Pediatric Chief Residents' Experiences as Inpatient Attending Physicians

Abstract

Background: Some pediatric chief residents perform supervisory clinical duties during chief residency, but these activities are highly variable and descriptions are limited. Our goals were to characterize inpatient service performed by pediatric chief residents and to explore factors that influence their experiences as inpatient attending physicians.

Methods: Pediatric chief residents at Accreditation Council for Graduate Medical Education-accredited programs in 2016 were invited to complete a 40-item electronic questionnaire about their inpatient service obligation as well as attitudes regarding this experience. Data were analyzed using Chi-square, analysis of variance tests, and logistic regression. Open-ended responses underwent content analysis.

Results: There were 116 completed surveys from a national sample of 223 (response rate 52%); 66% served as inpatient attending physicians during chief residency. On average, chief residents spent 5.5 weeks (range 1-16) in this role with a daily census of 11.5 patients (range 5-20). Those entering primary care were significantly less likely to spend time as an inpatient attending compared with chiefs entering fellowship or hospital medicine (45.7 vs 67.3 vs 83.3%, P = .01). Overall, 92% regarded their inpatient clinical experience positively and indicated they would like the same (40%) or more time (52%) in this role. The average favorability rating was 8.2 of 10, and this was not associated with clinical workload or career choice.

Conclusions: Most chief residents serve as inpatient attending physicians during chief residency. They rate their inpatient experience positively despite wide variability in clinical experiences, patient population, and clinical load. Further studies should examine the value of this experience and its impact on chief residents' future practice.

Keywords: chief residency; graduate medical education; hospital medicine; professional development.