Bridging Programs, Building Leaders: The Regional Chief Resident Experience

Chief residents (CRs) occupy a pivotal role in their residency programs but often assume these responsibilities without formal preparation of the cognitive, communication, and management skills that are necessary for success (1-2). Leadership programs improve role readiness (1-4), but are a significant lift for residency leadership. Regional multi-institutional or multispecialty retreats offer an efficient, lower-cost, collaborative model that strengthens leadership skills and peer networks while expanding access to professional development.

We met as a multiprogram team to plan a regional retreat with the following objectives: 1. Navigate common challenges related to chiefdom. 2. Build on key leadership and communication skills. 3. Co-create year-long goal/legacy planning. 4. Develop camaraderie amongst regional 4-year programs.

We co-designed a one-day, five-hour regional chief retreat across four Emergency Medicine (EM) programs using literature review and expert consensus by program leadership (PD) teams. The agenda combined short skills-focused lectures, small-group discussions, and a legacy-planning workshop. Leadership content aligned with Complexity, Situational, and Team Leadership frameworks. Chiefs completed anonymous post-retreat surveys evaluating perceived impact on communication, leadership, and interprogram connection using Likert and open-ended questions.

We offered the five-hour in-person regional retreat in September 2024 and August 2025 with 9 and 14 chiefs, respectively. Median ratings were 5/5 across all domains both years, including leadership readiness, communication, legacy planning, and camaraderie. Thematic analysis highlighted appreciation for short interactive sessions, interprogram networking, and applied leadership practice. Iterative changes between years included more discussion time, mixed-institution breakouts, chief-only legacy planning, and a social hour. The cost of the program was $500-1000.

This regional chief retreat model demonstrates a feasible, low-cost approach to developing leadership, communication, and community among EM chief residents, while strengthening the leadership pipeline across participating programs. Themes of communication, conflict management, and legacy planning aligned closely with leadership frameworks (Complexity, Situational, and Team Leadership). Chiefs described the retreat as a chance to develop practical strategies and form regional connections. Chiefs found the short lecture and small group discussions dynamic and able to hold their attention. Across two annual offerings, participants consistently reported high satisfaction in meeting program objectives. The positive qualitative feedback emphasized the benefits of short, interactive sessions, peer learning, timing during the year, and opportunities for relationship-building beyond their home institutions. Qualitative responses also informed several program improvements. There were heavy themes about communicating effectively and learning from other chiefs/leadership teams while building relationships. Requests for greater peer interaction and program mingling led to expanded discussion-based sessions, including an open panel where the chiefs could discuss anything they wanted with the residency leadership across all programs. This added session was the most highly regarded in the second year. We also added a “chiefs only” component as well as a social hour. Finally, we increased session length from five to six hours to allow for more discussion and adjusted the agenda to balance skill-based mini-lectures with collaborative activities. This model provides an adaptable template for institutions seeking to deliver meaningful leadership development, invest in early leadership training, and strengthen the EM leadership pipeline at a low cost. Key recommendations to programs aiming to implement a similar retreat include: (1) co-design with local PD/APD leadership, (2) short, high-yield sessions, (3) mixed small groups across institutions, (4) structured and unstructured time for interprogram connection and (5) collect feedback to iterate future events. Based on feedback, we hope to continue to offer this retreat and potentially include a midyear follow-up session to reinforce skill application and sustain regional collaboration. References: 1. Mustafa S, Stoller JK, Bierer SB, Farver CF. Effectiveness of a Leadership Development Course for Chief Residents: A Longitudinal Evaluation. J Grad Med Educ. 2020 Apr;12(2):193-202. PMID: 32322353. 2. Levy KL, Sheffield V, Sturza J, Heidemann LA. Important Leadership Skills and Benefits of Shared Leadership Training for Chief Residents: A Delphi Analysis. J Healthc Leadersh. 2023 Sep 19;15:221-230. PMID: 37744472. 3. Geerts JM, Goodall AH, Agius S. Evidence-based leadership development for physicians: A systematic literature review. Soc Sci Med. 2020 Feb;246:112709. Epub 2019 Nov 30. PMID: 31887629 4. Doughty RA, Williams PD, Seashore CN. Chief resident training. Developing leadership skills for future medical leaders. Am J Dis Child. 1991 Jun;145(6):639-42. PMID: 2035493.