Program Director’s Corner – October 2021

Role of a Chief Fellow in Endocrinology Fellowship

Ruchi Gaba, MD, Associate Program Director and Eric Deal, MD, Chief Endocrine Fellow
Endocrinology, Metabolism, and Diabetes Fellowship, Baylor College of Medicine

Chief residents have traditionally played an important role in the educational, administrative, and clinical structure in residency programs – and over the last few years the trend of assigning a chief fellow has caught up in most fellowship programs. Their exact role, however, remains ambiguous, especially in the field of Endocrinology, Diabetes and Metabolism.  In this PD corner, I would like to share our experience of incorporation of a chief fellow as a vital addition to our fellowship program – from the standpoint of program leadership, as well as from the chief fellow’s standpoint, with a hope that it will help in providing guidance for programs considering incorporating chief fellows.

We appointed our first chief fellow in 2014, with a goal of helping the program (including administrative and academic aspects) to be more efficient. Rising first year fellows chose one of their own to serve as a strong liaison between themselves and the faculty. They wanted an individual that was easily approachable and that had good organizational skills. This fellow served as the chief fellow in their second year of training and was responsible for both first- and second-year fellows. Our faculty were excited that we would be able to streamline the functioning of the program better – but we were in for a surprise when we realized the role that this person played in our program that year was more and beyond.

Our chief fellows’ roles include:

The chief fellow also plays a critical role as a member of Program Evaluation Committee. They are able to give insight into the development and implementation of educational activities in the program from a trainee perspective. They give candid feedback on faculty development and highlight areas of potential noncompliance of ACGME protocols. The chief fellow has an opportunity to be a leader to their peers and gain experience about leadership roles in the endocrine division.

The chief fellow’s role has recently expanded to include supporting fellowship recruitment. They synchronize organizing and leading the happy hour for the interviewees during interview days so that they can meet with our current fellows and ask questions. In fact, one past year the chief helped in the interview process when we needed a back-up interviewer due to a last-minute cancellation by an assigned faculty due to unforeseen circumstances. Their unique perspective and assessment of the candidates was very valuable for that year’s rank order list, and we now try to include them in the interview process.

Very soon, the chief fellow will also be helping coordinate wellness events for endocrine fellows alongside the faculty and program leadership in addition to checking on co-fellows during busy rotations, while on-call or when going through personal issues, and offering resources and help.

As the ambassador of the fellowship program, the chief fellow has the responsibility of representing all of the fellows. The chief relays the perspectives, challenges and needs of the fellows to program leadership in a fair, respectful, and unbiased way- serving as a strong link between the fellows, faculty, and administration. The chief fellow coordinates and disseminates time-sensitive information pertaining to fellowship and divisional matters to the fellows.

So, every year in the last quarter (Feb- March) of their first year of training, all the first-year fellows vote and choose their chief fellow for the next year. We as program leadership recognize that the chief fellow spends valuable personal time on top of their clinical and educational responsibilities, and so we always try to show appreciation by allowing them to participate in a program-sponsored CME conference. Lately, since all conferences have been virtual due to COVID restrictions we have instead been providing them acknowledgement with a special award/ certificate at the graduation ceremony. It is of essence that we as program leadership provide not only acknowledgement but also back up and support in important decision-making processes so that we prepare future leaders.

To wrap up, I would love to share with you a testimonial from our current chief fellow – Dr Eric Deal.

“Deep in the grind of rigorous clinical duties, my life came to a halt pondering this question upon learning that I was elected as chief fellow by my peers. I was extremely honored to be chosen for the position. After reviewing the duties and seeking counsel from my predecessors, I emphatically accepted.

The responsibilities of a chief fellow will vary between programs, but certain administrative and communication duties are universal. Scheduling is a pesky but crucial duty. The chief fellow is responsible for making and maintaining schedules for call, clinics, jeopardy, and vacation. This requires that I am available and responsive for jeopardy needs and schedule change requests. In a coordinating role, I communicate updates and deadlines from leadership or our institution to my co-fellows. I also respond to day-to-day requests from our fellows, such as granting access to patient lists or explaining how to order dynamic testing.

Perhaps the most impactful role of the chief fellow is to act as a liaison between fellows and program leadership. Information is constantly cycling between fellows and leadership, with the chief fellow acting as a conduit and relative filter. As an elected and trusted advocate, the chief fellow is in a privileged position to maintain a pulse on the fellows’ experiences. The chief can anticipate and proactively communicate potential issues to leadership. This is particularly important in a program of our size where our fellows are spread across several hospitals. In conjunction with a highly responsive leadership, my role promotes and rapidly facilitates process improvement.

l began my time as chief fellow understanding the defined roles of the position. I have been rewarded by the dynamic and fulfilling nature of advocating for my colleagues and promoting the collective success of our program.”

Dr. Ruchi Gaba is a member of the APDEM Newsletter Committee.