Below is the speech delivered by John Tennison, MD, during his campaign for chief resident at the University of Texas, San Antonio.  It is presented here in hopes that the principles discussed might be helpful wherever residents' rights and quality of life are of concern.

Chief Residency Speech

Delivered to Psychiatry Residents at UTHSCSA, on December 18, 2001, by John Tennison, MD, Candidate for Chief Resident

Diversity

Our residency has diversity in many forms:  military and civilian, women and men, DOs and MDs, people in their 20s, 30s, 40s, and 50s.  We also have substantial geographic, cultural, and ethnic diversity.

Diversity can be our strength or it can be our weakness.  The choice is ours.  If we chose to embrace and celebrate our differences, we will become stronger and more cohesive.  If, however, we allow ourselves to be xenophobic or neophobic, to fear that which is unusual or new, we will have become our own worst enemies.

General

[_____] and I are different people.  When I first heard that I would be running against [_____] for chief resident, I was concerned, because I knew that she would be a strong candidate.  It is a somewhat painful process to compare and contrast yourself to another person whom you respect.  At first it felt like I was running against my sister, but later, I came to think of myself not as running against [_____], but instead, running on the merits that I have to offer this program.

[_____] has skills that I don’t have and I have skills that [_____] doesn’t have.  The skills required to be an excellent chief resident are not the same skills required to be an excellent general psychiatry resident.  In particular, the chief resident is expected to have a greater degree of administrative and teaching skills.

To cast your vote based on whether you are friends with [_____] or me, or whether you like or dislike either one of us as a person, or based on ethnicity or gender, would be to vote for all the wrong reasons.  The difficult question that you must answer in order to responsibly cast your vote is the question of whose applied skills will best serve you and this residency?  It is my hope that this question alone will determine your vote, and if it does, then we will have approached a meritocracy, namely that of a democracy based on merit.

The person who serves as chief resident will affect your life.  The skill, motivation, time, energy, and dedication that someone has to put into the position of being chief resident can have dramatically different results by the time a year has passed.

Universal Standard of Fairness

Some might say that fairness or deciding what is fair is subjective.  I would disagree.  There is a universal standard of fairness that is thousands of years old.  This standard is the Golden Rule.

      Anyone who is making a decision that affects your life should not forget what it is like to be in your shoes and to carry the workload of a resident.  Whenever I have the power to do so, I will apply the Golden Rule.

The Schedule and Skills of the Chief Resident

        Being chief resident is not merely a title or position of prestige.  It is a position specifically defined for and with time allocated to administrative and teaching duties.  You will benefit most from someone who will utilize this time efficiently and productively.  If elected, I will use the specialized schedule of the chief resident to implement as fully as possible the good ideas that you have shared with me.

        I have had significant experience developing my administrative and teaching skills.

        With regard to Administration:  I have organized and carried out events with national breadth, such as the 9^th annual Stanford Health Policy Forum.

        I have represented PGY3 residents this year at the R.E.C. committee meetings, where I have been a vocal advocate about the need for adequate time for psychotherapy supervision.  Last year, I served on the committee chaired by [_____], which made the recommendations which have substantially improved the experience of medical students during their psychiatry rotations.

        In terms of Teaching,  I have been an instructor at both Johns Hopkins and Stanford Universities.  Moreover, my dedication to teaching is evident in my having given Psychiatry Grand Rounds here at the medical school last May, and in presenting my own psychiatric research in Boston 2 months ago.

        Any PGY4 can make contributions that serve to improve our residency, but as chief resident, I will be able to maximize what I can do for this residency.

Collegiality, Advocacy, and Availability

  In my mission statement, I spoke of collegiality.  I am your peer and I will not forget that I, too, am a resident.  I will be available and approachable at all times, and I want to hear your opinions.  It is a frustrating experience to work with anyone who has forgotten that you too, have something to teach.  No matter who we are, no matter what our title, status, or level of seniority, we ALL have something to teach each other.  For these reasons, I will always want to hear your ideas and know your opinions.

        If you have a good idea, or a legitimate complaint, I will join you with a strong voice to help express your concerns with more solidarity than you would have if speaking alone.  My cell phone and pager will be with me at all times, and I live directly across the street, only several hundred feet away from where we are at this very moment.  If I am your chief resident, you will have an open invitation to drop by my home at any time you feel the need for a person-to-person talk.

You are NOT Powerless

Despite what you might have heard, you are not powerless as a resident.  Even though we are not unionized, we have substantial power when we are mobilized as a group. 

For example, last year, another resident and I each wanted a week of vacation during a two-month rotation.  The supervisor for the rotation said he did not want to grant more vacation to the residents over that 2-month period since a third resident on the rotation was already planning to take a week of vacation.  Some might have assumed that taking vacation during that rotation was not possible.  But we did not stop there.  We took our case to the Residency Education Committee and we won.

Some might have been afraid that they would hurt their career opportunities or standing in the department by doing what we did, but fairness was on our side, and as a result of standing our ground, we gained credibility with the attending, and moreover, received superior marks on our evaluations for the two-month rotation.

       Four important lessons were evident in this experience:

1. As residents, you are NOT powerless
2. Persistence DOES make a difference
3. Standing up for what you know is fair has a better chance of improving, rather than harming your credibility.
4. Fairness is rarely subjective, especially when the Golden Rule is Applied.

The Power of Good Ideas

Some might say that the chief resident is a puppet of the department and has no real power.  However, I would disagree.  Even though the chief resident does not have executive power over major decisions in the department, the chief resident is in a position to communicate your good ideas and legitimate complaints to those in positions of executive power, such as Dr. Matthews, Dr. Moore, and Dr. Bowden.  You will be best served by a chief resident who can eloquently communicate your concerns.  If you have good ideas, you have power.

I was pleased to see last week that Dr. Matthews is open-minded to new ideas about better ways of doing things, such as how to deal with call for MOTHERS who need to take maternity leave. 

Asking “Why Not?”

If someone tells me that it is NOT possible to implement ideas that seem to be good ideas, I will ask “WHY not?”

For example, one resident with whom I spoke said they had been trying to get business cards for the last three yeas. By persisting with my inquiry of why it had not happened, I discovered the exact steps needed to make it happen.

The Bucket of Crabs Fable

           We can probably all think of times in our lives when we have encountered naysayers who told us our goals were not possible.  Just the other night, one of our senior residents shared her experience of having had a college pre-med advisor tell her that he didn’t think she had what it took to become a doctor.  Fortunately, she was smart enough to ignore his defeating message, and found a way to work around him.

           Her experience reminded me of the fable of the Bucket of Crabs.

• The fable says that some people are like crabs in a shallow bucket:  When one crab manages to get a claw up and is on the verge of escape, another crab will inevitably grab him and pull him back down to the bottom of the bucket.
• Thus, you don’t have to put a lid on a bucket of crabs because none will escape.
• The crab mentality is, "If I can't have it, then neither can you."

      If she had followed the advice of her professor, he would have pulled her down into the proverbial bucket of crabs.

     On the Internet, I discovered an account of at least one species of crab that are able to escape a bucket because they hold on to each other and form a living ladder, which allows each of them to crawl out of the bucket.  If I were to compare myself to this species of crab, I would want to be one of the crabs who contributes a link to that ladder of excellence.  If I reach the rim of the bucket, I would want to hold on with one hand, while offering a helping hand to those who would help maintain the ladder, rather than pull me down into the realm of stagnation and unfulfilled potential.

            As a group of residents, we are all in a proverbial bucket together.  I hope that we can all adopt attitudes and ethical ways of behaving towards each other which will benefit and bring greater fairness to all concerned.

The Reputation of Our Residency

    The need to protect and advance the reputation of our residency was made poignantly clear to me in a conversation I had with one of our child fellows, who told me that a psychiatry fellowship director in New York said that having gone to an Ivy League school would have helped our fellow’s application to the program there.  Regardless of what you know or how well you have performed on standardized tests, such as the PRITE or the boards, the reputation of the residency from which you graduate can have a substantial impact on your future employment opportunities.

     Although we are not an Ivy League School, I have no doubt in my mind that we can improve the reputation of this residency such that it can compete with any residency in the nation.  But in order for this to happen, we need strong leadership.  We need people with national ties to promote this residency to those who might not take us seriously.  As a fellow of the Group for the Advancement of Psychiatry, and as someone who attends the national APA meeting every year, and serves on the National Ethics Committee of AAPL, I am well poised to formally represent our residency at the national level as your chief resident.

Closing

    As a result of carrying two PDAs with me at all times, I would be a highly organized chief resident.  (Show two computers)  And now that Dockers has come out with Mobile Pants, I won’t have to wear those crazy bags any more.

    If I turn out not to be your chief resident for next year, I promise to SUBLIMATE my Narcissistic Injury by growing a beard even longer than the one grown by Al Gore when he lost the presidential election against George W. Bush.

          In terms of who you vote for, I praise those of you who have remained undecided up until the last moment, for it is only at the last moment that you have the most information from which to cast your vote.  Not personality, not favoritism, not gender, not even friendship should be the basis of casting your vote for chief resident.  Your vote should instead be based on your belief that the person you are voting for possesses the skills and will apply those skills to do the most for this program.

    If I am your next chief resident, I will make significant contributions to the improved quality and reputation of our residency.

    Thank you for your consideration.