But I was a Chief Resident Last Week! From Chief to Intern: 5 Tips to Deal with the Initial Shock of the Transition

by Efstathios Karamanos, MD; Husain Al-Qattan, MD; Noah Saad, MD

Division of Plastic and Reconstructive Surgery, Department of Surgery, UT Health San Antonio, San Antonio, TX


The independent model of training in plastic and reconstructive surgery in the United States requires five years of training in a general surgery program with increasing responsibility before you can enroll in plastic surgery. This means that immediately prior to starting a plastic surgery residency, all independent residents have experienced the role of being chief residents in general surgery. A general surgery chief resident is a unique species in the hospital; the chief has spent countless hours on the floors, the ED and the operating room. By the time one becomes a chief, the level of confidence is usually high and he/she is given relative autonomy in treating patients with critical condition. The general surgery chief is the person that everyone in the hospital turns to for help and advice. In the final year of general surgery residency, one mainly focuses on leading a team, perfecting his/her surgical skills and assigning tasks while overseeing the whole care provided by the surgical team. 

As one might imagine, every graduating general surgery resident enters plastic surgery with an altered reality of what he/she will be able to do during the first days of plastic surgery residency. One quickly realizes that hoping to maintain the same level of autonomy and leadership is at least delusional. But it is definitely worse than one would expect: people call you ‘intern’, a title you happily gave up on the last day of your first year of training as a general surgeon. And yet, here you are again, expected to make the list, pre round, perform all the daily tasks on the floors, write the notes and facilitate the cases in the operating room to avoid any delays. The level of regression every single independent resident experiences during the first weeks of training is oftentimes shocking for most and can make the transition difficult. 

Here are five tips to deal with the transition:

  1. Start the plastic surgery training with no expectations of being anything more than an intern. Step in the hospital with the assumption that you know nothing (you probably don’t know much about plastic surgery anyway), and keep an open mind.
  2. Concentrate on your field. While you can take care of a critically ill poly trauma patient, your job now is to only evaluate and treat the facial or hand trauma. Do not try to manage the patient as a whole—allow the trauma team to do that; this way you will avoid tensions between different teams.
  3. Do not consider the independent residency to be a fellowship. There is a reason why it is not called a “plastic surgery fellowship.” Most of your co-residents are now practicing faculty or have gone on to a general surgery-related fellowship with residents on their team. This is just not the case for plastic surgery training.
  4. Expect to be the primary provider for any consult in the emergency room. Do not expect someone else to do the primary investigation for you. And yes, when a plastic surgery consult is called, you will have to spend a significant amount of time in the ED, fixing the problem by yourself.
  5. Finally, start your training with a positive attitude. You are finally doing what you love! Work hard, learn, and engage in the magical world of plastic and reconstructive surgery. It is totally worth it!

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