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Letters to the Editor

In Reply to Dyster and Penner

Divakaran, Sanjay MD; Berg, David D. MD, MPH; Warner, Lindsay N. MD; Stern, Robert M. MD, EdM

Author Information
doi: 10.1097/ACM.0000000000003671
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We thank Drs. Dyster and Penner for their comments on our Perspective. We proposed 4 elements for fostering meaning during residency training: patient care, intellectual engagement, respect, and community. Drs. Dyster and Penner’s proposal to add institutional engagement as a fifth element is a welcome addition. Based on our experience, resident engagement in programmatic change is not only feasible, but meaningful for the resident and impactful for the institution. Here are a few examples from our hospital leadership at Brigham and Women’s Hospital and Harvard Medical School encouraging and celebrating resident engagement as the authors recommend:

  • (1) Collect feedback about the program from residents routinely and “close the loop.” Our residency program has a monthly, hour-long open forum that includes only residents and program leadership. Before the forum, residents submit ideas and concerns related to the residency experience, and during the forum, all submissions are shared and discussed as a group. At each forum, the chief residents are responsible for communicating improvements and outstanding action items resulting from the prior forums.
  • (2) Engage residents in efforts toward programmatic improvement. Successful programmatic improvement requires resident engagement and leadership. Residents have the insight, passion, and determination to successfully effect change. During our chief residency year, senior residents noted potential inequities in how Black and Latinx patients were triaged from the emergency room. Inspired to systematically study and eventually rectify this inequity, the residents, with the support of residency and departmental leadership, studied the problem, disseminated their findings in the medical literature,1 and championed changes at the residency, departmental, and hospital levels.
  • (3) Account for residents’ schedules when planning key meetings. Residents have rigid schedules and cannot meet during regular business hours. As chief residents, we allowed resident schedules to dictate meeting times. We found that the early evening, after day shifts had ended and night shifts were beginning, was the best time for residents to meet.
  • (4) Acknowledge and celebrate residents’ commitment to improving the training environment. House staff graduation is a proud day for our program. At graduation, our program director announces and celebrates every graduating resident’s committee memberships and contributions to resident life. This allows the entire community—hospital leadership, mentors, peers, friends, and family—to celebrate the commitment that every resident makes to improving the training environment.

These are just a few examples, and our program strives to continually improve institutional engagement. We commend the authors for highlighting this element of meaning making during residency training.


The authors would like to thank Drs. Joel T. Katz and Maria A. Yialamas for their mentorship and review of this reply.


1. Eberly LA, Richterman A, Beckett AG, et al. Identification of racial inequities in access to specialized inpatient heart failure care at an academic medical center. Circ Heart Fail. 2019;12:e006214
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