ship is interwoven throughout family medicine—it is devel­oped in a variety of settings and taught across numerous platforms. Successful leadership is intentional; it can be measured by several key factors: the ability to recognize and manage conicts in a timely manner with efciency, people, and productivity in mind, a desire to advocate for self and others, a keen understanding of self within the context of strengths and limitations, and the skillfulness to navigate complex systems—all while working within interdisciplin­ary teams and highly dynamic environments. For this rea­son, the eld of Family Medicine requires deliberate attention, and dedicated efforts to, faculty and resident lead­ership development.

patients, but also how to sustain—versus maintain, their indi­vidual practice working within larger systems that continu­ally demand so much of their time, energy, resources, and care [13]. Practitioners who are savvy in this regard can take care of, or at least address, peers’ needs when individual resilience or effective self-management strategies are not in place. The practice of developing appropriate advocacy mea­sures helps stave off physician burnout that is driven by a lack of control and autonomy, work quantity and pace, and satisfaction derived from the work itself [25]. Healthy boundaries (in the form of reasonable work hours, self­discipline practices, appropriate management of patient con­cerns, honing administrative efciencies, etc.) are important for physicians to start building proactively at the onset of their professional career as opposed to trying to implement measures reactively when problems are of epic proportions requiring more time and resources than are ideal.

tations for maintaining professionalism and adopted a behavior-based approach in meeting outcomes for residency which focuses on measurable behaviors such as giving and receiving clear expectations, feedback on performance, rein­forcement, emphasized through meeting milestones and competency markers [55]. Specic methods of teaching and evaluating professionalism appear later in this chapter.

Family Medicine residency programs integrate ACGME professional competencies into a longitudinal curriculum. Professionalism is made up of ve categories: (1) compas­sion and respect, (2) attentiveness to patient needs over per­sonal needs, (3) protection of privacy and self-determination, (4) accountability to the patient and the profession, and (5) ability to effectively work with a wide range of diverse patient populations [1]. These competencies form a basis for the residents to develop effective methods of interaction with patients and colleagues.

sidered an example of progressive development in the psy­chomotor domain of learning. It should be observed that, according to this model, prociency as a physician comes in stages that build upon one another. At the base is the need for a body of accurate, meaningful, medical knowledge. Without this, the development of later stages of performance would be compromised. Ultimately, the process will lead the physi­cian to take independent action in a manner consistent with the values and lessons taught through the curriculum. This is a progressive process and not one which can be rushed. The rst three stages of this model require the assistance of a teacher, mentor, and training team to ensure sufcient knowl­edge is transmitted, abilities are developed, and performance is monitored. There is a frequently used euphemism in medi­cal training, particularly in surgery, of “see one, do one, teach one.” Though the saying may be a little truncated, the underlying principle of active, practical, hands-on experi­ence to increase knowledge development and retention has long merit in training scenarios and models [36]. In fact, the principle is more accurately described by another statement, “see many, learn from the outcome, do many with supervi­sion and learn from the outcome, and nally teach many with supervision and learn from the outcome” [48]. Again, if we follow this train of thought, one of the central aspects to ensure expert skill acquisition, utilization, and promulgation is adequate and quality supervision.

Another well-known model of developing competence in any area of performance is the Dreyfus model. This model consists of ve stages: (1) Novice, (2) Advanced Beginner, (3) Competence, (4) Prociency, and (5) Expert [20]. This model has specic relevance to medicine and describes the growth and development ranging from the needs of freshman medical school students to learn the basic components of taking a quality medical history to the expert mid-career physician who has developed such recognition of patterns that “intuition” seems to guide their practice [7]. Recognizing how learners may develop through stages of knowledge and skill acquisition helps to ensure appropriate developmental practices are in place to challenge each member as they tran­sition into the next phase. The novice learns the basic com­ponents of more complex actions independent of situation with rigid boundaries in place while those with more pro­ciency can be challenged with novel situations to help hone their skills and develop their capacity to identify the most relevant aspects of the clinical situation. Development of expertise is largely based off implicit knowledge gained through experience, practice, and internalization of knowl­edge. This model is not without critics, who identify that skill acquisition could be based more on developing explicit knowledge and critical thinking skills which can be evalu­ated, rather than implicit knowledge and intuition which can’t [45]. Though credible alternatives exist to the postu­lates which follow from the Dreyfus model, overall the Dreyfus model supports competency based medical educa­tion (CBME) and self-evaluation of abilities [47].

There are numerous methods of teaching and evaluating pro­fessionalism within family medicine residencies. Below is a list of potentially useful activities: