z

APPD Chief Resident Virtual Café

#5April 27th, 2020

1-2 pm PST/2-3 pm MT/3-4pm CT/4-5pm ET

Hosted by:

Blair Dickinson, MD, MS Jay Homme, MD

Associate Program Director Assistant Fellowship (PHM) Program Director

St. Christopher’s Hospital for Children Mayo Clinic

Philadelphia, PA Rochester, MN

z

Format for Today’s Meeting Turn on video so we can see each other Keep audio on mute unless talking to avoid

background noise We will share some information and then open for

discussion We will attempt to use the “raise hand” function in

Zoom for when you want to share information If any questions/comments come up as we are

presenting, please record them in the chat box

z

Agenda for Today’s Meeting Content from Chief Forum (30-35 minutes)

◦ “Show Your Best” Chief Resident Platform Presentations Part 2 Chief Coaching: A unique mentoring program for Chief Residents

(Duke) The Chief Residency in Graduate Medical Education: Systematic

review (Johns Hopkins) Feasibility and acceptability of an animal assisted therapy dog

dedicated to a pediatric residency (UCSF)

Check-ins/Updates

◦ Sharing Challenges & Best Practices for Chief Residents during these changing times (20 minutes)

Future Topics

Open discussion (Remainder)

**Bonus Session for 3rd year Chiefs, solo Chiefs, small programs (extra 20-30 minutes for discussion)

z

Show Your Best: Chief Resident Platform Presentations

Chief Coaching: A unique mentoring program for Chief Residents

Ganga Moorthy, MD

Chief Coaching: A Unique Mentoring

Program for Chief Residents

Ganga Moorthy, MD; Jordan Pung, MD; Robert Benjamin, MD; and Betty Staples, MD

Duke Pediatric Residency ProgramAPPD Chief Residents Forum

April 27, 2020

Creating the program

• Chief residents are supported on many levels by program leadership

• At our institution there was no formal framework for personal development and on-the job advice during chief year

• Inspired by our internal medicine colleagues, we developed a chief resident coaching program to meet these needs

• Development of new skills or knowledge

• Action or task oriented• Can be a direct supervisor• Limited timeframe• Expert on the topic

COACH• Concerned with big

picture• Self-development and

emphasizes reflection• Not a direct supervisor• Longer relationship• Facilitates personal

goal setting, action planning and implementation

MENTOR

• Personalized learning and growth

• Cater to individual needs, personal styles and time constraints

• Complement formal training and educational experiences

• Process issues, problems and decisions

• Support positive outcomes

CHIEF COACH

Rolfe A. Do I need a mentor or a coach?. Korean J Med Educ. 2016;28(4):397–399. doi:10.3946/kjme.2016.45

Identifying coaches

Former chief (either at Duke or another program)

Ideally in a different division from chief’s career interests

Ideally mid-career

1

2

3

Not formally affiliated with residency program leadership4

Setting Expectations

Meet for one hour

quarterly

Be available via email or phone for

advice

Follow the lead and

needs of the current chief

Four Sessions

1 2 3 4

June

September

December

June

Personal• Achievement• Skill acquisition• Professional

development• Impact on the

program• Balance in new

faculty role

1 First Meeting: Goal Setting(June/July)

This is also a good time for the coach to share any challenges or issues faced when they started their own chief year.

What are your goals for the year?

Program• Improvement

– How is the program struggling?

• Check in on surviving the job

• Challenges encountered

• Discuss and develop a plan moving forward

2 Second Meeting: Challenges(September)

• Were the program weaknesses you identified early on accurate?

• Anything else that has come up that you’d like to work to change?

• How are you doing with the skills you hoped to develop?

• Are there formal opportunities (faculty seminars, etc.) that could help address these areas during the rest of your chief year?

H fli bt th till ?

3 Third Meeting: Benchmarking(December)

• What did you accomplish this year professionally?

• What did you accomplish this year personally?

• What are your next steps?

• What advice would you have for the next Chiefs?

4 Fourth Meeting: Reflection(June)

Our Experiences

Associate Program Director

Managing the program

The coach perspective

Current ChiefsDifferent chief experiences

• A coaching program for chief residents provides current chiefs a support system outside of the program leadership

• Offers sessions to set goals, troubleshoot challenges, and reflect on development

• Easy to create and manage, sustainable, interdisciplinary and inter-institutional mentorship

• Has been a beneficial experience for both the residents receiving coaching and the mid-career faculty providing the coaching

Lessons Learned

Contact Us

Rob Benjamin, MDrobert.benjamin@duk

e.edu

Jordan Pung, MDjordan.pung@duke.ed

u

Ganga Moorthy, MDganga.moorthy@duk

e.edu

z

Show Your Best: Chief Resident Platform Presentations

The Chief Residency in Graduate Medical Education: A Systematic

ReviewMatthew Molloy, MD, MPH

The Chief Residency in Graduate Medical Education: A Systematic Review

Matthew Molloy, MD, MPH, Chief ResidentLauren McDaniel, MD, Chief ResidentNicole Shilkofski, MD, MEd, Program Director

4/30/2020

Background & Objectives

Background: Chief residents are critical to the structure and function of residency programs in pediatrics and many other specialties. There is known variation in the structure, roles, and responsibilities of the position. Despite the importance of chief residents in graduate medical education, there is a dearth of literature on the chief residency.

Objective: To assess the current literature on the structure of chief residency, selection chief residents, the roles, responsibilities, and characteristics of chief residents, the training of chief residents, and the perceived benefits and challenges of chief residency. 4/30/2020

Methods

• Worked with informationist to develop search strategy.

• Medline, PsycINFO, ERIC, and Web of Science databases were searched through August 2019 for studies and publications about chief residency.

• Inclusion criteria: Publications addressing chief residency in ACGME specialties in the United States or Canada. Publications that used chief residents as a convenience sample were excluded. Only publications that use the term chief resident to refer to additional responsibilities beyond the typical residency training were included.

4/30/2020

4/30/2020

Results

4/30/2020

Anesthesia 1 1%

Emergency Med 4 5%

Family Med 9 12%

General Surgery 1 1%

Internal Med 12 16%

Multiple 16 21%

Pediatrics 7 9%

PM&R 2 3%

Psychiatry 19 25%

Radiology 5 6%

Rad Onc 1 1%

35 of 77 (45%) published pre-200030 of 77 (39%) published 2010 or later

Common Topics and Themes

• Description of chief resident roles and responsibilities

• Survey of programs asking about selection, roles, and responsibilities

• Evaluation of various training programs for chief residents

• Survey of chief residents asking about perceptions of role

• Very few looking at outcomes post-residency4/30/2020

Key Concepts Addressed in Pediatrics Studies• Characterization of chief resident

responsibilities • Exploration of motivations to become a chief

resident• Benefits and challenges of chief residency • Value of chief resident leadership training 1. Alpert, et al. Does being a chief resident predict leadership in pediatric careers (2000) Pediatrics. 2. Banker, et al. Chief residents’ experience as inpatient attendings (2019) Acad Pediatr. 3. Dabrow, et al. Two perspectives on the educational and administrative roles of the pediatric chief resident (2011) J Grad

Med Educ. 4. Doughty et al. Experiential leadership training for pediatric chief residents: impact on individuals and organizations (2010)

J Grad Med Educ. 5. Kim et al. Experience and reflections of former pediatric chief residents (1994) Arch Pediatri Adolesc Med.

What are Chief Resident Responsibilities & How Do They Perceive Their Importance?

• Survey of 127 program directors (PDs) and 101 current chief residents (CRs) in April/May 2008

• Nearly all PDs and CRs noted that administrative and educational duties were important aspects of the job

• Troubleshooting residency issues (73% PDs, 75% CRs) and on-call scheduling (71% PDs, 73% CRs) were viewed as the most important administration tasks

• Acting as a resident advocate (74% PDs, 73% CRs) and as a liaison between residents and staff (73% PDs, 74% CRs) were the most important educational activities

Dabrow, et al. (2011) J Grad Med Educ.

What Motivates People to Become Chief Residents? Was It Worth It?• Development of skills related to leadership was

viewed as the most important reason to become a chief resident (CR)

• 80% percent (71/89) of CRs indicated the position met their expectations

• 74% (65/88) reported they would choose to become chief again

• Most significant difficulties faced during chief year included a lack of support for administrative responsibilities, insufficient time, and difficulties with conflict resolution

Dabrow, et al. (2011) J Grad Med Educ.

Have Chief Resident Responsibilities Changed Over Time?• Surveyed 1137 individuals who were chief residents

between 1972-1992 (response rate 89%)• Over time (1972-1982 vs 1983-1992), chief residents

are spending less time teaching (28% versus 24%, p<0.01) and providing inpatient (26% vs 21%, p<0.01) and outpatient care (12% vs 10%, p<0.05)

• They are spending more time scheduling (17% vs 24%, p<0.01) and in other administrative duties (13% vs 17%, p<0.01)

Kim et al. (1994) Arch PediatriAdolesc Med.

Is There Value in Chief Resident Leadership Training?• Survey of former 363 chief residents who completed

the Chief Resident Training Program (CRTP) between 1988-2003 (response rate 37%, median years since chief residency was 7 years)

• 94% percent of chief residents (CRs), program directors, and department chairs reported that the CRTP was "very" or "somewhat" relevant/worthwhile

• 92% of CRs indicated CRTP had a positive impact on their year as chief resident

• 75% responded it had a positive impact beyond residency

Doughty et al. (2010) J Grad Med Educ.

Does Chief Residency Predict Future Leadership?• Survey conducted in 1995 of 475 eligible former

residents between 1965-1985• 163 chief residents (CRs) (34%)• Mean age 47, 67% male, 51% completed

fellowship• After controlling for CR status, gender, marital

status, and fellowship status, former CRs were 1.8 times more likely to report professional leadership

Alpert, et al. (2000) Pediatrics.

Conclusions and Areas of Future Investigation

• There is a dearth of literature on chief residency • The existing literature is largely survey-based • The majority of studies surveyed chief residents

who completed the position more than a decade prior

• This systematic review may serve as a starting point to develop best practices related to the selection, training, and job description of chief residents

z

Show Your Best: Chief Resident Platform Presentations

Feasibility and acceptability of an animal assisted therapy dog

dedicated to a pediatric residency program

Liat Bird, MD

The Dogtor is In:Feasibility and acceptability of an animal assisted therapy

dog dedicated to a pediatric residency program

Liat Bird and Pepper the dog4/27/2020

Wellness task force recommendation

AAT application

Training Pepper

Questions?

z

Group Sharing:Challenges & Best Practices

• Updates/experiences from the past week• What’s working for those hardest hit?• What should we be preparing for….?

z

Topics for Future SessionsMay 4th

• Check-ins/UpdatesChallenges/Best Practices

• Change Management as a Chief: Pitching for Change

Taylor Koerner, M.D., BaystateChildren’s Hospital

• Professional Development for Chief Residents

Maria Ramundo, M.D., Akron Children’s HospitalErin Giudice, M.D., University of Maryland School of Medicine

May 11th

• Check-ins/UpdatesChallenges/Best Practices

• Not your Average Morning Report – Part 2

zOpen Discussion

z

Special Considerations for 3rdYear Chiefs, Solo Chiefs,

Small Programs