at the end of their pgy-2 year in june 2012 , 12 prospective chief residents underwent a half - day training session using a curriculum customized by program leadership called lead ( leadership , education , advocacy and development ) . the training included several topics presented by two former full - year pgy-3 chief residents serving in administrative roles , as well as residency program leaders including the chairperson , program directors , and core faculty . session themes included communication , motivation , delegation , feedback , team - building , task completion , clinical teaching , running meetings and career success . in addition , based on self - identified interest or faculty evaluation , some residents were assigned additional roles as directors for the following boards : conference curriculum , continuity clinic , recruitment , community advocacy / esprit de corp , and transition to residency . each of these groups worked closely with faculty members to design strategies for the upcoming year . additionally , each chief met with core faculty early in the month during which they were chief ( an elective or outpatient clinic rotation , in most cases ) to review the chief resident curriculum . each third - year chief received a $ 500 stipend ( one - twelfth of the annual department budget for chief residents ) . after the rotating chief and leadership curriculum was implemented , survey questionnaires were sent to all 29 internal medicine residents in the program at the end of each month to evaluate each chief resident 's performance . these questionnaires were adapted from published literature using a previously evaluated reference model ( 1 , 5 ) ; respondents utilized a 010 scale for each question . the rotating chief for any given month was excluded from participating in the group surveys ; however , he or she was asked to participate in a separate set of surveys that evaluated his or her leadership capacities as demonstrated throughout the chief rotation . all other participating residents evaluated the rotating chief on his or her performance throughout the rotation . thirteen valid junior resident responses were obtained for the chief resident evaluation survey : eight from pgy-1 and five from pgy-2 . the data from the pgy-1 respondents yielded similar means to that of the pgy-2 class , so the two classes were merged for final analysis . junior residents reported that the chief residents elicited input from others ( 6.8 ) , were committed to the team ( 6.8 ) , resolved conflict ( 6.7 ) , ensured efficiency , organization and productivity of the team ( 6.7 ) , participated actively ( 7.0 ) , and managed resources ( 6.6 ) . pgy-3 ( n=16 ) responses provided higher averages on all the above measures ( table 1 ) . the pgy-3 class ( n=9 ) also gave higher ratings of the chiefs teaching skills than did the junior residents ( n=7 ) . rating of chief residents by postgraduate year of rater self - evaluation by the chief residents ( n=5 ) revealed that they rated their ability in leadership low ( mean 6.0 , sd 1.2 ) ; they also reported low comfort with being chief resident ( mean 5.8 , sd 0.8 ) . they were more comfortable running a morning report ( mean 8.4 , sd 1.5 ) or noon conference ( mean 7.6 , sd 1.5 ) than a quality improvement study ( mean 6.8 , sd 1.1 ) . additionally , pgy-1 and -2 residents appeared to be more critical of the leadership and teaching skills of the third - year chief residents than were their own pgy-3 cohorts . first , the responses from the pgy-3 class were self - ratings and may have inherent bias . second , the study was performed at a single internal medicine program , and may thus have limited generalizability to other residency programs . hypothesis testing was not applied to this data due to a lack of power to detect a statistically significant difference . despite these limitations , we suggest that there may be a role for introducing a rotating pgy-3 chief curriculum in residency programs that do not have pgy-4 chief residents . it may be worthwhile to explore on a larger scale whether obtaining input from junior residents would correlate with the success of elected chief residents . interestingly , 86% of family medicine programs utilize input from residents in the selection of chief residents ( 7 ) . it may be useful to extend the study to include internal medicine residency programs that have both pgy-4 and pgy-3 chiefs , and to gather data on the selection processes of chiefs as well as quantitative ratings of the chiefs productivity , leadership , resident satisfaction , and other metrics that would help other programs determine how to improve selection of , and role definition for , chief residents . the feasibility of accomplishing this through a rotating pgy-3 chief residency curriculum was explored at one small program , and larger studies are indicated .
introductionthe role of the internal medicine chief resident includes various administrative , academic , social , and educational responsibilities , fulfillment of which prepares residents for further leadership tasks . 
 however , the chief resident position has historically only been held by a few residents . 
 as fourth - year chief residents are becoming less common , we considered a new model for rotating third - year residents as the chief resident.methodsonline surveys were given to all 29 internal medicine residents in a single university - based program after implementation of a leadership curriculum and specific job description for the third - year chief resident . 
 chief residents evaluated themselves on various aspects of leadership . 
 participation was voluntary . 
 descriptive statistics were generated using spss version 21.resultsthirteen junior ( first- or second - year ) resident responses reported that the chief residents elicited input from others ( mean rating 6.8 ) , were committed to the team ( 6.8 ) , resolved conflict ( 6.7 ) , ensured efficiency , organization and productivity of the team ( 6.7 ) , participated actively ( 7.0 ) , and managed resources ( 6.6 ) 
 . responses from senior residents averaged 1 point higher for each item ; this pattern repeated itself in teaching evaluations . 
 chief resident self - evaluators were more comfortable running a morning report ( 8.4 ) than with being chief resident ( 5.8).conclusionthe feasibility of preparing internal medicine residents for leadership roles through a rotating pgy-3 ( postgraduate year ) chief residency curriculum was explored at a small internal medicine residency , and we suggest extending the study to include other programs .