If you have not read The Lord Of The Flies, you are missing out. It is a “must-read” for all professionals and especially for residents and residency leadership. For those of you who have never read the book, the story is about human beings’ “true nature.” A plane crashes on an uninhabited island, and the survivors are children without any adult supervision. The children create a society that slowly devolves into utter chaos. The book uses this as a metaphor for civilization and culture.
Well, how does this relate to radiology residency? Some residency programs over time become “leaderless.” This situation can occur due to a change in program directors, weak, ineffectual leadership, or program leadership in-absentia. When this happens, the residents may take over the “island.” This debacle can sometimes lead to utter chaos since most residents do not have the training to understand what is essential in radiology residency and beyond. Individual programs need residency leadership.
So, what are the signs that your residency program has turned into the Lord of the Flies?
Residents Arrive Late And Leave Early
You know the residents rule the roost when the program has no accountability for the attendance of your fellow resident colleagues. Your fellow resident arrives at noon because they “need to study” and leave at 2 pm for happy hour at the local bar without some form of consequence. Members of a residency “island” cannot survive unless all the participants band together and work to make residency the best it can be!
Residents Not Showing Up On Rotations
Residents miss out on the most crucial residency experiences when they miss their rotations. These rotations are the time to learn how to be a great radiologist and understand the subtleties and context of their future profession. Instead, the radiology residents gather in the library downstairs to read books rather than active cases. It’s just like not showing up to the hunt to get food for the members of your island. How can you survive?
Infighting Amongst Colleagues
When your fellow residents have decided to divide into two factions, constantly trying to throw each other under the bus, you can’t even look at your fellow residents in the eyes without arguing or getting upset. Even giving each member of your residency a conch before speaking does not help!!!
You notice that the radiology residents ignore their responsibilities. The attendings are now performing “resident procedures” like sentinel nodes and paracenteses. All members of a “residency island” need to perform their duties. In the book, the responsibilities of the society were to create shelter, forage, and hunt. In a residency program, it is performing procedures, consenting patients, and reading studies. Residents need to perform these duties to receive the training they need to meet the needs of the survivors. Perhaps, the faculty do all the work because they cannot rely on the radiology residents!
No More Evaluations
If the program director and attending staff have not evaluated you over the past year, the program leaders are likely not following up on your training. The leadership has abandoned its post! Each member of the “residency tribe” is now forced to assume that they appropriately perform their duties. Residents learn bad habits that can stick for the rest of their careers without the guidance they require. How can the individual know what to improve when the residency provides no feedback?
Educational Meetings Are Gone!
When the educational committee disappears, the individual resident has no representation in how they learn radiology during the four years of residency education. Just like the book, once the tribe members no longer have a say in the functioning of the island, the “leaders” slowly take over and create an oppressive society. Those who did not comply were tortured and killed! Education needs to be a partnership between the residents and attendings.
Residency Leadership And The Lord of the Flies
All residencies need leadership with the best intentions of the individual resident physicians in mind. Sometimes it means rules and regulations that the program needs to enforce that allow the individuals to maximize learning. Other times, it requires the participation of its constituents so that the program gives the best educational experience possible over the four years. If these institutions are not in place, you are in for a rough ride. Your residency island may not survive!!!