Roles Reversed: Resident to Attending Nina Ahmad, MD Ruth Deitz, MD Nancy Ruddy, PhD

Introductions Dr. Nina Ahmad Dr. Ruth Deitz Dr. Nancy Ruddy Resident at MSH-> Assistant Director at MSH Clinical Director at UMDNJ, Drexel and NYCOM Clinical Professor at St. Georges Dr. Ruth Deitz Advisor-> Colleague Dr. Nancy Ruddy Behavioral therapist-> Colleague

Environment Changes Expansions Fellowship Hospital being sold? Attending numbers down Expansions 6-6-6 residency ->6-6-8 residency

The Transition New attending role Supervisor role No orientation Medical students and left over assignments From novice to expert (e.g., football game supervision)

Challenges in the Transition Established relationships based on old role “Friend & colleague” -> faculty “Safe” person for complaints Some expectation to side with or advocate for residents and staff Old issues with individuals still there, but roles different Become triangulated in conflicts (residents, faculty and staff). Feel “two-faced,” worry about comments being taken out of context

Challenges in Transition Developmentally a “new” doctor, but in supervisory role Want to project confidence, tempered with reality that role is new Different levels of developmental differences (working with R1 vs R2 vs R3) Difficult to ask for back up from colleagues without undermining own position Supervising medical students

Challenges in Transition Relationships with Residents May trust new doctor less Hierarchy issues Become aware of resident issues Residents may share more, what stays confidential vs shared with faculty Residents may feel too comfortable intruding on personal time (friend or attending?) Residents likely to ask for help – less worried about being judged

Challenges in transition Faculty interface Some faculty inadvertently undermine Uncomfortable to be in evaluative role “Dumping ground” for tasks no one else wants Hard to say no, ask for help while trying to prove self From faculty/trainee relationship to colleague/friend relationship Role definition is murky at time See other “sides” of formerly idolized people

Scenarios Scenario 1: Front staff, MAs, residents, and attendings complained about issues to the New Faculty about problems in each department and not feeling like they have a ‘voice’. What do you do? Scenario 2: New faculty was invited into the residents meeting to discuss their conflicts with staff, attendings and the program. Should the new faculty member sit in the meeting and subsequent meetings? Scenario 3: A resident received critique from faculty and then came to the new faculty member crying and stated, “You didn’t tell me they hate me!” What should the new faculty say?

Pros and Cons PROS CONS Quicker transition Extension of learning Assisted in development of a more well rounded physician CONS -Triangulation -Conflicts of interest -Being evaluated at the same time as evaluating

Conclusion/ Recommendations Orientation Awareness of difference between a supervisor, teacher, and friend Fostering different ways of thinking Being aware of triangulation

Thank you