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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 insufcient 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 andFeedback
In this chapter, the terms evaluation and feedback are directed specically 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 signicant [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 specic 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 specic questions that allow a resident to provide their anonymous opinion about the learning environment is particularly important. For example, an evaluation question­naire about specic 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 rene implementation and performance, identify spe­cic 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 claried 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 specic 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 specic 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 specic 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 specic 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 renement 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.

References

1. Hughes MT. Meeting patients where they are. Virtual Mentor. 2013;15(4):293–8. Published 2013 Apr 1. https://doi.org/10.1001/
virtualmentor.2013.15.4.ecas2- 1304.
2. Association of American Medical Colleges, Matriculating Student Questionnaire (MSQ). 2022. Retrieved from: https://www.aamc.
org/data- reports/students- residents/report/matriculating- student­questionnaire- msq. Accessed 10 Nov 2023.
3. Ford CR, Moseley L. Challenges to health professions educa­tion and strategies for moving forward. New Dir Teach Learn. 2020;2020:199–207. https://doi.org/10.1002/tl.20404.
4. Parker K, Igielnik R. On the cusp of adulthood and facing an uncertain future: what we know about gen Z so far. United States of America. 2020. Retrieved from: https://www.pewresearch.org/
social- trends/2020/05/14/on- the- cusp- of- adulthood- and- facing- an­uncertain- future- what- we- know- about- gen- z- so- far- 2/. Accessed
10 Nov 2023.
5. Richey RC, Klein JD, Tracey MW. The instructional design Knowledge Base: theory, research, and practice. 1st ed. Routledge;
2010. https://doi.org/10.4324/9780203840986.
6. Allen SJ, Rosch DM, Riggio RE.Advancing leadership education and development: integrating adult learning theory. J Manag Educ. 2022;46(2):252–83. https://doi.org/10.1177/10525629211008645.
7. de Luise VP. Teachable moments, learnable moments: medical rounds as a paradigm for education. Mind Brain Educ. 2014;8:3–5.
https://doi.org/10.1111/mbe.12038.
8. Ritter KA, Horne C, Nassar A, French JC, Prabhu AS, Lipman JM.Multidisciplinary simulation training improves surgical resident comfort with airway management. J Surg Res. 2020;252:57–62.
https://doi.org/10.1016/j.jss.2020.02.008. Epub 2020 Mar 29
9. Dennick R.Twelve tips for incorporating educational theory into teaching practices. Med Teach. 2012;34(8):618–24. https://doi.org/
10.3109/0142159X.2012.668244.
10. Carter T. Millennial expectations, constructivist theory, and changes in a teacher preparation course. SRATE J. 2009;18:25–31.
11. Thomas P, Kern D, Hughes M, Tackett S, Chen B. Curriculum development for medical education: a six-step approach. 4th ed. Baltimore: Johns Hopkins University Press; 2022.
12. Iwasiw CL.Curriculum development in nursing education. 4th ed. Jones & Bartlett Learning; 2020.
13. Accreditation Council for Graduate Medical Education. ACGME family medicine program requirements. 2023. Retrieved from:
https://www.acgme.org/globalassets/pfassets/programrequire­ments/120_familymedicine_2023.pdf. Accessed 10 Nov 2023.
14. Phillips AW, Friedman BT, Utrankar A, Ta AQ, Reddy ST, Durning SJ. Surveys of health professions trainees: preva­lence, response rates, and predictive factors to guide research­ers. Acad Med. 2017;92(2):222–8. https://doi.org/10.1097/
ACM.0000000000001334.
15. Doran GT.There’s a S.M.A.R.T. way to write management’s goals and objectives. Manag Rev. 1981;70(11):35–6.
16. Adams NE.Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc. 2015;103(3):152–3. https://doi.org/10.3163/1536-
5050.103.3.010. PMID: 26213509; PMCID: PMC4511057.
17. Accreditation Council for Graduate Medical Education. Family medicine milestones. Retrieved from: https://www.acgme.org/glo-
balassets/pdfs/milestones/familymedicinemilestones.pdf. Accessed
10 Nov 2023.
18. Nodine TR.How did we get here? A brief history of competency­based higher education in the United States. Comp Educ. 2016;1:5–11. https://doi.org/10.1002/cbe2.1004.
19. Edgar, L etal. Accreditation council for graduate medical educa­tion. The milestones guidebook. 2020. Retrieved from: https://
www.acgme.org/globalassets/milestonesguidebook.pdf. Accessed
10 Nov 2023.
20. Christoff K, Irving Z, Fox K, etal. Mind-wandering as spontaneous thought: a dynamic framework. Nat Rev Neurosci. 2016;17:718–31.
https://doi.org/10.1038/nrn.2016.113.
21. Lacasse M, Audétat MC, Boileau É, etal. Interventions for under­graduate and postgraduate medical learners with academic dif­culties: a BEME systematic review: BEME guide no. 56. Med Teach. 2019;41(9):981–1001. https://doi.org/10.1080/01421
59X.2019.1596239.
22. Brookeld S. Powerful techniques for teaching adults. San Francisco: Jossey-Bass; 2013.
23. Taylor MJ, McNicholas C, Nicolay C, etal. Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf. 2014;23:290–8.
24. Verhoef MJ, Casebeer AL.Broadening horizons: integrating quan­titative and qualitative research. Can J Infect Dis. 1997;8(2):65–6.
https://doi.org/10.1155/1997/349145. PMID: 22514478; PMCID:
PMC3327344.
Part IV
Resident Issues
Recruitment ofResidents
P.T.Dooley andM.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 signicant 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 Table14.1). 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 (includesregistration stepsfor 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 Table14.1). 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 Table14.1), the Texas Seeking Transparency in Application to Residency (TexasSTAR) web­site (see Table14.1), and the Doximity Residency Navigator (see Table14.1). 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 theERAS® Program Director’s WorkStation (PDWS)[2]. New programs will need to com­plete the registration steps for an account (see Table14.1). 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, speci­cally 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 Table14.1). 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 andProcedures
Program leadership must ensure that the program complies with all applicable policies and laws throughout the recruit­ing process. This starts with understanding the ACGME denition of eligibility for appointment to an accredited
14 Recruitment ofResidents
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 ofcial (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 ofwhen inter­viewing applicants (see Table14.2). 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 48hours 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 Table14.1) [10]. An on-line program to educate ERAS® users about unethical and fraudulent behaviors is available (see Table14.1).
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-come­rst-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 unlled 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. Certication 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 Table14.2.
Participating programs in Family Medicine are bound by the “Main Residency Match All In Policy” (see Table14.1). 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 Table14.1) 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
condentiality
• 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
conicts 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 con­icts 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 andPipeline 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 signicant 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 ofResidents
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 & Scientic 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
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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 specic 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 specic 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 stafng 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 afliated 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
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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 2–4weeks 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 4weeks 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 inuence 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 andExecution
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 inuential 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.