problems you can�t solve FOLLOW-UP Even if there isn�t a solution right now, at least the individual was heard and knows their concerns matterBe OK with things not being perfect all the time (e.g: not enough beds in the hospital): If problems: Faculty and Residents will come to you first You are NOT ultimately responsible for success/failure of the program Listen attentively, stay calm and cool, hear them out Give yourself time to think, process, explore the alternatives It�s OK to say �I don�t know the solution right now�� There will be problems you can�t solve FOLLOW-UP Even if there isn�t a solution right now, at least the individual was heard and knows their concerns matter

13. Mediator/Negotiator Get all sides of any story Be OK with things not being perfect all the time Get to know other chiefs in other departments Might see people you admired in a different way � i.e. you now have a �behind the scenes look� at faculty Get all sides of any story example: an intern comes to you furious about an RN because the RN went above the intern�s head and called the senior resident to assess their patient. Instead of bringing it up with the RNs unit director, you go to hear the RNs side of things, and they tell you that they�d been paging the intern and not getting responses all night, so they had to start bypassing them. Now you have a different issue � is there something wrong with the intern�s pager? Were they really ignoring pages? Problem with setting priorities? Should the RN have handled it differently. Alternative example: residents say the faculty aren�t teaching them anything. Faculty say the residents are never available when they try. Be OK with things not being perfect all the time: If problems: Faculty and Residents will come to you first You aren�t ultimately responsible for success/failure of the program Listen attentively, stay calm and cool, hear them out Give yourself time to think, process, explore the alternatives It�s OK to say �I don�t know the solution right now�� There will be problems you can�t solve FOLLOW-UP Even if there isn�t a solution right now, at least the individual was heard and knows their concerns matter Get all sides of any story example: an intern comes to you furious about an RN because the RN went above the intern�s head and called the senior resident to assess their patient. Instead of bringing it up with the RNs unit director, you go to hear the RNs side of things, and they tell you that they�d been paging the intern and not getting responses all night, so they had to start bypassing them. Now you have a different issue � is there something wrong with the intern�s pager? Were they really ignoring pages? Problem with setting priorities? Should the RN have handled it differently. Alternative example: residents say the faculty aren�t teaching them anything. Faculty say the residents are never available when they try. Be OK with things not being perfect all the time: If problems: Faculty and Residents will come to you first You aren�t ultimately responsible for success/failure of the program Listen attentively, stay calm and cool, hear them out Give yourself time to think, process, explore the alternatives It�s OK to say �I don�t know the solution right now�� There will be problems you can�t solve FOLLOW-UP Even if there isn�t a solution right now, at least the individual was heard and knows their concerns matter

14. Mediator/Negotiator A word on complaints Used to drive me crazy Some level of complaining drives program improvement Consider complaints as an endorsement They trust you and they believe you can make a difference Overly negative or unreasonable complaints help folks re-frame their complaints ? constructive sometimes all someone needs is someone to listen and they just need to vent. That�s OK (consider the resident�s mental health) Example of an overly negative complaint: the cafeteria STINKS! It�s a total rip off, and I hate it. Re-framing the complaint: the cafeteria prices are too much for our meal budget, or the speediness in the cafeteria is making it really hard to get to conference and I�m frustrated. Now you can brainstorm on solutions. Also, might want to explore why they�re so angry about something like this � did they just leave rounds and get mistreated on rounds about something, and they�re displacing the anger on the cafeteria situation? Example of an overly negative complaint: the cafeteria STINKS! It�s a total rip off, and I hate it. Re-framing the complaint: the cafeteria prices are too much for our meal budget, or the speediness in the cafeteria is making it really hard to get to conference and I�m frustrated. Now you can brainstorm on solutions. Also, might want to explore why they�re so angry about something like this � did they just leave rounds and get mistreated on rounds about something, and they�re displacing the anger on the cafeteria situation?

16. Keeping it in balance � Personal/Professional Life YOU need to vent, too! Find a constructive way to release You can work non-stop at the job, if you let yourself � set limits Administrative duties � avoid getting too bogged down Set some limits for yourself, e.g. check your email 2 times per day MAX Talk to your program director or co-chiefs if you are out of balance prioritize, prioritize, prioritize (Be OK with things not being perfect all the time)

18. Counselor Listen and be available Follow-up Utilize your resources When someone is talking with you, think about their overall goals Try to maintain the balance of being �friendly/supportive� with �pleasing everyone� you can end up being treated like a friend rather than respected like a chief resident / attending Be available Be positive but also be real � it�s OK to level with folks when they�re upset don�t have to convince someone who�s complaining that they�re wrongBe available Be positive but also be real � it�s OK to level with folks when they�re upset don�t have to convince someone who�s complaining that they�re wrong

20. Leaving Your Legacy Set priorities or else the year will pass you by Break big projects into small/realistic pieces re-vamp continuity clinic scheduling, introduce a new curriculum item (sim center? EBM? other?), collaborate with neighboring residency programs, research xyz�

21. Leaving Your Legacy

22. Leaving Your Legacy

24. Carving your Professional Path See yourself as a colleague/faculty member Take advantage of career development opportunities that arise Just like in med school and residency, you deserve to give/receive feedback, e.g. Discuss expectations with PD early Share your priorities with your PD Schedule weekly coffee with PD, to f/u Discuss clinical cases with senior faculty

26. Administrator Identify the administrative/programmatic tasks for the year agree to division of labor with co-chiefs. If only you, then set a timeline for yourself for these tasks Tough decisions: You will likely have to make tough decisions and say/do something outside your typical comfort zone, e.g. calling people in for emergency call calling someone into the office to give negative feedback is difficult for many people, advocating on behalf of your residents to a faculty member can be extremely difficult, etc� but that�s why YOU were chosen�because people believe you have the talent and skill to do this effectively Get to know other chiefs in other departments

28. Clinician Prioritize your clinical development Patient safety is critical, so is your ability to sleep without worrying about a decision you made Identify your clinical allies Rely on your mentors They (should) expect you to ask questions Set time each week to read or study for boards

30. Educator Hold people to a reasonable but high standard People often more respect those who tell them when they aren�t meeting expectations than when they avoid confrontation and say nothing Discuss teaching techniques with PD Different strategies: Set aside time on rounds or clinic while attending Participate in formal teaching activities: Medical student rotations / experiences Journal clubs / didactics �

31. Nike Dunk SB Dr. Huxtable / Bill CosbyNike Dunk SB Dr. Huxtable / Bill Cosby