The results of the study by Garg and colleagues 1 shine a light on a legacy practice of internal medicine (IM) residencies across the country: the honorific chief resident year, typically served after completion of the formal residency program. Although the majority of chief residents surveyed would repeat their chief residency year again, respondents reported serving as primary program schedulers, and substantial numbers reported little feedback on teaching, clinical skills, or leadership skills. 1Although Garg et al 1 focused primarily on chief residents from academic centers, the chief residency year is a recognition of exemplary performance and is often considered to be a steppingstone to an academic career. The ambiguity of the role and lack of formal credentials for these future leaders is a lost opportunity both for the learners themselves and the institutions in which they work.Additionally, with medical school indebtedness steadily increasing, any year that delays entry into a position that is compensated as a practicing board-certified physician carries a high economic cost.Peers of chief residents are often hired into hospitalist positions with greater flexibility and compensation. Thus, ensuring that the types of exemplary physicians typically chosen for chief resident roles find the role to be value-added demands that we consider reengineering the year as a launching pad to leadership.
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