Congratulations on being the chief residents for 2009-2010

I am excited that you will be helping shape the residency. We have enjoyed many success the last few years, and a big reason of this is the leadership of the chief residents.

I thought I would put a few thoughts on paper.

1. I think key for any group or organization’s success is to align leadership, management, communication styles, authority, accountability, responsibility, resource distribution, reporting structure, performance, potential, activities, accomplishments, to values and culture. We have set up a meeting for Wed 4/3 at 11:30 (location to be announced) to discuss your roles, chief resident transition, and 2009-2010.

2. Based on my experience with three chief residents in the past and the realities of day, eve, night shift, vacation, CME and the inherent challenges of having all three chiefs, five residency directors (Ankel, Dahms, Hegarty, Morgan, Taft), and Pat and Lori all in one place simultaneously, I have delineated 2009-2010 chief roles, responsibilities, and reporting structure. My hope is that this will allow for even increased operational efficiency and prevent inadvertent parallel work and triangulation. My expectation is that all of you work collaboratively on all three areas (one of the reasons I didn't specify ED chief, admin chief, social compliance chief in the announcement).

3. Brent is education chief, Aaron is operations chief, and Leah is compliance chief. e.g. on educational issues, Brent  will communicate for the chiefs to Matt, on scheduling issues Aaron will communicate to Rachel, on compliance issues Leah will communicate to Rachel.

4. Leadership success is directly related to the skill to delegate. My hope is that you experience and grow this skill as chief residents and engage as many other residents in leadership opportunities to capture the energy and creativity of others. In other words, just because one person is the education or admin chief, doesn't mean that others (e.g. other chiefs, other residents) aren't involved or in charge of certain elements, e.g. wild schedule, core competency set up, backup schedule etc.

5. I envision chief residency as a combination of service, leadership experience and education, .e.g. get experience promoting a vision, building consensus, managing conflict, observe various leadership, management and communication styles. I would like to see all three chiefs have four months of one of the day-to-day responsibility of chief on-call.

6. Chief residents duties and workload are often in a series of boluses rather than an even drip (e.g. setting up scheduling template, interview season etc.) Again, my expectation is that you work with each other to even things out (based on my experience of speaking at the chief resident forums at SAEM for several years on occasion intra-chief resident behaviors bring out criticism of martyrdom, bullying, or slacking form others). I don't anticipate this for 2009-2010, but want to make you aware of it as this sometimes happens in high stakes, high stress environments.

7. We would like to engage the chief residents into residency, leadership, vision and mission realms. For 2009-2010, there will be chief resident letters of agreements, just like all faculty in our residency have letters of agreements.

8. I would like to set up the chief resident role for success. This involves appropriate resources, authority and accountability expectations. In general chiefs receive up to $1200 for chief residents expenses, a shift reduction for chiefs up to 10/yr, a title of chief resident that can be used in communications and CV when applying for a job, a degree of authority with other residents for some of the day-to-day scheduling issues, and my eternal gratitude. My hope is that you find creative ways to delegate tasks and consider delegating some of the resources to follow the tasks (though I would ask you to discuss with us before delegating any title or any authority for the residency outside of the residency).

9. An important role of the chief residents has been the day to day management of the schedule. I will let you know the desired block schedule when we meet next week. IMPORTANT: I would ask you not to share any block schedules with any residents until the block schedules are finalized to prevent any misunderstanding. Although I hope I don't operate in a vacuum, I view myself as the final interpreter of residency policy or historical context. My recommendation is more info is better than less info, if any question arises about any residency policy, especially scheduling, feel free to give me a holler -.especially if changes are anticipated.

10. One of the crucial elements for our residency is clinical presence and leadership in our ED. For me that means that every part and shift of the ED is covered by at least one EM resident. I do not think having a department where patients are asked whether they would like to be on a resident-free team is helpful for patient care or education. I can give you more of a historical context at the meeting. In other words, this coverage is to be maintained with few exceptions (e.g. NCS, JFac shifts, selective, electives, some off-service rotations etc....all are impacted before the ED presence is impacted). I doubt this will happen and may only happen with a resident leaving, multiple leaves, multiple out of country electives at the same time etc. My expectations are that Regions EM residents are scheduled on average 45 hours clinically per week (18 10-hour shifts per 28-day period.)

11. One the other hand, I would also like to limit EM resident glut in the ED, and unhinge the ED schedule from med student, rotating resident, and PA schedule. e.g. the EM residency will staff the ED a minimum of 72+ hours a day (3 day, eve, night shifts) 365 days/year....this schedule is set a year in advance...the focus can then move away from scheduling and towards education....other ED departmental scheduling needs are addressed by others. If there are extra clinical expectations of residents, this involved, NCS, JFac or other experiences. I would like to have the chief resident take ownership of off-service resident scheduling and orientation. This will help unhinge off-service residents as a possible solution to EM staffing needs (they're not).

What would I like from you before our next meeting?

1. Thoughts on any of the above.

2. Review of job descriptions below to see if they need to be tweaked.

3. Any resources, authority etc.... you may need to ensure success.

4. Thoughts on the block schedule.

5. Thoughts on daily schedule.

6. Thoughts on current EM policies (e.g. backup, leave, academic development etc.)

7. Thoughts on any changes in chief roles (e.g. have education chief facilitate bigger role of residents selecting critical cases, etc.)