Children’s National pilots Chiefly’s Swap Portal: never-before flexibility for residents, 85% took part, ~350x less admin time

Before Chiefly, residents at Children’s National had never been able to trade their own blocks. That is the norm in residency: once the block schedule is out, it is final except for parental leave and emergencies, and any change means finding a partner, emailing the chiefs and waiting.

Chiefly changed what was possible. The 2026-27 block schedule went out on February 18, three months earlier than the year before (how Children’s National did it), which left time for a one-month window to trade blocks before the schedule was final.

A resident asks for a change in the Swap Portal, say cardiology instead of the ICU in block two. Chiefly only lets through swaps that fit the program’s rules and ACGME requirements, every resident the swap moves approves it, and a chief gives the final sign-off. No one sends an email. Chiefs and coordinators can also make swaps directly from an admin view, with more controls.

Very little. Of the 231 requests that reached a decision, 111 (48%) were settled among the residents themselves: 67 declined by another resident, 44 expired with no decision in 48 hours. Of the 120 that reached a chief, 107 (89%) were approved, so the chief’s job was a quick confirmation, not a negotiation. At 15 to 30 seconds a review, the whole month took an hour or less of chief time.

Let’s put some numbers to this story. If each of those 231 requests had been a 45-minute email thread, the month would have cost the chiefs roughly 170 hours, about 22 working days. In the Swap Portal, the 120 that reached a chief took 15 seconds each: about 30 minutes. Even at a third-year resident’s salary at Children’s National, a conservative estimate for a chief, that’s about $7,600 of chief time by email against $22 in Chiefly.

Because the rules were already checked, a chief could say yes to a request on the human level without worrying about the numbers.

Yes. About 85% of residents who could swap took part: 63 submitted requests, and 7 more were involved in requests from others. By the end of the month, 67 residents had a different schedule from their preliminary one. 44 of them had asked for the change, and 23 agreed to move as the other half of a swap.

Requests picked up through the month as residents realized what they could move, and many tried out several swaps before settling on one.

For flexibility they had never had, both in their time off and in their careers. Of the 63 residents who submitted requests, 43 (68%) moved vacation to the weeks that fit their lives, and 19 (30%) moved a core rotation with no vacation involved, shaping the order of their training. One moved only electives.

Vacation: a life outside the hospital

That is the second half of what the Swap Portal did. It saved the chiefs time, and it gave residents a say in their own year that they had never had: vacation in the week that actually works, an outpatient block in the month with family commitments, the heaviest rotations spaced out, and for some, a subspecialty seen sooner.

Career moves: a subspecialty sooner, so fellowship decisions aren’t delayed

The career moves stood out to the chiefs: pulling cardiology or the NICU into the first quarter, or stacking two or three subspecialties early to decide what to apply to.

That timing matters. In pediatrics, most residents who go on to fellowship settle on a field during residency and some decide late (Macy et al.), and neurology’s program directors have argued residents are asked to choose before they have seen the subspecialties (AAN position statement). A swap window lets a resident see one sooner.

Chiefly tells the resident clearly that it would break a rule, so they can try another idea. When a swap made sense on paper and Chiefly flagged it, a staffing, cadence or ACGME conflict the resident couldn’t see was behind it, so the no came from the rules, not a chief.

Yes. Each program sets its own swap periods in Chiefly, from a single month like Children’s National to ranges across the whole year, and can open the published schedule to residents with or without swaps turned on. The rules a program already runs on are the ones every swap is checked against.

For how Children’s National built the schedule the swaps started from, read Children’s National’s five-year partnership with Chiefly.