This Resident Roundup post comes from Erik M. Hegeman, MD, an active duty PGY-3 resident with the Brooke Army Medical Center Orthopaedic Residency Program in San Antonio, Texas. This is the first in a 3-part Resident Roundup series on leadership and organizational involvement opportunities for trainees.
Orthopaedic residency is a long and challenging 5 years. It is packed with opportunities for personal and professional growth as we make our way from naïve interns to fully competent surgeons who can manage the depth and breadth of musculoskeletal health care. Along the way, we are almost guaranteed to experience or become aware of institutional or health-care delivery challenges that may affect our patients, us as residents, or our profession.
Why is it important that we become advocates and address these issues? After all, we’re just residents. Well, as residents, we are positioned in many cases to identify challenges early and to help provide insightful solutions or suggestions. Just as we are trained to identify, treat, and advocate for our patients to achieve the best outcomes possible, we can apply the same principle when engaging with our institution, peers, and staff.
At the end of the day, actively contributing to and improving our institutional environment will make our organization more efficient in achieving the overarching goal: safe, timely, and effective patient care.
To be clear, leaders do not have to usher major change to demonstrate a large impact. Even identifying small issues that may not seem significant at the time can have profound impacts and still deserve to be addressed. This is important because, as residents and trainees, we are usually not in the position to make large sweeping institutional or departmental changes, although we are often at the front lines of clinical care and may first encounter these issues. The point is, we should always advocate for improving our environment when issues arise, both large and small. For example, if the mini C-arms in your ED are barely functional, you may advocate to your department to purchase new mini C-arms that can upload directly to the imaging system. This would be ideal and save many headaches at morning report, but it also may not be feasible for the department to address. On the other hand, the development of a simple medical student rotating guide designed for new students on the trauma service may lead to more efficient rounding and improved patient care and be easily accomplished.
What are some potential leadership opportunities at your institution?
Not all institutions are the same in structure, organization, and resources. Some of us train at rural community hospitals, some at large private institutions, and others at large Level-I trauma centers. Below is a list of possible opportunities that exist among institutions. If you are interested but the resource is not available at your institution, it may be time to develop one, and what an exercise in leadership that would be!
1. House Staff (Resident) Council
The house staff council is usually a Graduate Medical Education (GME)-related body of residents who advocate for resident issues and resident well-being. Concerns may range from the availability of overnight resources (food, call rooms, coffee, etc.) to streamlining communication of health-care delivery issues shared between departments. An example illustrating this concept could be the council discovering that orders for echocardiograms are being placed incorrectly by non-cardiology services and are not being performed. The council would then work with the hospital to devise a solution and distribute this information to all residents to ensure echocardiograms were ordered correctly. The council is usually structured as a formal governing body with a president, vice president, secretary, and treasurer, with resident liaisons representing each specialty. In some institutions, fellows are involved as well.
2. Institutional GME Subcommittees
Similar to the house staff council, GME usually has a robust number of subcommittees that benefit from resident involvement. The number of committees varies by institution but may offer a variety of different avenues for you to get involved. Subcommittee examples include those focused on accreditation and compliance; quality improvement and patient safety; research; diversity, equity, and inclusion (DEI); supervision/transitions in care; professionalism; well-being; work environment and fatigue mitigation; medical simulation; and virtual health care. Reach out to your GME program to find out your options or, if necessary, advocate for the development of a new committee.
3. Create a Resident Interest Group
There is power in fostering and maintaining relationships. Oftentimes we find ourselves deep in the “ortho world” and only interact with other non-ortho residents via consults or other patient care activities. Taking time to create a group with similar interests, whether based on medical interest or non-medical interests such as personal finance or sports, is a great way to streamline patient care by fostering interdisciplinary relationships outside of the hospital. It’s also a great way to decompress from the shared resident experience while being exposed to new perspectives.
4. Advocate for Your Junior Residents
One of the most interesting transitions in residency is becoming a more senior resident and learning how to teach, mentor, and guide junior residents effectively. It is a built-in leadership experience if you choose to take it on. One of the easiest ways to demonstrate leadership is to listen to junior residents and become an advocate to address the specific issues they may be facing. Optimizing their learning and success not only demonstrates proficiency of your own skills but highlights your ability to lead effectively while supporting junior residents.
5. Residency-Level Leadership Positions
Every residency is different in terms of how roles are assigned to junior and senior residents. If there is a need and you are interested, approach your program director to see if you can help. Positions that are available may include medical student coordinator/liaison, administrative chief resident, academic development representative, and resident well-being/social coordinator. These are just a few of many examples.
Personally, my journey to discovering the importance of leadership and advocacy started long before residency, with experiences gained in my undergraduate training and medical school at the Uniformed Services University, both of which emphasized the importance of building, fostering, and optimizing teams through effective communication and developing a shared vision among team members. Recently, I participated in a root cause analysis (RCA) for a patient who suffered a preventable adverse event, which emphasized even further the importance of each team member.
As I sat in a conference room surrounded by a host of different departments (surgery, anesthesia, along with patient safety advocates, OR nurses, scrub techs, radiology techs) I couldn’t help but realize that the health-care team that surrounds us as residents is much larger than I had ever noticed. I was under the impression that, because I was a resident on this team, my observations and opinions would be not as important or insightful as the other more senior members. I was wrong. I am glad I spoke up to address issues others hadn’t considered and could bring a new perspective to a well-established team. This experience validated for me that, no matter your position, you can exhibit leadership qualities and make your team better. Usually it only requires you to speak your thoughts and to not be afraid to have others see your perspective.
Erik M. Hegeman, MD
We’d like to hear from residents and other trainees. Interested in submitting a post to OrthoBuzz? Please see our Resident Roundup blog post guidelines.
Recent posts include:
The Importance of Mentoring During Residency
Am I a Bad Resident? Facing Self-Doubt in Orthopaedic Training