Heterogeneity in internal medicine chief residency selection processes and role preparation: an opportunity for...

The chief resident (CR) role is integral to graduate medical education and the administrative, educational, and clinical functions of residency programs. There are limited data on the selection and job training of CRs in internal medicine (IM).

We used data from a previously published cross-sectional survey of IM CRs from 2018 (Garg M, et al., JAMA Netw Open 5:e223882, 2022).. As there is no publicly available national database of CRs, it was not possible to calculate a total number of eligible participants or select a random sample. Therefore, we employed snowball sampling as well as the Association of Program Directors in Internal Medicine listserv. Data were analyzed using descriptive statistics. We used Chi square testing to compare responses across gender, race/ethnicity, and academic versus community programs.

There were 169 respondents. Response rates were 57% in the snowball sample and 12% for the listserv. Forty-two percent of IM CRs were selected via formal application, compared to 49% selected via informal processes. Chi square testing showed a significant difference in formal versus informal selection by race/ethnicity; Black/African American CRs were more likely to be selected via formal processes compared to white, Hispanic/Latinx, and Asian respondents (p = 0.047). There were 69% who reported receiving some formal job training, with no differences in role preparation by gender, race/ethnicity, or program type.

Standardization of selection and job training across IM chief residencies could improve consistency in role preparation, performance, and CRs' experiences as well as supporting equity and diversity in CR selection.