Study highlights evolution of chief resident roles in internal medicine residency programs

The chief resident role has evolved over two decades: ©Asean Studio - stock.adobe.com

A study published in the American Journal of Medicine illustrates how the role of chief resident in academic internal medicine residency programs has evolved over the past 20 years. The findings, which emerged from a 20-year multicenter study that included the University of Colorado (CU) Internal Medicine Residency Program, reveal significant changes in the responsibilities of chief residents, the career paths they pursue, and improvements in gender representation within these roles.

William Turbyfill, M.D., an assistant professor in CU’s Division of Hospital Medicine and a practicing hospitalist at the Veterans Affairs Eastern Colorado Health Care System, was among the study’s site investigators. He noted that the study, led by Tyler J. Albert, M.D., was initiated due to a lack of research on chief residents, despite their pivotal role in medical education.

The research team, comprising site investigators from 22 academically affiliated internal medicine residency programs across the U.S., created a registry of 2,060 chief residents who served between 2001-2002 and 2020-2021. The study aimed to provide insights into how the chief resident role has evolved and how these changes can support the broader mission of providing excellent medical care.

Changing roles

The role of chief resident typically involves an additional year of training with increased responsibility and autonomy. Chief residents act as a bridge between residents and supervisors, managing day-to-day operations, addressing scheduling conflicts, and playing a key role in recruitment. Over time, the position has diversified, with more role-specific chief resident positions emerging, particularly in areas like quality improvement and patient safety, according to the study.

"At the VA, there has been a notable trend towards having chief residents focused on quality and safety projects, which aim to improve the overall hospital systems they work in," Turbyfill said in a statement.

The study found that larger residency programs tend to offer more specialized chief resident roles, while smaller programs generally have more generalized positions. Overall, the number of chief residents has increased by 38% over the 20-year period, with the median number of chief residents per program rising from three to five.

One of the key findings of the study was the significant improvement in gender parity among internal medicine chief residents. Over the 20-year period, the proportion of female chief residents increased from 39% to 52%, reflecting a positive trend toward gender equality in these roles.

The study also explored the career paths of former chief residents, finding that approximately 63% pursued subspecialty training, with cardiology, pulmonary and critical care medicine, gastroenterology, and hematology and oncology being the most common subspecialties. Additionally, 36% of chief residents remained in internal medicine, with 18% entering primary care and 17% pursuing hospital medicine. The proportion of those entering hospital medicine has increased over the years, indicating a shift in the perceived value of chief residency as a steppingstone to various career paths, including hospital medicine.

The study found that 56% of chief residents stayed in academic medicine, often remaining at the institutions where they trained, suggesting that chief residency serves as a pipeline for future academicians.

While the study provides valuable insights into the evolution of the chief resident role, Turbyfill said there is a need for further research to understand the underlying reasons behind these trends. Questions such as why the number of chief residents has increased and why more chief residents are choosing careers in hospital medicine remain unanswered.

"Understanding the ‘why’ behind these trends will be crucial for shaping the future of medical education and ensuring we continue to train the next generation of leaders in academic medicine," Turbyfill said.