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Fig. 18.2 Example of potential progression toward disciplinary action against a resident [14]
S. M. Carek et al.
By approaching dismissal with transparency, fairness, and a commitment to support residents’ well-being, training pro­grams can balance the need to uphold high standards of patient care and professionalism with the responsibility to guide residents toward successful careers in medicine. Figure18.2 outlines a proposed progressionfrom informal constructive advice to formal counseling to warning, proba­tion, and termination of employment that a program may have totake when helping a resident through their training.

Conclusions

Family medicine resident performance issues are an integral part of the learning journey, offering opportunities for growth, development, and transformation. By recognizing and addressing these issues with empathy, support, and evidence- based strategies, mentors, supervisors, and educa­tors can play a pivotal role in guiding medical residents toward achieving their full potential. As stewards of medical education, our commitment to fostering a culture of continu­ous improvement ensures that helps residents overcome challenges and emerge as skilled, compassionate, and com­petent physicians who positively impact patient care and the broader healthcare landscape.

References

1. Mitchell M, Srinivasan M, West DC, etal. Factors affecting resident performance: development of a theoretical model and a focused lit­erature review. Acad Med. 2005;80(4):376.
2. Reamy BV, Harman JH.Residents in trouble: an in-depth assess­ment of the 25-year experience of a single family medicine resi­dency. Fam Med. 2006;38(4):252–7.
3. Dupras DM, Edson RS, Halvorsen AJ, Hopkins RH, McDonald FS.ENT of the 25-year experience of a single family medicine resi­dency. Literature Review. Am J Med. 2012;125(4):421–5. https://
doi.org/10.1016/j.amjmed.2011.12.008.
4. Svystun O, Ross S. Difculties in residency: an examination of clinical rotations and competencies where family medicine resi­dents Most often struggle. Fam Med. 2018;50(8):613–6. https://
doi.org/10.22454/FamMed.2018.794779.
5. Chandler N, Henderson G, Park B, Byerley J, Brown WD, Steiner MJ.Use of a 360-degree evaluation in the outpatient set­ting: the usefulness of nurse, faculty, patient/family, and resident self- evaluation. J Grad Med Educ. 2010;2(3):430–4. https://doi.
org/10.4300/JGME- D- 10- 00013.1.
6. Dudek NL, Marks MB, Regehr G.Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005;80(10):S84.
7. Guerrasio J.Remediation of the struggling medical learner. 2nd ed. Association for Hospital Medical Education; 2017.
8. Kalet A, Chou CL, editors. Remediation in medical educa­tion: a mid-course correction. Springer; 2014. https://doi.
org/10.1007/978- 1- 4614- 9025- 8.
9. Hauer KE, Ciccone A, Henzel TR, et al. Remediation of the deciencies of physicians across the continuum from medical school to practice: a thematic review of the litera­ture. Acad Med. 2009;84(12):1822. https://doi.org/10.1097/
ACM.0b013e3181bf3170.
10. Cleland J, Leggett H, Sandars J, Costa MJ, Patel R, Moffat M.The remediation challenge: theoretical and methodological insights from a systematic review. Med Educ. 2013;47(3):242–51. https://
doi.org/10.1111/medu.12052.
11. Guerrasio J, Garrity MJ, Aagaard EM. Learner decits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006–2012. Acad Med. 2014;89(2):352. https://doi.org/10.1097/
ACM.0000000000000122.
12. Warburton KM, Goren E, Dine CJ.Comprehensive assessment of struggling learners referred to a graduate medical education reme-
18 Addressing Medical Resident Performance Issues: Strategies forImprovement
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diation program. J Grad Med Educ. 2017;9(6):763–7. https://doi.
org/10.4300/JGME- D- 17- 00175.1.
13. Frazier W, Wilson SA, D’Amico F, Bergus GR.Resident reme­diation in family medicine residency programs: a CERA survey of program directors. Fam Med. 2021;53(9):773–8. https://doi.
org/10.22454/FamMed.2021.546572.
14. Smith J, Lypson M, Silverberg M, etal. Dening uniform processes for remediation, probation and termination in residency training. West J Emerg Med. 2017;18(1):110–3. https://doi.org/10.5811/
westjem.2016.10.31483.
Part V
Faculty Issues

Faculty Recruitment: Best Practices

RebeccaMartin, ShantieHarkisoon, andLondonMuse
19
Key Points
• A number of signicant challenges exist in the recruit­ment of qualied family medicine faculty, including sal­ary gaps between academic and private practice settings, insufcient support for protected faculty time, inadequate skill set development for full-spectrum training, and nationwide shortages in the family medicine faculty workforce.
• Attention to diversity, equity, and inclusion and the foster­ing of a culturally diverse climate are increasingly being recognized as vital factors in robust family medicine fac­ulty recruitment and retention as well as in physician workforce diversity more broadly.
• An inclusive recruitment framework for diversifying GME training programs includes building on strong insti­tutional support by setting diversity as a priority, imple­menting inclusive recruitment practices, seeking out suitable candidates, investing in trainee success, and building the pipeline.
• Led by the program director, every department member and individual within the sponsoring institution, who can contribute to the successful recruitment of faculty, resi­dents, and students, is a stakeholder in the residency pro­gram; the program director must have a vision for the program that is aligned with that of the institution and
R. Martin (*) Palliative Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA e-mail: rebecca.martin@wmchealth.org
S. Harkisoon Family Medicine Residency Program, Garnet Health Medical Center, Middletown, NY, USA e-mail: sharkisoon@garnethealth.org
L. Muse MercyOne Adel Family Medicine, Adel, IA, USA
Des Moines University, Des Moines, IA, USA e-mail: London.muse@mercyoneiowa.org
which cultivates and guides each member of the institu­tional team in shared ownership and synergistic teamwork toward the program’s success.
• The “what’s on your plate” framework is a helpful way to track individual faculty portfolios while simultaneously facilitating cross-training of faculty skill sets; in this framework, faculty maintain a list of their individual responsibilities and scope of practice, ranging from clini­cal and academic to administrative. When faculty are out on leave for extended periods (such as maternity/paternity or sick leave), the program director can divide their “plate” among the remaining faculty (who can develop additional strengths) and then gradually reintroduce tasks to the fac­ulty member when they return, to minimize overwhelm.
• Residency leadership is continuously recruiting at every level, including through student recruitment where men­torship and role modeling efforts can help expand stu­dents’ imagination of what an academic career can look like. When students encounter positive family medicine faculty role models, they share those experiences with other students and retain favorable impressions even later when pursuing faculty and/or clinical positions; even if they are not recruiting a particular person, such efforts can serve as a means of effective marketing, thus helping spread word about their program (and family medicine more generally).
• Faculty with prior clinical experience contribute invalu­able insights, practical wisdom, complementary proce­dural skill sets, and increased condence and are often able to step right into their patient care role, generally offering a fresh perspective and new creative ideas; at the same time, seasoned clinicians may struggle to develop a robust faculty skill set from scratch or appreciate estab­lished paradigms for approaching learners in a graduate medical training context.
• New residency graduates joining faculty offer the advan­tage of reduced intimidation as teachers, familiarity with resident-related concerns including board certication,
© 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_19
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licensure, and job searching, and the absence of genera­tional differences; however, they also have growth edges unique to their relatively limited clinical and teaching experience, often related to issues of insecurity, underde­veloped skill sets, or inexperience in navigating institu­tional frameworks and partnering effectively with management-level leadership.
• There are signicant advantages when programs retain their own graduates by focusing their efforts on internal recruitment, ranging from cultivating a healthy program culture and supporting student and resident recruitment efforts to optimizing cost savings; robust advising of potential future faculty members within a residency program, and providing opportunities for faculty develop­ment during training, can support a smooth transition for “growing your own” faculty.

Background

Recent years have seen an alarming nationwide shortage in family medicine faculty [12], medical school primary care preceptorships [2], family medicine preceptor training sites [8, 15], and, more broadly, the family physician workforce [1,
10]. These shortages have the potential to impact graduate
training opportunities for a generation of family physicians to come and underscore the imperative of high-quality faculty recruitment practices to mitigate these concerning trends.
A number of challenges have been identied in the
recruitment of qualied family medicine faculty. (1) These include:
• Marked salary gaps between private and academic practices
• Insufcient nancial or institutional support for protected faculty time
• Inadequate skill set development (ranging from teaching and scholarship to procedural and obstetrics)
• Insufcient overall pool of family physicians, owing to nationwide shortages from which to recruit clinical faculty
It is not uncommon for residents and graduates to assume
(or even be told) that their priority should be to pursue pri­vate practice before they might ever consider joining a fac­ulty. Starting their careers and paying off debt is their priority, and academic medicine is often the last thing on their mind— especially if there is limited family medicine faculty role modeling and academic medicine scholarship opportunity and encouragement. It is incumbent on the residency pro­gram director and faculty to shift this mindset by igniting curiosity and interest in clinical academic medicine and by enlisting the support of the institutional stakeholder team.
While members of the “stakeholder team” are traditionally thought of as department heads, physicians, administrators, and executive staff, it is helpful to remember that ostensibly anyone at the institution can reasonably be considered to hold a stake in the interests of a residency program and its outcomes, given its integral role in the ourishing of the institution and community.
Setting Priorities: Diversity, Equity, andInclusion
Attention to diversity, equity, and inclusion and the fostering of a culturally diverse climate are increasingly being recog­nized as vital factors in robust family medicine faculty recruitment and retention [11] as well as in physician work­force diversity more broadly [7]. Best practices based on cur­rent evidence have been proposed for recruitment, retention, and representation in leadership of a diverse faculty work­force. One proposed framework offered the following strate­gic priorities [5]:
• Identify diversity as a clearly articulated commitment in the institution’s mission statement and on the program or departmental websites.
• Ensure that the recruitment efforts conscientiously expand the pool of underrepresented minority (URM) candidates through inclusive language in position advertising and marketing, set minimum thresholds for URM candidate interviews, and support targeted outreach efforts to URM candidates across the spectrum of medical education and training.
• Create diverse recruitment committees, drawn from both the family medicine faculty team and interdepartmental institutional leadership, through either committee appointment or peer nomination.
• Incentivize stakeholders (all involved parties) to create accountability for diversity efforts, and develop specic metrics to track the rates of recruitment, leadership devel­opment, and academic promotion of URM faculty members.
• Incentivize URM physician candidates through recruit­ment packages that include targeted funding initiatives, competitive salaries, debt reduction programs, and loan forgiveness incentives.
• Ensure a holistic review of applications, emphasizing the behavioral traits and characteristics valued by the institu­tion, and utilize objective tools and scoring systems to support a standardized evaluation process.
• Connect candidates with current URM faculty ambassa­dors for additional insights shared.
• Evaluate for biases in the faculty promotion and tenure process and consider mandating training in implicit bias.
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To help address healthcare disparities and promote high- quality, culturally sensitive care in the United States, the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies propose cultivating a more diverse physician workforce. In addition, improved training and patient outcomes have been demonstrated for diverse care teams. However, prioritizing graduate medi­cal education (GME) diversity and inclusion efforts can be challenging, with the need to attend holistically to mul­tidimensional considerations to achieve the greatest suc­cess [13].
Limited literature exists regarding actionable steps to pro­mote diversity in GME.Building on the existing literature and the authors’ experiences at different institutions, we pro­pose a ve-point inclusive recruitment framework for diver­sifying GME training programs. This chapter details each of the ve steps of the framework, which builds on strong insti­tutional support by setting diversity as a priority by ensuring adequate attention. Forming a cycle, the other four steps are implementing inclusive recruitment practices, seeking out suitable candidates, investing in trainee and faculty success, and building the pipeline (Fig.19.1).
Practical strategies for each step and recommendations for measurable outcomes for continued support for this work are provided. The proposed framework may better equip col­leagues and leaders in academic medicine to prioritize and effectively promote diversity and inclusion in GME at their respective institutions.
Implementing Inclusive Practices: Cultivating aShared Team Vision
Faculty recruitment is an institutional effort led by the pro­gram director. Every department member and individual within the sponsoring institution and its partners, who can contribute to the successful recruitment of faculty, residents, and students, is a stakeholder in the residency program. One unanticipated example is the impact of environmental ser­vices (ES) on recruitment. ES staff can have a signicant inuence on resident satisfaction and recruitment success by ensuring the tidiness and cleanliness of the hospital and the “call room” environment. The authors found in their own medical institution that the personable and friendly relation­ships established by their staff with ES team members fre­quently led to warm hallway greetings that contributed to an inviting work atmosphere—a collegial tone that impressed recruits during interview tours. A similarly welcoming work climate can be achieved between family medicine faculty, residents, and staff with other specialty departments and hos­pital staff.
To harness and maximize the collective contributions and inspirations of the institutional stakeholders toward the suc­cess of the residency program, the program director must have a vision for the program that is aligned with that of the institution and that which cultivates and guides each member of the institutional team toward the achievement of the resi­dency program goals. One such vision could be “train the
Fig. 19.1 The ve-point inclusive recruitment framework for diversifying GME programs
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best and brightest physicians” or “bring family physicians to [the local community].” The more department heads, admin­istrators, and staff enlist in the program’s vision and value their own contribution to the vision, the greater their positive impact will be on the program and recruitment. From envi­ronmental services to the C-suite, every department can be engaged in the recruitment process.
There are several ways to engage institutional depart­ments. Faculty can present program highlights at hospital meetings and publish updates in institutional newsletters. The program director and faculty can attend departmental meetings of other institutional departments and meet one-on­one with department heads and administrators. Department physicians and staff are often surprised by the enthusiastic interest in their involvement and engagement in the family residency program. Contexts like this can be an excellent opportunity to educate and raise awareness of their important role in the recruitment and overall residency program suc­cess. Potential questions to ask when engaging with potential stakeholders in each department could include:
• What do you think is needed for a successful residency
program?
• What do you see as potential barriers?
• What do you envision for the program?
• How could our program help you?
Relationships with institutional administrative leadership can be pivotal to the success of the program and recruitment. For example, establishing professional relationships with the CEO and vice presidents in the C-suite can help facilitate all aspects of the program, including budgets, grants, marketing, and benets. A direct connection with individuals in the mar­keting department can facilitate program director (PD), fac­ulty, and resident involvement in outreach efforts and simultaneously enhance support for the program website, social media, and recruitment material development. Engaging the development department can provide them with a vision that can be used to engage donors and generate grants, which, in turn, can create funding to support endow­ments, faculty development, conference attendance, special equipment, and more. The PD, faculty, and residents can par­ticipate in development meetings with individuals and groups and thereby support their institution’s nancial goals and well-being and shore up the residency program’s stake and role in the institution.
The same engagement process can be applied within the residency program, especially since every element of the program can enhance recruitment. Program leadership works on creating and sustaining a healthy, successful clinical envi­ronment to support faculty supervision and direct patient care. Ample research evidence shows that faculty are role models for residents and that their happiness and well-being
deeply impact resident engagement, education, recruitment, and more [13]. Similarly, engagement of nurses, medical assistants, and other clinical support staff as stakeholders in the family medicine program (FMP) and all clinical settings afrms them as vital elements of resident education, recruit­ment, and patient care. Soliciting their feedback as to what is working and what is not and including them in quality improvement initiatives alongside residents and faculty will augment success. This type of collaboration also fullls important ACGME program requirements for interdisciplin­ary collaboration and teamwork.
This mindset that engages and values others in the institu­tion as family medicine residency stakeholders feeds a sense of shared ownership and synergistic teamwork toward the program’s success, with effects that can amplify outcomes and create ripples far beyond recruitment. Cultivating and implementing a team vision creates an environment in which faculty (and all others) will want to work and, more impor­tantly, seek to contribute to this shared vision.

Seeking Out Suitable Candidates: Recruitment Methods

Traditional recruitment methods include advertising in aca­demic journals and on specialty-specic websites, although such advertising is typically done in short increments of time and can be cost-prohibitive, often with less-than-ideal results. Maintaining an ongoing relationship with the institutional physician recruiter can help garner support for faculty recruitment, especially when demonstrating cost savings associated with hiring graduates [4, 9, 14] and also by ensur­ing a clear appreciation for the value of the program and fac­ulty within the larger context of the institution’s advancement. A relatively easy way to increase visibility and connection to potential hires is to encourage all members of the program, including residents, to establish and maintain an updated presence on various social media outlets, particularly profes­sionally focused ones. A robust online network can pay divi­dends decades later when programs boast a vast, strong network of successful faculty and graduates. Such outcomes speak more powerfully than most recruitment spiels, and maintaining the connections can result in the recruitment of program graduates and qualied individuals within their net­works. Other options for recruitment include listing posi­tions on faculty organization email message groups, and this is incrementally more powerful when the PD and faculty interact with the email group on a regular basis. Individuals who contribute meaningful questions and solutions are more likely to benet from word-of-mouth recommendations or other program PD’s encouragement of their graduates to apply for a position. Seeking out and applying for grants that can support faculty recruitment and development efforts are
19 Faculty Recruitment: Best Practices
Table 19.1 Faculty recruitment resources
ACGME job board: https://web.cvent.com/event/0b33fe58- c838- 4586- 8f89- 6462b6795cd5/
websitePage:460aea77- d3a3- 4288- 81e4- fbbfe29be9b9
AAFP career link posts jobs via various outlets: https://www.aafpcareerlink.org/ American College of Osteopathic Family Physicians Career Center (American College of Osteopathic Family Physicians (ACOFP), ACOFP Career Center|Find Your Career Here) Association of Family Medicine Residency Directors (AFMRD) job board: Job board main page Grants: Seek and apply for grants that can support faculty recruitment and development Hospital/institutional recruiter: Maintain an ongoing relationship and demonstrate the value of the program and faculty LinkedIn: Maintain an updated prole Post position on AFMRD, Association of Family Medicine Administration (AFMA), and other listservs Social media: Maintain active social media pages for the program and/or PD The STFM Preceptor Expansion Initiative: https://www.stfm.org/about/keyinitiatives/preceptorexpansion/preceptorexpansioninitiative/ The STFM Residency Faculty Fundamentals Certicate Program: https://www.stfm.org/facultydevelopment/certicateprograms/
residencyfacultyfundamentals/overview/
The STFM Faculty Skills Course (online): https://www.stfm.org/facultydevelopment/onlinecourses/faculty- skills- course/overview Volunteer as a mentor (https://www.stfm.org/about/keyinitiatives/antiracism- and- health- equity/urm- initiative/urmmentorship/; https://www.
stfm.org/publicationsresearch/cera/ceramentors/
AAFP American Academy of Family Physicians, STFM Society of Teachers of Family Medicine
191
another way to help attract and retain faculty members for a multitude of reasons: faculty value faculty development, grants lead to publicity that attracts attention, and enhanced resources lead to a more supportive environment in which faculty are fullled, which is highly valued by all program members and recruits. Finally, engagement with specialty organizations, including conference presentations, commit­tee membership, and faculty development initiatives, such as those offered by the Society for Teachers of Family Medicine, can be a great way to network with other programs and meet potential faculty members at conferences, trainings, and mentorship events (Table19.1).
Investing inFaculty Success: What’s onYour Plate?
The authors propose the framework, “what’s on your plate” as a helpful way to track individual faculty portfolios while simultaneously facilitating cross-training of faculty skill sets. The goal is to support all faculty team members in creat­ing and achieving their dream jobs. In this framework, fac­ulty maintain a list of their individual responsibilities and scope of practice, ranging from clinical and academic to administrative. Junior faculty should start with increased clinical time to build condence and gradually add responsi­bility and leadership roles with sufcient guidance and sup­port via regularly scheduled meetings with the program director. When new faculty members join the team, faculty “plates” can be reorganized and tasks redistributed based on each faculty member’s interests, strengths, needs, and areas of expertise.
When faculty are out on leave for extended periods, the program director can divide the absent faculty’s plate among the remaining faculty (who can develop additional strengths)
and then gradually reintroduce tasks to the faculty member when they return, to minimize overwhelm. Such a clear, structured system of support for absences or other changes in faculty makeup can enhance diverse faculty recruitment and empower faculty members while also allowing cross­pollination within the team and ensuring a shared under­standing of each member’s various roles. Similarly, all program director responsibilities and roles can be shared among faculty with the appropriate allocation of administra­tive time. This helps engage faculty and prepares them to take on additional leadership roles. It also supports optimal job satisfaction for program directors, which, in turn, sup­ports faculty and program morale.
Practically speaking, the following is a list of sample “what’s on your plate” headings and ideas for a given facul­ty’s responsibilities. They can track their duties from year to year, such as in an online shareable, and live-edit the docu­ment, by copying forward their list year to year and editing accordingly; the list also serves as a way for faculty members to capture and track items to update on their curriculum vitae and support academic promotion efforts.
Sample “What’s On Your Plate” Headings
• Outpatient clinical (direct patient care, annual training
requirements, and other maintenance of institutional
privileges)
• Inpatient clinical (including inpatient care supervision,
hospitalist duties, annual training requirements, and other
maintenance of institutional privileges)
• Residency teaching/precepting
• Medical school teaching/precepting
• Mentoring/advising initiatives
• Specialty-specic initiatives (i.e., women’s health, global
health, sports medicine, palliative medicine, etc.)
• Grant work
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• Scholarly activity (current institutionally-sponsored research/posters/manuscripts/presentations/peer reviews)
• Committee service/leadership
• Professional and faculty development (including Continuing Medical Education and Maintenance of Certication events)
• Program administration (resident recruitment, standing meetings)
• Volunteering/community service/outreach participation
• Personal commitments
• Future goals and aims
Unique Challenges: Faculty Transitioning fromClinical Practice
Faculty with prior clinical experience contribute invaluable insights and practical wisdom. Those transitioning from ambulatory, hospital-based, maternity care, and other set­tings can be exceptional mentors and role models, especially for residents who plan to pursue related practice models upon graduation. Such clinicians often have a skill set that can complement the existing team, adding potential proce­dures, curriculum, and approaches from which the residents and existing faculty can learn. They are also more likely to bring a sense of increased condence, based on their previ­ous clinical experiences, as well as have no preconceived notions about residents based on memories of them as fellow trainees. In the transitional period, such a clinician is more likely to be able to step right into their patient care role and can dedicate the typical “ramp up” period of more junior cli­nicians to build their faculty development skills. Finally, cli­nicians coming from outside an institution, with experience in other health systems and settings, can bring a fresh per­spective with a new set of creative ideas.
Despite these benets, physicians transitioning from clini-
cal to faculty practice may nd that they face unique, even unexpected, challenges in this new role. Program directors may receive pushback from those who are unfamiliar with the rules of graduate medical education (GME) or even the appli­cation of evidence-based guidelines to clinical care. It can be helpful to start with a “plate” that accounts for this knowledge gap, arranging to meet often with the faculty member to review the GME structure, faculty development resources, and addi­tional support for other identied areas of need. Placement with other faculty attendings in a shared ofce, or as co-pre­ceptors collaborating on resident supervision in various clini­cal settings, can be a helpful bridge and source of faculty skill development while also recognizing that it can be a two-edged sword, offering both inspiration and intimidation.
It can be difcult to assign curriculum responsibilities to
someone who is unaccustomed to them, especially when they are “starting from scratch” with regard to the realm of
GME.Seasoned clinicians may nd it challenging to learn whole new paradigms for approaching graduate medical training, particularly when they were not previously privy to all that is involved in teaching. Those outside of academia may discover that there is a great deal involved in developing a robust faculty skill set, including, but not limited to, creat­ing actionable goals and objectives for rotations, supervising ACGME milestone achievements, advising resident mentees (particularly when it comes to addressing the needs of trou­bled learners), completing rotation evaluations, executing Clinical Competency Committee and Program Evaluation Committee responsibilities, attending to scholarly activity commitments, participating in institutional committee ser­vice and leadership, and fullling program administrative duties such as those required for residency recruitment and standing meeting responsibilities.
Program directors will likely nd it helpful to manage expectations prior to hire. Every faculty member must be open to learning this range of faculty-specic skills and should be willing to prioritize and address learner needs according to the established ACGME program requirements. Successful integration of new faculty contributes to success­ful recruitment because to achieve otherwise may result in consequences that also have a far-reaching impact. Failed integration may contribute to a negative reputation within the family medicine community and affect faculty, resident, and student recruitment.

Unique Challenges: Faculty Who Are New Residency Graduates

Just as seasoned clinicians face their own challenges when transitioning into an academic role, new residency graduates have growth edges unique to their relatively limited experi­ence. Issues of condence, both over- and under-, can also create the potential for conict. Whether motivated by inse­curity or owing to a lack of experience and an underdevel­oped skill set in working with management-level leadership, this inexperience can lead to friction within residency teams—both among faculty members and between faculty members and residents.
One author, who transitioned from early career practice to a role in residency faculty, reected on her initial challenges in this area, recalling that her rst few anonymous faculty evaluations by resident learners indicated a trend toward an overly critical or harsh manner of teaching. In her desire to teach with excellence and high standards, and owing in part to her own self-critical attitude and undercondence in her own clinical and teaching abilities, she tended to project unattainably high standards without simultaneously creating a supportive learning environment. Over time, she intention­ally practiced articulating what her learners were doing well
19 Faculty Recruitment: Best Practices
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when precepting cases in the clinic or bedside and sought to cultivate an awareness of the profound vulnerability of resi­dent learners who are generally only too aware of their own gaps in knowledge and skills and nd those deciencies in themselves threatening or scary. In so doing, she was able to soften her expectations, without lowering them, in light of this awareness of learner insecurity. Such self-reection, especially considering any feedback received, can aid new graduate faculty members in balancing critique with support.
Another challenge for more junior faculty members is the lack of lived clinical experience. This can make it difcult for faculty to appropriately gauge levels of “alarm” in man­aging clinical conditions or to judge optimal follow-up rec­ommendations in patient care. At one extreme, a faculty member may have insufcient concern for true emergencies and fail to recognize the need for close-interval follow-up, further testing, or referral to a higher level of care. At the other extreme, a faculty member’s excessive anxiety around their own clinical uncertainty may risk a patient going for unnecessary testing, cumbersome follow-up schedules, or expensive referrals. All of this can make it hard for junior faculty to lend practical shading to their recommendations to learners. Additionally, newer faculty members may struggle to allow resident learners to have some autonomy in their medical decision-making; this is especially likely when pre­cepting patients “from a distance,” that is, offering indirect supervision such as in the ambulatory ofce. All this high­lights the need for ongoing faculty development aimed at clinical skill-building to effectively and supportively trans­late their own fresh clinical knowledge in learner-centered ways.
Particularly if staying in the same program after gradua­tion, a new faculty member may struggle with bridging the transition to a faculty role, perhaps because they nd them­selves more closely aligned with their resident peers than with faculty. It is not uncommon for a new graduate to feel reluctance in addressing former teachers on a rst-name basis. They may also have difculty being recognized as a peer by some senior faculty, or even other residents, with whom they worked while in training themselves. Often, time itself is a helpful antidote to this challenge and requires patience on the part of the junior faculty member. Such tran­sitions can be made smoother and less burdensome when a program director is able to recognize, name, and normalize this process in the context of routine faculty mentoring, in both individual and group settings. Based on their under­standing of what would best support resident needs in their own team culture, program directors may also choose to encourage their junior faculty to align with resident learners in their experiences, and even engage them at a peer level, instead of assuming a superior role according to their percep­tion of whatever traditional hierarchy “ought” to apply.
Residents frequently cite various benets of having recently graduated faculty, including reduced fear and intimidation, familiarity with resident-related concerns including board certication, licensure, and job searching, and the absence of generational differences.
Building thePipeline: Recruitment fromWithin
We know that programs can also “grow their own” when it comes to faculty recruitment and that such programs have a larger proportion of their own graduates on faculty when they focus efforts on internal recruitment, particularly if they have a faculty development or other clinical fellowship afli­ated with their program [16].
While the same challenges outlined above apply to these newly minted attendings, this approach can also have signi­cant advantages.
As graduates of the program, such faculty members are likely to have a deep sense of loyalty and ownership stake in the program’s success. They are likely to be trusted as a known entity in the program and, because of their longevity, are well-positioned to build on close relationships with other system stakeholders. They will have established connections with other clinicians, including consultants, hospitalists, and community-based family physicians, through committee ser­vice and clinical encounters over the course of their training. As an example, one writer rotated as a resident with a family physician not previously afliated with the program, and, because that attending had such a positive experience, she was interested in precepting with the residents and eventu­ally assumed a leadership role as core faculty with the pro­gram. Similar relationships developed at the program enabled expansion of rotations, ranging from medical and surgical subspecialties to women’s health.
When supporting faculty development for residents, it is good practice to explore and cultivate areas of their passion. Residents are able to create strong curricula when they work on things they are enthusiastic about; because they know what works within the institution, they can tailor trainings appropri­ate to a given level of learner, they will want to use their rela­tively limited free time for their passions, and they possess a beginner’s mind that allows for new levels of creativity and openness. Empowering residents to participate in curricular development initiatives helps build their faculty skill set and grow condence in their abilities while simultaneously keep­ing curricula fresh and learners engaged. Residents may also have specialty-specic interests (i.e., underserved care, wom­en’s health, sports medicine, hospital medicine) that align with the program’s identied areas of need in the faculty team. Alternatively, they may have developed particular skills (i.e., uency in a particular language, certication in performing