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- •Preface
- •References
- •Contents
- •Author Biographies
- •About the Series Editors
- •Family Medicine Advocacy Summit
- •Robert Graham Center Workforce Studies
- •HealthLandscape
- •Residency Resources
- •Medical Education Policy Development
- •Residency Program Solutions
- •Residency Leadership Summit
- •Chief Resident Leadership Development Program
- •Educational Resources
- •Continuing Medical Education (CME) Tracking
- •Graduate Medical Education Awards
- •Summary
- •References
- •AAFP Structure
- •AAFP Governance
- •Workforce Mission
- •AAFP Workforce Advocacy
- •Residency Redesign
- •References
- •Osteopathic Recognition Requirements
- •Osteopathic Recognition Program Essential Personnel
- •Osteopathic Faculty
- •Osteopathic Recognition Resident Requirements
- •Osteopathic Educational Program Core Competencies
- •Osteopathic Program Evaluation
- •References
- •Reference
- •5: Association of Family Medicine Administration and the Key Role of the Residency Program Coordinator
- •Appendix 1
- •References
- •References
- •Membership Categories within NAPCRG
- •The AAFP Robert Graham Center
- •AAFP National Research Network (NRN)
- •Family Physicians Inquiry Network (FPIN)
- •The Family Medicine Physician-Scientist Pathway (PSP) Program
- •NAPCRG Grant Generating Project
- •Building Research Capacity (BRC)
- •Conclusion
- •References
- •Reference
- •9: Family Medicine Residency Accreditation
- •Why Accreditation Matters
- •ACGME Organizational Structure
- •The Family Medicine Review Committee (RCFM)
- •The Clinical Learning Environment Review (CLER)
- •The Site Visit
- •Initial Accreditation Period
- •Subspecialty Fellowship Application
- •The Annual Program Review
- •The Next Accreditation System Annual Review Process
- •Accreditation Data System (ADS)
- •Citations
- •Accreditation Status
- •Program Requirement Development
- •Competency-Based Medical Education (CBME)
- •References
- •10: Graduate Medical Education Funding
- •Introduction
- •Residency Operating Costs
- •Medicare GME Funding
- •Residency Caps
- •Rural Track Programs
- •Inpatient Prospective Payment System (IPPS) Subtype Hospitals
- •Rural Referral Centers
- •Sole Community Hospitals
- •Medicare-Dependent Hospital
- •Medicaid GME Funding
- •Teaching Health Center Funding
- •Veteran’s Administration GME
- •Children’s Hospital GME (CHGME)
- •State Line Item Funding
- •Hospital Supplemental Funding
- •Patient Care Revenue
- •Philanthropy
- •Conclusions
- •References
- •Introduction
- •Informed Self-Assessment
- •Faculty Development
- •Summary
- •References
- •12: Core Competencies, Milestones, and Entrustable Professional Activities
- •Entrustable Professional Activities
- •Entrustment
- •Pearls
- •Pitfalls
- •References
- •Objectives
- •Educational Strategies
- •Implementation
- •13: A Practical Approach to Curriculum Development
- •Introduction
- •Cognitive Learning Theory
- •Behavioral Learning Theory
- •Humanistic Learning Theory
- •Goals
- •Conclusion
- •References
- •Introduction
- •Preparation Phase
- •Information Technology Systems
- •Medical Student Rotations
- •Interview Season
- •Application Screening
- •Interview Day
- •Second Looks
- •Postinterview Communication
- •Ranking
- •Using R3®
- •Match® Week
- •SOAP®
- •Conclusion
- •References
- •Preboarding
- •Planning New Resident Integration
- •Baseline Assessment
- •Individual Learning Plan
- •Integration Components
- •Longitudinal Integration
- •Learner/Residency/Institutional Goal Alignment
- •Conclusion
- •References
- •Introduction
- •History
- •Residency Application
- •Conclusion
- •References
- •References
- •Introduction
- •Identifying Performance Issues
- •Medical Knowledge
- •Patient Care
- •Interpersonal Skills/Communication
- •Professionalism
- •Systems-Based Practice
- •Remediation
- •Medical Knowledge
- •Patient Care
- •Interpersonal Skills/Communication
- •Professionalism
- •Systems-Based Practice
- •Conclusions
- •References
- •19: Faculty Recruitment: Best Practices
- •Background
- •Seeking Out Suitable Candidates: Recruitment Methods
- •Unique Challenges: Faculty Who Are New Residency Graduates
- •Concluding Thoughts: Always Recruit!
- •References
- •20: Faculty Performance
- •Faculty Performance Concerns
- •Appendix 1: Sample Family Medicine Residency Program Director Job Description
- •Job Summary
- •Educational Delivery
- •Evaluation
- •Administration
- •Appendix 2: Sample Family Medicine Residency Core Faculty Job Description
- •Job Summary
- •References
- •21: Faculty Development
- •Introduction
- •Clinical Skills
- •Scholarly Work
- •Tasks that Family Medicine Residency Faculty Perform
- •Role Modeling
- •Faculty Peer Support
- •Teaching
- •Training Courses
- •Workshops
- •Learning by Doing
- •Self-Directed Learning
- •Career Development
- •Organizational Resources
- •References
- •Introduction
- •Promoting Loving Accountability
- •Clinical Setting
- •Curriculum
- •Social Connection
- •Assessment
- •Vision Forward
- •Handling Microaggressions
- •Financial Investment
- •References
- •Building Trust
- •Positionality
- •Set the Stage
- •Normalize Not Knowing
- •Probing, Not Prodding
- •Accurate
- •Addressing Implicit Bias
- •Micro-Level
- •Macro-Level
- •Conclusion
- •References
- •Introduction
- •Background
- •Risk Factors
- •Stigma
- •FSMB Recommendations Regarding Licensing Questions
- •Physician Health Programs (PHP)
- •Individual-Level Actions
- •Conclusion
- •References
- •References
- •The Clinical Learning Environment
- •Feedback
- •References
- •27: Teaching Maternal Health Care
- •ACGME Requirements
- •Obstetric Family Medicine Faculty Shortage
- •Maternity Care Curricular Elements
- •Preconception Care
- •Prenatal Care
- •Immunizations
- •Common Conditions Which Complicate Pregnancy
- •Breastfeeding
- •Intimate Partner Violence (IPV)
- •Substance Use
- •Food Insecurity
- •Inpatient Obstetrical Care
- •References
- •Introduction
- •Family Medicine Residency Advocacy Curricular Development
- •Evaluation
- •Conclusion
- •References
- •Faculty Leadership
- •Resident Leadership
- •Patient Satisfaction
- •Professional Conduct
- •Ethical Considerations
- •Curriculum Development
- •The Hidden Curriculum
- •Conclusion
- •Context Matters
- •References
- •30: Teaching Behavioral Science
- •Introduction
- •Core Mental Health Topics
- •Patient-Centered Communication Skills
- •Contextual Care
- •Integrated Behavioral Health Care
- •Master Adaptive Learner
- •Clinic-Based Learning
- •Classroom-Based Learning
- •Interprofessional Education
- •Balint Groups
- •Conclusion
- •Appendix 1: Sample Behavioral Health Rotation (Myerholtz 2023)
- •References
- •31: Teaching Evidence-Based Medicine
- •Introduction
- •Longitudinal Deep Dives
- •Journal Club
- •Family Physicians Inquiries Network
- •Case-Based Learning
- •Day-to-Day Integration
- •Curriculum Development Tips Summary
- •Institutional Involvement
- •Summary
- •References
- •32: Teaching Practice Management
- •Background
- •Current Curriculum
- •Activities
- •Quality Improvement Project
- •Virtual Practice Instructions
- •Presenters
- •Topics Covered
- •References
- •Overview
- •Why Training Is Needed
- •Stressing Communication
- •Balint Group
- •Putting It All Together
- •References
- •Introduction
- •Broad Scope
- •Primary Contact
- •Emerging Technology
- •Rural Generalism
- •Public Health Advocate
- •Rural Practice Systems
- •References
- •Introduction
- •Basic Logistics
- •Operational Considerations
- •Billing Requirements
- •Additional Funding Considerations
- •Engaged Leadership
- •The FMC-Residency Partnership
- •Scheduling
- •Data-Driven Improvement
- •Empanelment
- •Panel Weighting
- •Panel Transitions
- •Team-Based Care
- •Population Management
- •References
- •Introduction
- •Personnel Management
- •Meeting Management
- •Communication Management
- •References
- •37: Managing Change in Family Medicine Residency Programs
- •Introduction
- •What Is Change Management?
- •Change Management Case Study
- •Kotter Model
- •Step 1: Create Urgency
- •Step 4: Communicate Buy-In
- •WIFM Worksheet
- •Step 5: Empower Others
- •Step 6: Generate Quick Wins
- •Step 7: Consolidate Gains
- •Conclusion
- •References
- •Negotiating Styles
- •Collaboration
- •Summary
- •References
- •Anticipating Task Cycles
- •Residency
- •Home Life
- •Seize Control
- •Delegate
- •Delegate Residency Chores
- •Delegate Domestic Chores
- •Exercise
- •Lunch
- •Organizing
- •Summary
- •References
- •Introduction
- •References
- •Introduction
- •Anticipate Common Disasters
- •Learn About Your Regional Emergency Infrastructure
- •Learn Your Organization’s Command Center Structures
- •Here Are Some Alternative Care Site Scenarios That May Arise
- •Regional Emergency Infrastructure
- •Managing Your Program During Disaster
- •Community Recovery
- •Consolidate Your Learning
- •Author Background
- •References
- •Conclusion

130
B. D. Panchal and E. Bruce
support, anticipating and addressing obstacles, and planning the introduction and maintenance of the curriculum.
The resources needed for the curriculum include people
(faculty, staff and administrators), preparatory time (for
the faculty teaching the curriculum), materials (clinical
equipment or computer modules), facilities (where the
education will occur), and funding (direct costs for materials, faculty compensation) [11]. A curriculum will more
likely be successful if it has support from multiple sources.
Support from the learners is particularly important to have
before implementing curriculum change as they can be
key to acceptance of new ideas. Adult learners need to
know why the goals and objectives are important to their
education and how they will positively affect their personal goals [22]. Additionally, having broad faculty support, especially from those who will be delivering the
educational experiences is important. Ideally, the curriculum should be engaging, worthwhile and enthusiastically
delivered. Support from those in higher administrative
roles (i.e., the program director, department chair, medical director, etc.) is crucial in that they can agree to allocate funds and other resources critical to the delivery of
the curriculum. Educators must ensure there is an appropriate administrative structure to support implementation
of the curriculum. This includes preparing schedules, distributing materials, collecting and analyzing evaluations,
and day-to-day communication [11]. Program coordinators are invaluable to ensure the day-to-day operations are
functioning and that internal communication is optimal.
Anticipating barriers before implementing a curriculum
will be helpful to ensure success. Barriers might include a
lack of resources, limitations on time for both the residents (due to duty hour limitations and competing
demands) and faculty educators, and insufcient support
from stakeholders [11]. Anticipation of obstacles is better
than discovering them later in the process at which time it
may be too late to effect change.
Once the resources are aligned, introducing the curriculum to the learners and the educators is critical. Ideally,
before full implementation occurs, a trial of the curriculum
with a small group of residents or phasing in one part of the
curriculum at a time can help ensure the readiness of the curriculum and audience acceptance [11]. For example, for a
new POCUS curriculum, starting with a workshop will introduce the basics of its use as well as engage learners who can
help with expansion of the curriculum, such as using bedside
ultrasound during inpatient rounding. Successful implementation of the curriculum is highly dependent upon the other
steps in the process. Keeping in mind each step throughout
the curriculum development process will allow the curriculum director to ensure implementation is not only successful,
but allows for continuous process improvement through
evaluation and feedback.
Evaluation andFeedback
In this chapter, the terms evaluation and feedback are directed
specically toward the curriculum and its improvement. The
residency program’s curriculum will become stagnant without a continuous cycle of evaluation and feedback. Feedback
can elicit change in the curriculum goals and objectives to
better prepare the resident for independent practice. For the
purposes of curriculum development, evaluations are most
effective when performed during each stage of the process.
Similar to the “Plan, Do, Study, Act” cycle of quality
improvement, openness to feedback and willingness to
change is crucial for a program to remain signicant [23].
Evaluation of a curriculum can and should come from
many resources. Evaluations should be comprehensive and
timely. It is important to allow both the learners and the
teachers to evaluate the overall curriculum as well as each
individual component of the experience [11]. For instance,
feedback from the residents might indicate that the overall
experience is appropriate, but a specic educational resource
is outdated such as the required readings or on-line
modules.
Feedback from the teaching faculty is helpful to keep the
curriculum current and evidence based. The teaching faculty
can note if there is an objective of the curriculum that residents are repetitively not meeting or cannot be met due to a
lack of resources. Also, if a planned experience is about to
change because a faculty member is leaving the institution, it
is important that this information be obtained as early as possible. Additional resources for feedback about the curriculum can include the annual ACGME surveys of residents and
faculty, an institutional review process or observations from
individuals external to the team directly engaged in the curriculum. For example, a clinic nurse may observe that residents are giving inaccurate information to patients about a
testing protocol because of a lack of communication about a
clinic process that has changed.
The ACGME is concerned about the resident’s learning
environment, not just the components of the education.
Asking specic questions that allow a resident to provide
their anonymous opinion about the learning environment is
particularly important. For example, an evaluation questionnaire about specic faculty members might ask if the faculty
provided residents a learning environment that was open to
inquiry. Allowing anonymous feedback from residents will
allow the respondent freedom to provide honest answers,
especially if improvement on the part of a faculty member is
warranted.
Deciding on the method of evaluation is as important as
who provides the feedback. A mixed-method approach using
a combination of quantitative and qualitative data collection
is most useful in obtaining the comprehensive information
needed for a thorough curriculum evaluation [11].

13 A Practical Approach to Curriculum Development
131
Quantitative evaluations will provide numerical or measurable data that can be used to test hypothesis and gather information about opinions, attitudes, and practices of a large
population. Common quantitative surveys use rating scales.
Qualitative evaluations typically use open-ended questions
to gather data and to help in the development of an educational hypothesis. A qualitative study can help develop a
more expansive quantitative survey to test the hypothesis
[24].
In general, evaluations can provide either formative or
summative feedback. Formative evaluations of a curriculum
aim to rene implementation and performance, identify specic areas for improvement and provide explicit suggestions
for that improvement. In the evaluation of a curriculum, formative feedback uses surveys of learners to identify areas of
the curriculum that need improvement.
Example
During a workshop about colposcopy, the learners
were given both a pre- and posttest to evaluate what they
learned and the skills they obtained. A question regarding
knowledge of what the squamocolumnar junction was
and how to nd it revealed similar wrong answers before
and after the workshop by most participants. This would
indicate an area in the workshop discussion that will need
to be claried and emphasized in the future. ◄
A summative evaluation of a curriculum is used to make
judgments or decisions about the program or its developers
and teaching faculty. Summative evaluations can be used to
identify if and to what degree the objectives were met. They
can also provide an overall opinion about the curriculum
from both the learners and the educators involved. This
information can be shared to aide in further curriculum
development, address unforeseen barriers and identify the
needs for additional program support [11].
Example
During the semiannual summative review of resident
evaluations and milestones, the Clinical Competency
Committee noted a lack of evaluations addressing the
milestone specic to advocacy. Given this summative
data, further investigation regarding the program’s advocacy curriculum was warranted. ◄
Formative feedback is generally collected during the
implementation of the curriculum whereas summative data is
collected at the conclusion [11].
After deciding which type of evaluation (formative or
summative) is necessary, the curriculum developer will need
to design the evaluation and identify appropriate questions to
ask. The evaluation should help answer the question “are the
specic objectives of the curriculum being met through the
current curricular design?”. As discussed previously, objectives should answer 5 basic questions: 1. Who? 2. Will do? 3.
How much? 4. Of what? 5. By when? At times, as the evaluation questions are being developed, it may become necessary to clarify curricular objectives. For example, an objective
for a colposcopy workshop might state “Demonstrate the
steps required for a satisfactory colposcopy exam.” As evaluation questions are being developed, the educator might
acknowledge that this objective needs to be more specic to
be able to measure the success of the workshop. The curriculum developer may want to measure the percentage of the
residents who successfully demonstrate the required steps.
The objective may eventually read, “By the end of the workshop, 95% of the learners will successfully demonstrate the
steps required for a satisfactory colposcopy exam.” Or the
educator might like to ensure the resident can verbally report
the steps of a satisfactory exam. In this case, the objective
might explicitly identify what “satisfactory” means. Other
questions that the evaluation may ask can be related to the
effectiveness of the curriculum and not necessarily be
directed to the curricular objectives. For example, if the
developer of a POCUS curriculum wants to rate the effectiveness of the curriculum in preparing the resident to independently perform a dating ultrasound in the rst trimester of
pregnancy, the question may ask, “What is your comfort
level in independently performing a dating ultrasound?” The
scaled response options might range from “not comfortable”
to “very comfortable” with a few other options in between.
This scaled survey can be analyzed quantitatively.
Alternatively, the evaluator could ask the learner an openended question such as “What were the strengths and weaknesses of the POCUS workshop?” and thus obtain qualitative
data.
Once the evaluation questions are selected, the design of
the evaluation should possess both internal and external
validity. Internal validity exists when the evaluation accurately assesses the impact of the specic curriculum (i.e.,
inpatient adult medicine) on the targeted population (i.e., the
PGY3 residents) in the particular setting (i.e., during the
rotation). It possesses external validity when the same evaluation can be generalized to other populations of learners (i.e.,
PGY3 residents at other programs) or in other settings (i.e.,
other rotations) [11].
Perhaps the most commonly used quantitative designs
are combinations of pre- and posttest surveys of an experience [11]. Qualitative evaluations can be embedded
within quantitative evaluations, or can occur during or
after the experience separate from the quantitative evaluative questions, depending upon what the developer desires
to learn. Uniquely, qualitative evaluation data can be collected and reviewed concurrently with the curriculum and
help with real-time renement and subsequent data collection [11].

132
B. D. Panchal and E. Bruce
It is beyond the scope of this chapter to delve into the
world of data collection, measurement tools, and statistical
analysis. The variety and combination of these tools is broad
and can be used in different combinations depending on the
type of data that is desired.
Evaluation is the nal step in the discussion of curriculum
development but just one part of the cycle in which each step
directly affects the others. The evaluation and feedback process will help both individuals and programs in the curriculum improvement process and prevent programs from falling
into the trap of complacency and stagnation.
Conclusion
This chapter only scratches the surface of the possibilities
open to a program that is striving to develop a strong curriculum with faculty who are engaged in the process.
Understanding the audience of resident-learners and the theory of teaching adults in the current environment is important. The task of curriculum development is never truly
complete. Following the six-step process described in this
chapter will allow for consistency in the teaching, and continuous improvement of the program curriculum. Family
medicine residency faculty educators have limited time to
transform residents from undifferentiated medical students
into comprehensively trained competent family physicians
who are ready for independent practice in the community.
The principles outlined in this chapter will offer a launching
point to create and revive the curriculum any program
provides.
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Part IV
Resident Issues

Recruitment ofResidents
P.T.Dooley andM.P.Williams
14
Key Points
• The recruiting strategy for each program should be
designed to identify and attract applicants whose personal
mission, vision, values, and aims align with those of the
program.
• Recruiting policies and procedures must comply with
federal, state, and local employment laws as well as
ACGME®, ERAS®, and NRMP® policies.
• Programs may elect to complete their formal interviews
in-person, virtually, or using a hybrid approach.
• While program directors may unilaterally create the rank
order list, most elect to involve others in the ranking
process.
Introduction
Resident recruiting occurs within every family medicine
residency program on an annual cycle with the next cycle
often starting before the formal end of the previous cycle.
While some aspect of the recruiting operation is almost
always running, it typically remains in the background for
most residents and faculty for most of the year; however, it is
rarely far from the forefront of a program director’s mind. At
certain times of the year, especially during the interviewing
and ranking season, the recruiting process leaps into the foreground for everyone in the program as it potentially disrupts
educational and clinical operations. A successful recruiting
P. T. Dooley (*)
Department of Family and Community Medicine, Family Medicine
Residency Program at Ascension Via Christi, University of Kansas
School of Medicine– Wichita, Wichita, KS, USA
e-mail: Philip.Dooley@ascension.org
M. P. Williams
Department of Community Health and Family Medicine,
University of Florida College of Medicine, Gainesville, FL, USA
e-mail: maribethporter@u.edu
effort may or may not require signicant direct nancial
investment, but it will always incur major indirect nancial
costs due to the required time investments from residents,
faculty members, and GME staff. This chapter will describe
the resident recruiting cycle in a roughly chronological order.
Given the diversity present across Family Medicine residency programs, there is no single method or timeline that
can be implemented off-the-shelf in every location. Each
individual program must develop their own processes to
ensure they align with the program’s mission, vision, values,
and aims. The ultimate goal of a successful resident recruiting cycle is to match a class of new PGY-1s who enthusiastically adopt the mission of the program, share the program’s
values, and help the program advance toward its vision and
aims.
Preparation Phase
The resident recruiting cycle requires the use of a few different information technology (IT) systems and is governed by
a complex series of often overlapping policies, procedures,
and laws. Program directors and coordinators must have
access to all these systems and familiarize themselves with
the details of all applicable policies. These leaders subsequently ensure that other individuals (i.e., associate program
directors, core faculty, and residents) involved in recruiting
have appropriate levels of access and understanding of
policy.
Information Technology Systems
Program Directors will want to annually review the accuracy of
their program’s listing in the Fellowship and Residency
Electronic Interactive Database (FREIDA™) website (see
Table14.1). Access to FRIEDA™ requires creation of a free
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_14
135

136
Table 14.1 Residency program information technology systems
Fellowship and Residency Electronic Interactive Database
(FREIDA™)
American Medical Association: Create Free Account https://fsso.ama- assn.org/sign- up
Association of American Medical Colleges (AAMC) Residency
Explorer™ Tool
Texas STAR: Seeking Transparency in Application to Residency https://ais.swmed.edu/texastar/
Doximity Residency Navigator https://www.doximity.com/residency/
AAMC: Sign In (create new account and log-in) https://auth.aamc.org/account/#/login
ERAS® for Programs Getting Started (includesregistration stepsfor
new programs)
NRMP® The Match: All Returning Users (Registration, Ranking, and
Results® (R3®) portal sign in)
ERAS® Integrity Promotion—Investigation Program https://www.aamc.org/services/eras- for- institutions/program- staff/
ERAS® Integrity Promotion—Education Program https://www.aamc.org/services/eras- for- institutions/program- staff/
NRMP® The Match Policies and Compliance https://www.nrmp.org/policies/
NRMP® The Match: Main Residency Match All In Policy https://www.nrmp.org/policy/main- residency- match- all- in- policy/
NRMP® The Match Codes of Conduct https://www.nrmp.org/intro- to- the- match/the- match- agreement/
NRMP® The Match® Calendars https://www.nrmp.org/match- calendars/
NRMP® The Match SOAP Resources for Programs https://www.nrmp.org/programs- institutions/
https://freida.ama- assn.org/director/edit- program/X
https://students- residents.aamc.org/apply- smart- residency/
residency- explorer- tool
https://www.aamc.org/services/eras- for- institutions/program- staff/
getting- started
https://r3.nrmp.org/
policies/investigation
policies/integrity- promotion
match- codes- of- conduct/
soap- resources- for- programs/
P. T. Dooley and M. P. Williams
account with the American Medical Association see Table14.1).
FREIDA™ is just one source of online information used by
applicants for preapplication research. Other databases include
the Association of American Medical Colleges (AAMC)
Residency Explorer™ Tool (see Table14.1), the Texas Seeking
Transparency in Application to Residency (TexasSTAR) website (see Table14.1), and the Doximity Residency Navigator
(see Table14.1). Of note, the accuracy of Doximity’s data has
been seriously questioned [1].
If the program director does not yet have an AAMC
account they must create one because the AAMC operates
the Electronic Residency Application Service® (ERAS®)
and program details are managed via ERAS® Program
Management (EPM) within theERAS® Program Director’s
WorkStation (PDWS)[2]. New programs will need to complete the registration steps for an account (see Table14.1).
The program must use EPM to opt into the next ERAS®
cycle every year, typically in April, and update key information which is shared with prospective applicants. This information includes contact information, application
requirements, and a brief program description (1000 character maximum). Students create their applications in the
MyERAS® portal while programs receive and manage
applications using PDWS. Programs may begin preseason
PDWS set-up starting in late June [3]. Students may begin
submitting applications through MyERAS® in early
September and programs are given access to submitted applications in PDWS at the end of September.
While ERAS® includes an interview scheduling inter-
face, many programs have opted to use third-party platforms
with a more robust feature set. The one drawback to third-
party platforms is a lack of direct communication with
ERAS® which necessitated the manual export of data from
PDWS and subsequent upload to the third-party website. In
April 2023 the AAMC announced a strategic collaboration
with Thalamus. For the 2024 cycle, programs participating
in ERAS® “will receive complimentary access to Thalamus’
leading interview management platform, Thalamus Core and
Itinerary Wizard, as well as Cerebellum, a novel data and
analytics dashboard to assess recruitment outcomes, specically from a diversity, equity, inclusion, and geographic perspective” [4]. Thalamus’ video interview platform and
automated application screening tools are available at an
additional cost. The ERAS® scheduler will be replaced by
Thalamus Core starting with the 2025 cycle which should
also be the rst year where Thalamus enjoys a direct connection to the data in ERAS® [5].
Lastly, the program director will need access to the
Registration, Ranking, and Results® (R3®) portal operated
by the National Resident Matching Program® (NRMP®)
(see Table14.1). Student registration with NRMP® begins in
September, Rank Order List (ROL) entry by students and
programs occurs throughout February and is followed by
Match® Week in March [6].
Policies andProcedures
Program leadership must ensure that the program complies
with all applicable policies and laws throughout the recruiting process. This starts with understanding the ACGME
denition of eligibility for appointment to an accredited

14 Recruitment ofResidents
137
residency program (Program Requirements, Section III)
[7]. If an applicant has already completed prior GME training, the program will need to be familiar with the American
Board of Family Medicine guidelines for advance credit
[8]. In addition, programs may need to discuss these applicants with their designated institutional ofcial (DIO) and/
or scal leadership since Medicare GME funding may be
reduced for applicants who exceed their “initial residency
period.”
ERAS® policies are primarily focused on privacy protections for applicants and data integrity. Documents accessed
from PDWS “…may not be printed, faxed, e-mailed or otherwise transmitted to any individual or organization that is not
associated with securing the applicant’s training position at
your institution. Documentation received via the PDWS may
only be used for the review and evaluation of an applicant for
a training position” [9]. There are several prohibited questions and/or topics programs should be aware ofwhen interviewing applicants (see Table14.2). For example, programs
may not ask about other programs where the applicant has
Table 14.2 Most Common Match® Agreement Violations Reported to NRMP®
Overbooking interviews The number of interview slots available to schedule places a hard cap
Retracting interview offers too quickly Applicants must be given at least 48hours to accept or reject an
Questions about protected information Programs may not ask applicants to disclose their ranking preferences,
Failure to provide complete, timely, and accurate information Applicants may fail to disclose pertinent information impacting their
Applicant initiated contact during SOAP® outside of ERAS® All direct communication during SOAP® must be initiated by
Failure to adhere to the binding commitment created by matching In the absence of an NRMP® approved waiver, neither applicants nor
Failure to accept/offer a position obtained through the Match® or
SOAP®
Adapted from https://www.nrmp.org/policy/reporting- and- investigation- of- violations/
NRMP® national residency matching program, SOAP® supplemental offer and acceptance program®, ERAS® electronic residency application
service®
applied nor may they ask about the applicant’s use or nonuse
of signals, other than why the applicant signaled their program if they received a signal. Suspected fraudulent or unethical behavior should be reported to ERAS® Investigations,
prompting a formal investigation (see Table14.1) [10]. An
on-line program to educate ERAS® users about unethical and
fraudulent behaviors is available (see Table14.1).
The NRMP® updates the Match® Agreement annually
and program directors must attest to reviewing policy
changes during the registration process (see Table 14.1).
Programs and applicants enter a binding commitment
through the Match® that “exists through the rst 45 calendar
days of the start date of the relevant appointment contract”
[11]. To avoid a Match® violation, early termination of this
binding commitment must be approved by the NRMP®.
Program coordinators may assist with ROL entry; however,
the program director is the only person authorized to certify
the ROL in R3®. Programs and applicants both, “have a
right to make selection decisions that are free of undue or
unwarranted pressure and should report to the NRMP® any
on the number of interview offers which may be extended at any one
time. Programs may not force applicants to engage in a rst-comerst-serve scheduling process whereby later scheduling applicants will
not be able to schedule an interview. Waitlists are still allowed, as long
as applicants know they are not being guaranteed an interview.
invitation to schedule an interview.
identity of other programs where the applicant interviewed or even
applied, nor where they used their preference signals. Programs may
ask the applicant why they applied to or signaled their program, and
applicants may spontaneously volunteer any information they’d like to
share.
ability to start training on time or to comply with program
requirements.
Programs may fail to provide information regarding appointment
eligibility, program policies, or a copy of the resident employment
contract
programs. Neither unmatched applicants, nor their representatives,
including a student’s medical school, may contact programs regarding
unlled positions. Applicants must submit applications through
ERAS® and wait to be contacted by programs.
programs may discuss, interview, offer, or accept positions that would
run concurrently with a binding commitment created through the
Match®. Neither programs nor applicants may unilaterally release
each other from this binding commitment.
Certication of the rank order list obligates the applicant/program to
accept/offer any position match which is generated by the algorithm.
Programs should only rank the applicants they want in their program
and applicants should only rank programs with whom they are willing
to train.

138
P. T. Dooley and M. P. Williams
violations of these rights” [11]. The most common Match
violations are described in Table14.2.
Participating programs in Family Medicine are bound by
the “Main Residency Match All In Policy” (see Table14.1).
Programs must “attempt to ll all [PGY-1] positions through
the Match® or another national matching plan.” Furthermore,
all programs, even those which opt out of participating in
the Supplemental Offer and Acceptance Program®
(SOAP®) during Match® Week, may not offer positions
outside of the Match® until the conclusion of the SOAP®.
Requests for exceptions to the All-In policy must be submitted in writing. Approved exceptions, which may be granted
for unique situations, such as a rural scholar’s program or an
accelerated medical school track for Family Medicine
bound students, must submit annual attestations by
November 30th.
The NRMP® Code of Conduct (see Table14.1) further
details ethical expectations in the following areas:
• Accepting responsibility for the actions of ALL recruit-
ment team members
• Engaging in application and recruitment activities that
promote transparency and wellness
• Refraining from asking illegal questions
• Fully disclosing pertinent information to applicants
• Respecting an applicant’s right to privacy and
condentiality
• Declining to require second visits
• Limiting postinterview communication
• Ranking with integrity [12]
Lastly, federal law, as enforced by the United States Equal
Employment Opportunity Commission (EEOC), prohibits
discrimination based upon race, color, religion, sex (including gender identity, sexual orientation, and pregnancy),
national origin, age (40 or older), and disability or genetic
information in all phases of employment, which explicitly
includes recruiting, interviewing, and hiring (i.e., ranking
within a residency context) [13, 14]. Some examples of illegal questions include:
• You may be required to work on short notice (ex: continuity delivery or home call if this is used by the program). Is
this a problem for you?
• Are you able to perform the essential functions of this job
with or without reasonable accommodations? (Note: this
question is asked on the ERAS® application.)
• Do you have any upcoming events that would require
extensive time away from residency?
State and local employment laws may be more stringent
than federal law and could include additional protected
classes. Programs must also be familiar with the applicable
human resource policies of their sponsoring institution and
the residents’ employer, which may be separate from the
sponsoring institution. Program directors must ensure that
everyone who interacts with an applicant is aware of the
kinds of topics that are off limits unless raised by the applicant. As program directors are responsible for all interactions
representatives of their programs have with applicants, one
suggestion is to review the rules around interviews and ranking annually with all those involved in the recruiting process
at a program to ensure everyone adheres to the expectations.
As residents graduate each year and faculty may turnover, it
is ultimately the responsibility of the PD to ensure all rules
are followed.
One potentially overlooked policy involves mitigating
conicts of interest. Academic institutions commonly maintain a “Relationships Policy” that governs the professional
interactions between family members, intimate partners, and
other types of relationships which may introduce bias into
employment and evaluation decisions. When programs interview applicants who are related to current members of the
program, they need to not simply think about avoiding conicts of interest in the short-term, but also consider the longterm impact of the relationship on supervision, evaluations,
and schedules should the applicant match into the program.
Preinterview Recruiting andPipeline
Development
• Which religious holidays do you observe?
• Do you have, or plan to have, children?
• Can you get childcare on short notice?
• Do you have any disabilities?
• Are you a member of the National Guard or Reserves?
Potential legal alternatives to the above include:
• Are you able to work with our required schedule?
• Are you available to work nights, weekends (details of
local call schedule), on occasion?
Resident recruiting, like most of what we do in Family
Medicine, is all about relationships. These relationships may
form during the formal interview, but many programs devote
at least some of their recruiting resources toward pipeline
development and growing their applicant pool. These efforts
are now frequently aligned with local and institutional justice, equity, diversity, and inclusion initiatives. Medical
schools engage in signicant efforts to recruit students from
ethnic groups that are underrepresented in medicine and may
also focus on other demographic disparities, such as the relative lack of medical students from rural areas [15]. While

14 Recruitment ofResidents
Table 14.3 National and regional medical student recruiting opportunities
Conference name Website
American Academy of Family Physicians (AAFP) National Conference/
FUTURE
American College of Osteopathic Family Physicians (ACOFP) Annual
Convention & Scientic Seminars
American Medical Student Association (AMSA) Future Physicians for Change
Conference
Family Medicine Education Consortium (FMEC) Annual Meeting https://www.fmec.net/
Family Medicine Midwest https://www.fmmidwest.org/program
Global Missions Health Conference (GMHC) https://www.medicalmissions.com/events/
Latino Medical Student Association (LMSA) National Conference https://national.lmsa.net/programming/
Medical Student Pride Alliance (MSPA) Annual Conference https://www.medpride.org/mspa- conference
Student National Medical Association (SNMA) Annual Medical Education
Conference (AMEC)
https://www.aafp.org/events/national- conference.html
https://www.acofp.org/acofpimis/Acofporg/Events/Acofporg/
Events_Main.aspx
https://fp4change.org/
https://snma.org/page/events
139
pipeline development programs may easily extend beyond
the premedical undergraduate community all the way back to
interactions with high-school and middle-school students,
this section will focus on efforts to reach medical students.
Many institutions, especially osteopathic medical schools,
offer a “Hospital Day” program where students are given an
opportunity to meet with residency representatives to learn
more about various specialties and residency programs. These
events may be heavily attended by preclinical students who
have typically not settled on their specialty trajectory and thus
represent an opportunity to recruit for the specialty as much as
a specic residency. Other schools may organize Residency
Fairs that are more focused on clinical students. Another high
yield method of connecting with students is to coordinate with
a local Family Medicine Interest Group (FMIG). This may
present an opportunity to directly talk about your residency
program, or it may present an opportunity to partner with the
FMIG to implement an educational program which facilitates
interactions between the student members and representatives
of the program, both residents and faculty.
The single biggest gathering of Family Medicine bound
students takes place in Kansas City, Missouri, each year during the American Academy of Family Physicians’ National
Conference for residents and students—now called FUTURE.
Hundreds of programs sign up to exhibit each year as thousands of students from across the country descend upon the
expo hall for a few days in late July or early August. This is an
outstanding opportunity for students to meet residents and faculty members in-person and rapidly screen programs from
across the nation. Some state AAFP chapters provide funding
for students to attend the conference each year and will often
organize state specic social gatherings to connect students
and program representatives outside of the more formal expo
hall setting.
Programs ought to carefully consider the design of their
exhibit booth as well as any materials they make available
for distribution. Due to the overwhelming (700+) number of
programs exhibiting, and a limited amount of time to meet,
students are often rapidly skimming the booths from a dis-
tance. Programs could think about a few guiding questions to
improve the “curb appeal” of their booth: What do you most
want students to know about your program from a glance?
What can you do to draw students in and entice them to not
just keep walking, but to stop and engage with the people
stafng your booth? After you get a student to engage in conversation, how do you want them to remember your program? What do you want the student to take away from the
interaction? Programs should strive for transparency in terms
of their application criteria, interview methods, culture, and
curricular outcomes. Ideally, the mission, vision, values, and
aims of the program are woven throughout these interactions
and into the materials shared with potential applicants.
While the AAFP’s National Conference/FUTURE is the
single largest annual residency recruitment event, there are
many other national and regional meetings where residency
programs attend as exhibitors to meet with students (see
Table 14.3). Programs may also have opportunities to recruit
interested students during their state chapter meetings. Lastly,
programs should not neglect their online presence as it is another
avenue to recruit students. More information is included in the
Preparation and Execution section of this chapter.
Medical Student Rotations
The clinical experiences that Family Medicine residency
programs provide medical students have many names and
offer a wide variety of experiences. In the preclinical years,
programs may help teach clinical skills workshops, participate in enrichment week curricula, or even have longitudinal
student interactions in clinical settings. Programs afliated
with medical schools frequently offer third year clerkships.
In some situations, the clerkships run by the residency may
cover a variety of specialty experiences beyond Family
Medicine including aspects of Internal Medicine, Obstetrics,
and Pediatrics. These earlier encounters provide opportunities to grow the pipeline of students who choose Family
Medicine and may be an opportunity for programs to start

140
P. T. Dooley and M. P. Williams
developing relationships with students who will eventually
apply for residency. However, fourth-year rotations are
where the rubber really meets the road.
Practically all programs offer rotations to fourth-year
students that last for 2–4weeks and may satisfy core curriculum requirements or count as elective credit. One of the
most frequent types of experience is known as the “acting
internship” or “sub-internship,” which may or may not be
synonymous with the concept of an “audition rotation.”
Typically, during these experiences, the medical student is
expected to take on additional responsibilities for patient
care and demonstrate their readiness for residency.
Programs should recognize that all of these interactions
present the opportunity for bi- directional evaluation. While
residents and faculty members are evaluating the student’s
clinical and interpersonal suitability for the program, the
students are obtaining an intimate understanding of the
program.
Family Medicine applicants report “overall goodness
of t” as the most important factor in their ranking process and after 4weeks of working with a program they
will understand their t at a far deeper level compared
with a one day interview [16]. While applicants heavily
weigh “work/life balance” they also care deeply about
each program’s “quality of educational curriculum and
training.” Over the course of a 4-week rotation, an astute
student will learn far more about both the good and the
suboptimal aspects of a program. Therefore, programs
should be mindful of every aspect of the rotations they
offer to ensure the experience provides the students with
meaningful education and aligns with their overall recruiting strategy.
Interview Season
The formal interview portion of the recruiting process is
typically the most resource-intensive phase. While some
of this resource investment involves direct nancial
expenditures, the indirect costs involved in formal interviews are oftentimes underappreciated. Applicants’
impressions of the current residents and the quality of the
program director are two of the most frequently cited and
most important factors that inuence applicant rankings
of programs [16]. An accounting of student, resident and
faculty time invested in the interviewing process easily
dwarfs the total direct costs [17, 18]. Furthermore, the
time residents spend on recruiting and interviews should
not detract from their education and must be balanced
against the many other clinical and administrative
demands on their time.
Preparation andExecution
Preparing for the next interview season typically begins
shortly after Match® Week. Many programs nd it helpful to
survey applicants after their interviews to gain insight into
how their program was perceived as well as strengths and
weaknesses applicants appreciated. Some programs do this
on a weekly basis after applicants interview while other programs may wait until after all interviews have been completed. Programs may also decide to send a postmatch survey
to all applicants that did not match at their program but were
ranked higher than the lowest matched applicant, to explore
their rationale behind selecting another program. Response
rates may be somewhat lacking on these types of surveys;
however, they can provide some important information for
program directors to help improve the following interview
season and highlight any blind spots the program may have.
The survey may even provide supportive information and
reinforce the program’s current direction and recruitment
techniques.
Once the new residents start their intern year, another suggestion is to candidly discuss how the prior interview season
was for them. Frequently they can provide more insight on
where the program excelled and areas where the program
might improve. The new recruits may also provide additional
ideas or suggestions they saw on the interview trail that
would help their programs in the future interview season.
They can offer suggestions on things like hotel accommodations, food, tours, interview style/length, etc. Programs that
offer in-person interviews will need to account for the associated increased expenses in their annual budgets [17].
Social media is another area programs should pay close
attention to. Online discussion forums such as Reddit and
Student Doctor Network may be heavily inuential and
could impact a program’s prospective applicant pool. Studies
have found applicants frequently use social media to explore
programs and their application requirements before they
apply [19]. Many programs have a Facebook, Instagram, or
other type of social media account. Different sponsoring
institutions/hospital systems may have rules around social
media accounts that the program must take into consideration. Often residents enjoy managing the social media
accounts and have great ideas on the content applicants may
want to see. However, programs must be clear if there are
any institutional limitations on what can be posted. If programs do allow residents to oversee their social media presence, they should consider a succession plan for when the
residents graduate whether that be another resident and/or
program administration picking up the responsibility. It is
important to maintain a steady online presence once accounts
have been created.
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