The psychiatric chief residency year is a stage in professional development during which a psychiatrist-in-training is assigned roles of both administrator and trainee. Negotiating the responsibilities of these two positions simultaneously leads to a particular set of opportunities and dilemmas. The varied characterizations of the roles of the chief resident highlight its potential: the chief resident has been described as “boundary phenomenon” (1), “double agent” (2), “broker for excellence” (2), “staff therapist” (3) “middle-manager” (4), and “role model” (5), among other things. Several articles have recognized the chief resident’s role as ambiguous (1, 4, 6, 7) and pointed to the value of making the roles of chief residents explicit and directly delegating specific powers to them (4, 6, 8). This has apparently become the norm: Lim and colleagues (9) found in a 2006 survey that 71% of programs now provide written job descriptions of the chief residency and that these are considered useful in anchoring chief residents in their position. The literature is sparse, however, on formal training for psychiatric chief residents (see Table 1 for a list of articles that mention training for chief residents; most offer few details).

Several 1- to 3-day workshops are available to introduce incoming chief residents to their new position (10–12). Although these provide a useful taste of the skills necessary in the chief resident role, they cannot substitute for ongoing, comprehensive learning. A curriculum for teaching, mentorship, and supervision—which are often important functions of the chief resident—is described elsewhere (13); in this article, we focus on key administrative issues and challenges encountered in a contemporary psychiatry chief residency and propose a curriculum to address these learning opportunities.

A review of the roles of the chief resident and the challenges inherent in them is useful in understanding the educational needs that this curriculum would address. In general, the chief resident’s administrative role is three-pronged: a technical/logistics function, a liaison position, and an educational development/advocacy role (see Table 2 for details). Depending on the program, there may be varying emphasis on each prong.

Although the technical/logistics function is complicated and time-consuming, of the three prongs in the chief resident’s job description, it is perhaps the least fraught with dilemmas. Challenges of this role include learning how to manage a vast number of details and often complicated systems, in a short amount of time, on the job.

In the liaison position, the tension between being an administrator and being a trainee is accentuated. The chief resident has been described as a legislative leader, guiding residents to problem-solve and make changes among themselves, and as a representative leader, representing the residents to the teaching faculty and to the residency program director (14). Indeed, the relationships that chief residents develop with other parties—their co-residents, faculty, administrators, and, for the two-thirds of psychiatric residency programs that have more than one chief resident each year (9, 15), their co-chiefs—are inevitably challenging and complex.

Finally, in furthering the program’s educational mission, the chief resident’s role as both administrator and trainee is clearly an asset. Because they are both implementers and recipients of clinical education, chief residents can recognize strengths and shortcomings on both sides. Recognizing and harnessing the value of this special position to advocate for and promote progress is an important skill to develop.

The chief residency commonly coincides with a period in which one is also establishing one’s own professional identity and pursuing one’s career plans in a more concrete way. Given the vast potential for development of projects and relationships, chief residents have an opportunity to tailor some of their projects to their larger goals. Specific attention needs to be paid to this aspect of chief residency, as it does not always happen spontaneously (16).

Conceptualizing the chief residency as a training experience transforms the above challenges into educational opportunities. Drawing upon suggestions from previous authors (such as those cited in Table 1), as well as the role challenges described, we propose a curriculum that addresses the three primary administrative roles through a combination of didactic teaching in the form of a seminar series, shadowing of outgoing chief residents and more experienced administrators, and ongoing supervision and mentorship both by training directors and by an administrative consultant not directly connected with the training program (Table 3). The seminar series and shadowing are completed before the formal beginning of the chief residency year (March–June), whereas administrative supervision and mentorship continues throughout the year.

The seminar series is designed to be heavily interactive, with references serving as a theoretical basis and springboard for discussion about the specific circumstances of each particular program and chief resident cohort (Table 4). Flexibility is built into the curriculum to maximize relevance to the system in which the chief residents will function. Shadowing of outgoing chief residents and more experienced administrators should have a structured component, explicitly listing major skills that new chief residents would benefit from observing and learning before the actual chief residency year begins. Finally, ongoing supervision occurs on a weekly basis with the training directors, as well as on a biweekly or monthly basis with an external administrative consultant who can provide an outside space for chief residents to process their experiences and hone their administrative skills.

The psychiatric chief residency is a distinct stage in professional development, with its own set of challenges and dilemmas. Chief residents would benefit from being trained for the role, in order to optimize their effectiveness in the position, but also as a springboard for potential further work in administrative psychiatry. The curriculum proposed in this article addresses key conceptual issues for the chief residency; however, its success in enhancing leadership and administrative skills remains to be empirically tested. The assessment of this curriculum is inherently limited by the small number of chief residents trained in each program each year. Furthermore, the fact that the curriculum is designed to be tailored to each individual program makes standardization across programs difficult, and not necessarily desirable. Nonetheless, it may be useful to examine the effect of the curriculum on chief residents’ sense of preparedness for their role, as well as having a “360-degree assessment” of their subsequent efficacy in their position by co-residents, faculty, administrators, and co-chief residents.

We acknowledge the manuscript review and assistance of Drs. Sallie DeGolia, Chris Hayward, and Barr Taylor.