Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2725_Библиотеки_им_академика_М_И_Перельмана.pdf
39 Time Management forFamily Medicine Program Directors
459
Once you have identied the projects you wish to pursue,
tackle them with focus and anxiety-free enthusiasm. While
multitasking can distract your focus, it is equally difcult to
focus and be efcient when your mind is distracted by visual
clutter. Clear your workspace of everything except that task
upon which you are actively working. The residency ofce
(and the home ofce) should be conducive to optimizing productivity. Good lighting, an ambient temperature, and appropriate ergonomics can also positively impact productivity.
Many utilize “to-do lists” to increase efciency and focus.
However, it is human nature to rst try to “knock off” the
easiest or least complicated tasks from the list. That often
results in postponing or never getting to the more complicated, but likely more important or impactful tasks. If the
easiest tasks are completed rst, by the time we do get to the
important tasks, we have less energy and time to devote to
them. Discipline yourself to do the most important tasks rst,
even if they will take longer and delay the gratication that
comes with checking off a simple item on the list.
Life Eciency
Exercise
Exercise is another critical cog in the pursuit of effective
time management. When one feels behind or overwhelmed,
often the rst thing to be cut is a regular daily workout. This
results in more lethargy, which further decreases productivity, and promotes feeling even more overwhelmed. This
vicious cycle can be reversed by scheduling regular exercise.
Exercise generates focus and energy, which increases efciency, and allows more time for exercise and health maintenance. Schedule your daily workouts the week prior as you
would any other meeting or obligation and protect that time
from being overscheduled. By deliberately plotting when
you will exercise each day, you can anticipate days that will
be more challenging to schedule. If you identify conicts
after work oneday, you know you will have to plan to get up
early and work out in the morning that day.
Look for opportunities to sneak in exercise. When I would
take my son to football practice each evening, a group of
parents would just be sitting in the bleachers waiting for
practice to commence. They would sit there casually socializing the entire two-hour practice so that they would be available to pick up their child as soon as practice ended. Instead
of joining them, I would pack a workout bag and walk around
the eld for the duration of practice. I was still present and
supportive, but simultaneously getting a workout. If not sitting with the parents feels isolating or antisocial, they can be
invited to join you in your exercise pursuits. If you always
have workout gear with you, you can capitalize on unexpected opportunities. If your last patient does not keep their
appointment, or a meeting is canceled at the last minute, you
can sneak in otherwise unplanned exercise.
If you have trouble committing to your workout plan,
consider scheduling with a friend or colleague who will hold
you accountable. My next-door neighbor and I meet at
5:30a.m. every morning to work out. I never feel like getting
out of bed that early in the morning, but I know that I must
because she will be standing in my driveway. Once I overcome that initial inertia, I enjoy the workout. It’s just getting
out of bed initially that feels insurmountable. Without the
obligation to meet her, I would just go back to sleep.
On days that you are not working professionally, consider
not showering until the end of the day. Rather than reecting
poor hygiene, this opens more options for you to squeeze
that workout into your day. Once someone cleans up for the
day, they are unlikely to commit to working out even if an
opportunity does present itself later in the day. Even if you
exercise rst thing in the day, if you remain in workout
clothes you are more likely to tackle other projects that might
require you to break a sweat, or even consider a second
workout that day.
Tracking your exercise also increases accountability.
There are so many ways now available to track your activity,
many of which have motivated people to become more
active. Even an “old-school” paper calendar will sufce if
you dene your exercise goals. For example, each day that I
work out for at least 30minutes or complete three miles, I get
a slash on that date. The goal is to get “the X” (the equivalent
of two slashes) every day. If I look back and see that I’ve
missed a day or two that previous week, I feel compelled to
add an extra workout. If I’m thinking of calling it a day after
ve miles, I might be motivated to go one more, just so I can
get the second slash. Find and use whatever system works for
you and your exercise routine. Sharing your workout goals
or participating in a home or workplace competition can also
enhance your accountability.
Lunch
Make a deliberate choice regarding your lunchtime. Some
enjoy a mid-day break to socialize and experience a change
of scenery. They may take a full hour to drive somewhere,
meet friends or co-workers, and order food at a restaurant.
However, others may prefer to use that time to work, so that
they can go home earlier or with more work completed.
There is not a correct choice, but it is an opportunity to be
intentional about time allocation. For those choosing the
latter, lunch can be prepared the evening before, while in
the process of cooking or cleaning up dinner. One can still
experience a lunch break, but simultaneously go through
mail or other mindless tasks. Most people do not need
60 minutes to consume enough calories to sustain them
until dinner.
460
E. Ringdahl
Organizing
Living an organized life allows you to control your environment, reduce distractions from clutter, and maximize your
efciency. It is easier to pick up your ofce and your home a
little bit every day and stay on top of things than to let things
get out of control and then devote a lot of time to organizing
or putting things away. Clear your desk before you end work
for each day and clear your home ofce or kitchen counter
before you retire each evening. With regular workouts, a lot
of laundry is generated. Likewise, it is easier to throw a load
in every day than to let the piles grow and then have laundry
consume the weekend. Fold clothes as you extract them from
the dryer, rather than throwing clothes in a pile to be sorted
and folded later.
Plan your meals for the week so that you only need to go
to the grocery store once a week. Electing to go to the grocery store multiple times a week wastes a signicant amount
of time that could be conserved with just a minimal amount
of forethought. Conrm the next day’s dinner menu the night
before, put out the appropriate pans/ingredients, and set the
table. It is less stressful to do it right before going to bed than
when you are transitioning from work to home at the end of
the day. Furthermore, if you are missing a key ingredient,
you now have the opportunity to change the menu or plan to
pick up what is needed on the way home. This amount of
preplanning and preparation also encourages a healthy and
relaxing dinner each evening, rather than scrambling to pick
up fast food on the way home at the end of the day. Healthy
eating generates more energy that in turn increases
efciency.
Life involves errands that must be run on a recurring
basis. Executing these errands in a haphazard fashion takes
more time. Have a running list of errands you need to do
each week. If you schedule a block of time to run errands,
start with the errand located the farthest distance from you
and work your way back home. Map out your stops to maximize efciency. If you have a running list prepared and nd
yourself with a small block of time, you can quickly and easily pick off one of your errands in your geographic location
to ll that time.
Extreme organizing can help you save time in the long
run. It may sound excessive to alphabetize your spices or
color code your closet, but those actions help you complete
mundane tasks more efciently, again generating time for
more important activities. If your spices are alphabetized,
you know right where to look when you need basil (right
between the almond extract and cayenne pepper) and spend
less time hunting in the cabinet. It is also easier to identify
ingredients you may need for future dinner planning.
Similarly, if you color code your closet you will more quickly
nd the outt you are looking for and it will take you less
time to get ready for work.
Summary
When you feel behind and overwhelmed, you lose focus and
energy. This means things take longer to do, which results in
you feeling more overwhelmed and behind. This vicious
cycle is hard to break. Guilt over poor time management and
uncompleted tasks kindles workaholism. Workaholics are
often committed to long hours and inefciency as that justies their existence. Reasonable hours with industry, organization, and anxiety-free enthusiasm can accomplish much
more in less time. Program Directors are stereotypically
hard-working overachievers. Therefore, a common pitfall for
this personality is also the devotion to long hours rather than
specic goals, which can develop into the long hours/exhaustion/inefciency cycle. Fortunately, this cycle can be
reversed. Good time management allows for guilt-free leisure, which then fosters health and energy for good time
management. Time management is not just about shortcuts
that reduce the quality or quantity of important work. It is not
just about getting through work quickly. Rather, optimal
time management involves identication of the most important events, deliberate allocation of the time to those events,
and fostering a lifestyle that generates focus and energy to
tackle these events efciently.
As with most things, time management should be
embraced with moderation and perspective. When my stereotypical “Type-B” son was home from college, I found
him in the basement playing video games. I asked him to
complete several tasks. An hour later I returned to nd him in
the exact same position. I regaled him with my efciency and
noted that I had completed ten tasks at the same time he had
completed nothing. He turned to me and said, “Yes, but I’m
a lot happier than you are.”
References
1. Taylor FW.The principles of scientic management. In: History of
economic thought books. McMaster University archive for the his-
tory of economic thought. NewYork: Harper & Brothers; 1911.
2. Covey SR. The 7 habits of highly effective people: restoring the
character ethic. Rev. ed. NewYork: Free Press; 2004.
3. Brown SR, Gerkin R. Family medicine program director tenure:
2011 through 2017. Fam Med. 2019;51(4):344–7. https://doi.
org/10.22454/FamMed.2019.730498.
4. Allen D.Getting things done. NewYork: Piatkus Books; 2002.
Part X
Special Issues to Consider
Starting aNew Program: Asking Good
Questions
IreneA.Gutierrez, BarbaraH.Miller, JodiL.Parungao,
andRandallLongenecker
40
Key Points
• Pathways for development of family medicine residency
programs differ and programs evolve in unique ways.
• Having a detailed blueprint to get started on the development of a family medicine residency program is less helpful than having a general framework that leads program
developers to ask key questions and allows them to analyze situations, compare to previously established
assumptions and priorities, and make rational decisions
about next steps.
• In starting a new program, commit to beginning well,
armed with a roadmap, relevant questions, curious minds,
a community-engaged and collaborative approach, and a
commitment to excellence, innovation, and continuous
program improvement.
• First, ask these questions, “Why are we doing this?” and
“What are the values that will inform our mission and
vision for the program?”
• The mission, vision, and core values statements are vital.
They will guide all other decisions as the program
develops.
I. A. Gutierrez (*)
College of Osteopathic Medicine, Touro University Nevada,
Henderson, NV, USA
e-mail: Igutierr2@touro.edu
B. H. Miller
Family Medicine Residency , Kansas City University-GMEC/
Freeman Program, Joplin, MO, USA
e-mail: bhmiller@freemanhealth.com
J. L. Parungao
Family Medicine Residency, Adventist Health Ukiah Valley,
Ukiah, CA, USA
e-mail: jparungao@longvalley.org
R. Longenecker
Ohio University Heritage College of Osteopathic Medicine,
Athens, OH, USA
e-mail: longenec@ohio.edu
• Utilize “appreciative inquiry” as an approach to strategic
planning, emphasizing discovery, understanding, and
innovation.
• Conduct a SOAR (strengths, opportunities, aspirations,
and results) analysis, as an alternative to a SWOT analysis, focusing on a positive approach to building the future
through collaboration, shared understanding, and a commitment to action.
• Before diving into the intricacies of program design, complete a comprehensive review of the Accreditation Council
of Graduate Medical Education (ACGME) requirements
for family medicine residency programs.
• The Association of Family Medicine Residency Directors
(AFMRD) is a rich resource for those engaged in the
development of a family medicine residency program.
• The program director is the linchpin connecting mission
and vision with execution and is the hub for partner
engagement.
• Administrative costs of starting a new residency begin to
accrue years before revenue appears from traditional
funding streams.
• Training the next generation of family physicians to be
prepared to signicantly impact the quintuple aim of
health care (improving population health, enhancing the
care experience, reducing cost, reducing workforce burnout, and advancing health equity) requires that programs
evolve on pace with the science of medicine, changing
demographics, quality of care metrics, and the social
determinants of health that affect patients and
communities.
Introduction
Despite a prescribed set of accreditation standards, there is
signicant variation among family medicine residency programs, including size of program, funding sources, community partners, and relationships with sponsoring institutions
© 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_40
463
464
I. A. Gutierrez et al.
and primary clinical sites. This can lead to conicting advice
when starting a new program. Developmental pathways for
programs differ and they evolve in unique ways. Having a
detailed blueprint to get started is often less helpful than having a general framework that leads program developers to
ask key questions and allows them to analyze situations,
compare to previously established assumptions and priorities, and make rational decisions about the next steps. The
key questions posed here are adapted from a Harvard
Business Review article, “The Questions Every Entrepreneur
Must Answer” [7].
Why Start aNew Residency Program?
Before identifying key collaborators, starting an accreditation application, writing curriculum and policies, or assessing current and future facilities, one must ask the questions,
“Why are we even doing this?” and “What are the values that
will inform our mission and vision for the program?”
Thinking about this more broadly, “Why do we need more
family medicine residency programs, and why in this place?”
Identifying your purpose in this huge endeavor will guide
everything else along the way; it will become your north star
or guiding light.
For a new residency program, mission and vision statements are vital. They will guide all other decisions as the
program develops in the early stages. A mission statement
describes the purpose of what is being done right now; in
contrast, a vision statement explains hopes for the future.
Building a mission and vision can begin in the traditional
way, with a strengths, weaknesses, opportunities, and threats
(SWOT) analysis, but we recommend an approach from the
strategic planning world called “appreciative inquiry.”
Appreciative inquiry is a more positive approach to organizational analysis and development, emphasizing discovery,
understanding, and innovation within organizations.
The SOAR model was developed as an alternative to
SWOT.SOAR is a “positive approach to strategic thinking
and planning that allows an organization to construct its
future through collaboration, shared understanding, and a
commitment to action.” [24] SOAR focuses on identifying
strengths, opportunities, aspirations, and results (Table40.1).
After completing a SOAR analysis, imagine how it might
look to realize your aspirations and see results in the next
12months of your journey. What will success look like in
ve and tenyears? List specic examples. Does this list have
an ongoing theme or shared commonality? If so, pick one
theme to highlight. As you keep the end in mind, think about
this outcome and how it relates to your broader vision and
mission. What is the residency program bringing to your
community? How does a highlighted theme relate to your
broader vision of healthcare in your community?
Table 40.1 The SOAR model
Framework Questions
Strengths What is going well in the current healthcare
landscape in our community?
Who is providing high-quality care?
What resources are available to patients in our
community that are underserved or vulnerable?
What would make our program unique?
What is the hospital doing well?
Opportunities What are the community needs?
Who are the most vulnerable patient populations
that have the least access to care?
How can we best meet the needs of our
stakeholders?
What skills do we need to meet these needs?
Aspirations What do we care deeply about?
Reecting on our strengths and opportunities, who
are we and who do we want to become?
What do we want our future to look like?
What strategies would support our aspirations?
Results How do we know we are doing well or succeeding?
Reecting on our strengths, opportunities, and
aspirations, what outcomes or measures would give
us an indication that we are achieving our goals?
Following is an example of meeting community needs
from the Adventist Health Family Medicine Residency
Program in rural Ukiah, California.
Example #1
We revamped our vision and mission in 2023 at a fall fac-
ulty retreat where we were rst introduced to the SOAR
model by leadership coach David Achata. He asked us,
“If someone on the street were to ask you what you want
to see in the future of your community, (how) would you
explain your vision in the simplest terms?” We came up
with: “Transform health in the Mendocino region.” For
a mission statement, he prodded us further and asked,
“What would you need to do to make that vision happen?”
We came up with: “Educate residents to engage with the
community and provide full spectrum rural healthcare.”
This exercise of working deeply through our strengths,
opportunities, aspirations, and results, then having to
envision these outcomes in 12months and distill them
into one common theme was challenging but enlightening. We found the common theme in our analysis was
high-quality care in a rural community. Our mission and
vision were framed around this organizing concept, and it
helped us to practically focus our broader vision and mission on the work at hand. ◄
Once the vision and mission have been established, focus
next on conducting a community asset and needs assessment
and collecting practical data such as current demographics
and health outcomes stratied by different populations in the
community, current quality metrics in the local and other
40 Starting aNew Program: Asking Good Questions
465
health systems, the number of physicians needed for the current (and future) population, and rates of social determinants
of health affecting your patients. These data will help answer
the questions, “What good is already happening?” and “How
will our residency program build on these assets and meet
these community needs?” What will be your program’s
unique niche?
Example #1 (continued)
Returning to the Ukiah example, in 2019 Mendocino
and Lake Counties had some of the highest adjusted rates
of drug overdose deaths in California, more than double
the state average of 19.6 deaths per 100,000 residents [9].
Our residency program partnered with existing local initiatives to address substance use disorders in Mendocino
County. We developed partnerships with the local homeless shelter Building Bridges and the local needle
exchange program Mendocino County AIDS and Viral
Hepatitis Network to develop a Street Medicine Clinic.
Within this special clinic, the residents provided primary
care, treated hepatitis C, and provided low-barrier
medication- assisted treatment (MAT) for unhoused
patients and other vulnerable groups. This has been an
impactful educational experience for the residents, making a difference in the local community and providing
services to an under-resourced population in a small rural
community that are likely sustainable and long-lasting.
This program has evolved into a focused Street Medicine
Accelerated Resident Track (SMART), allowing two residents per year to dedicate hours in the Street Medicine
Clinic and develop a community medicine project focused
on this vulnerable population. This track is unique to our
residency and has given us a niche as perhaps the only
residency in the country with a track focused on unhoused
populations. ◄
What are other potential benets of starting a new resi-
dency program? Teaching hospitals tend to have higher quality overall when residents are providing care for patients [5,
14, 22]. Residency programs, faculty, and residents are often
quality improvement and population health-focused with
some programs emphasizing community medicine in their
curriculum. Residency clinics are often primary sites of care
for the under-resourced in the community. Residents often
provide inpatient care to unassigned patients and rapid
response coverage in the hospital. Faculty often participate
in institutional committees and play leadership roles within
the system and community. Residency programs are often
“early incubators” for new innovations [12].
Starting a new program can address widely projected
shortages of primary care physicians. The AAMC published
a report “Physician Supply and Demand, A 15-Year Outlook:
Key Findings,” which projected that by 2034 demand for
physicians will exceed supply by 37, 800 to 124,000 fulltime- equivalent physicians [4].
Residency programs often lead to recruitment of residents
directly into the local health care system through (1) low barrier entry (i.e., residents already familiar with the EHR, consultants, and community resources), (2) access to early
incentives (i.e., bonuses during residency training), and (3)
savings in physician recruitment of an out-of-town physician, which may cost a minimum of $50,000–100,000 per
physician [23]. Studies have shown that location of residency
is one of the best predictors of location of future practice
[21]. The presence of residents tends to attract specialists and
other health professionals to an area, and medical students
are often introduced to communities, institutions, and physician practices through rotational experiences at residency
programs.
Exploring mission and vision, values, community capacity, assets and needs, strategies for recruitment and retention,
and improving quality of care can lead to other benets in the
future. Although often underappreciated, knowing the core
values and benets of your residency program can strengthen
future negotiations and talks with sponsoring institutions and
other key partners in creating a robust program. Articulating
these benets and showing non-nancial value will go a long
way in creating buy-in and support in initial development
and in further building a new program. It can very well
“make or break” collaborative relationships with key partners. Doing thoughtful strategic planning PRIOR to detailing
the logistics of implementation will set the program up for
success.
Where Do WeStart?
The journey of starting a new residency program is a multifaceted endeavor that demands careful planning, strategic
vision, and meticulous execution. Explore the resources
available to help (Table40.2). An architect of such a groundbreaking initiative should consider a comprehensive roadmap as a guiding framework for the program’s inception and
sustainable growth [13]. This roadmap encompasses a series
of interconnected pieces, each crucial to the overall success
of the program. From the foundational steps of exploration
and community engagement, capacity and needs assessment,
and accreditation gap analyses to the intricate details of faculty recruitment and curriculum design, each piece plays a
vital role in shaping a residency program that not only meets
the highest standards but also fosters a nurturing environment for the professional development of future healthcare
physicians.
Before diving into the intricacies of a new program, complete a comprehensive review of the Accreditation Council
of Graduate Medical Education (ACGME) requirements
466
Table 40.2 Resources available when starting a new family medicine residency program
Source What is available Links to resources
American Academy of Family
Physicians (AAFP)
American Board of Family
Medicine (ABFM)
American Osteopathic Board of
Family Physicians (ABOFP)
Accreditation Council for
Graduate Medical Education
(ACGME)
Association of Family Medicine
Residency Directors (AFMRD)
Rural Graduate Medical
Education
Society of Teachers of Family
Medicine (STFM)
Teaching Health Center Graduate
Medical Education
Residency Leadership Summit
Educational resources (educational resources, curriculum
guidelines, expert consultation, etc.)
Requirements for initial board certication after residency
(includes guidelines for resident leave, advanced placement
credit, etc.)
Requirements for initial board certication (osteopathic
physicians only)
Accreditation documents
Frequently asked questions
Family medicine milestones 2.0
Educational resources for PDs, faculty
Journal of Graduate Medical Education
Member Forum
PD Toolbox
National Institute for PD Development
Tools for program development
Funding resources
Educational resources for PDs, faculty https://stfm.org/
Tools for program development
Funding resources
https://www.aafp.org/events/residencyleadership- summit.html
https://www.aafp.org/students- residents/
residency- program- directors.html
Available free to the public
https://www.theabfm.org/become- certied/
resources/
Available free to the public
https://certication.osteopathic.org/
family- physicians/certication- process/
family- medicine/
Available free to the public
https://www.acgme.org/
Many resources free to the public
https://www.afmrd.org/home
Membership is required for most resources.
https://ruralgme.org/
Free access, but requires registration.
Membership is required for most resources.
https://www.thcgme.org/
Free access, but requires registration.
I. A. Gutierrez et al.
(https://www.acgme.org/globalassets/pfassets/programre-
quirements/120_familymedicine_2024.pdf). Aligning your
mission with ACGME requirements is crucial. Navigating
the labyrinth of a new program application adds another
important layer of complexity. Scrutinizing the application
requirements, deadlines, and any additional requisites
ensures a smooth and successful application process.
Developing a timeline that incorporates the deadlines for the
ACGME Family Medicine Review Committee meetings can
be constructed in consultation with the Family Medicine
Review Committee’s Executive Director. Moreover, delving
into ACGME frequently asked questions (FAQs) for family
medicine residency programs (https://www.acgme.org/glo-
balassets/pdfs/faq/120_familymedicine_faqs.pdf) provides
valuable insights into common concerns, claries uncertainties, and leads to a deeper understanding of the ACGME’s
expectations.
Joining the Association of Family Medicine Residency
Directors (AFMRD) proves to be an invaluable step for those
engaged in the development of a family medicine residency
program. This membership offers a unique platform that
brings together seasoned program leaders and peers who
share a wealth of collective knowledge and experiences in
family medicine education. As a member, individuals gain
access to a supportive network of experts who can provide
insights, guidance, and practical solutions to the myriad
questions and challenges that arise during the developmental
phase. The AFMRD facilitates collaboration and information
exchange through conferences, workshops, and online
forums and listservs, fostering an environment where the
collective expertise of its members becomes a valuable
resource for addressing the intricacies of curriculum development, faculty recruitment, accreditation processes, and
other critical aspects of residency program creation. A new
program director should also consider applying for the
National Institute of Program Director Development
(NIPDD) fellowship (https://www.afmrd.org/
nipdd- faculty- the- academic- council).
Crafting an effective program design in establishing a
new family medicine residency program requires careful
consideration of educational goals, clinical experiences, and
overall curriculum structure. The program design should
align with the mission and vision of the institution while
building on the assets and addressing the unique needs of the
community. The following is an example of this alignment
from a rural-suburban, community-based program in Joplin,
Missouri, at the Kansas City University-GME Consortium/
Freeman Family Medicine Residency.
Example #2
Assessing our community’s needs led to a strong program focus on achieving high levels of competence in
managing behavioral health disorders. Joplin’s rate of suicide mortality is 22.7 per 100,000, greater than the Ozarks
40 Starting aNew Program: Asking Good Questions
467
region, the state of Missouri, and the United States [19].
There has been a 4.4% increase in suicide deaths per year
for the state and a 5% increase in the number of Medicare
beneciaries diagnosed with depression. Emergency
department visits involving opioid-related diagnoses are
257% higher than the benchmark [1]. To equip our graduates to meet these needs, residents are learning to manage
complex psychiatric diagnoses, including those in special
populations such as children and adolescents, and
evidence- based treatment of substance use disorders. ◄
As new programs move forward in development, strategic
goals must be established. A well-dened implementation
strategy should marry the vision and aspirations of the program’s leaders and where they see the program going with
the community’s assets, capacity, and needs, the specic
requirements of the ACGME, and the work of the clinical
organization. At its best, the new program’s design will align
with the strategic planning of the academic and clinical
health system by expanding access in locations that will
meet community health needs [3]. The program design needs
to be specic enough to guide activity, and exible enough to
adapt when changes are necessary.
As design begins in earnest, it is important to address
governance, gaps in meeting accreditation requirements,
and how to optimize available funding [16]. Who will
identify and appoint a program director? Who will oversee preparing the application, and preparing for site visits? A program director with prior experience may be fully
capable of completing the application, but someone new
to the role will likely need signicant help from experienced personnel within the sponsoring institution or the
primary teaching site. Who will help with the application
review process? It is important to establish a practical
application timeline. Setting unrealistic timelines for program development and accreditation may lead to rushed
decision-making and compromise of the quality of the
program.
Who will contribute to an overall educational map, determining how the program is teaching and assessing each competency in the various clinical learning environments and
over time? Who will plan the curriculum, including clinical
block rotations, didactic teaching, board review sessions,
and longitudinal curricula?
Who will be included in the educational team? A family
medicine program requires core faculty who are boardcertied/eligible in family medicine, as well as several different specialist physicians to host residents in clinical
rotations. Recruiting faculty with insufcient experience in
both clinical practice and medical education can compromise the quality of instruction. A lack of diversity in faculty
members may limit the program’s ability to provide a wellrounded educational experience.
The incorporation of diverse clinical settings, ranging
from outpatient clinics to hospitals and long-term care settings, ensures exposure to the breadth of family medicine.
The curriculum must promote continuity of care, allowing
residents to follow patients over time and manage a broad
spectrum of medical issues. Integration of behavioral health,
preventive medicine, and community-based care further
enriches the educational experience. Fostering a culture of
interdisciplinary collaboration and patient-centered care
within the program design instills essential skills and values
in residents, preparing them not only as competent clinicians
but also as compassionate and community-focused healthcare providers. But all of this cannot be done alone.
Who Needs toBeInvolved?
The successful inception of a residency program requires a
strategic orchestration of visionary program founders, dedicated sponsors, and core faculty members. It should begin
with establishing a core leadership group that meets regularly and often. Engaging prospective residents, clinical partners, community representatives, and experts in medical
education are imperative in shaping a program that not only
meets educational standards but is also responsive to the
evolving needs of both the medical professionals it trains and
the communities it serves. In the following section, we
describe the pivotal roles of all partners (used in this chapter
to describe all parties invested in the program’s success),
their unique contributions to the foundational stages of a
family medicine residency program, and the importance of a
collective commitment to excellence in medical education.
Taking a page from the literature on community engagement,
we suggest starting with the most historically and/or economically marginalized groups and keeping the end in mind
[25]. Engaging all collaborators does not need to be done in
sequence. It should occur in parallel and grow in an iterative
fashion (Fig.40.1).
The active involvement of Community collaborators and
eventual creation of a community advisory council is key to
the development of a family medicine residency program
that is not only academically sound but also deeply connected to the unique assets and needs of the communities it
serves. Engaging community representatives, healthcare
organizations, and local leaders ensures that the program
aligns with the specic health challenges and priorities of the
area. Community collaborators provide valuable insights
into cultural considerations, socioeconomic factors, and
prevalent health disparities, shaping the program to be culturally competent and socially responsive and, especially for
family medicine residencies, contributing to the program’s
sustainability. Furthermore, the process of community
engagement sets a tone and fosters collaborative partnerships
468
Corporate Leadership
• Chief Executive Officer
• Chief Medical Officer
• Strategy and Chief
Operations Officers
• Chief Financial Officer
• Legal Advisors
•Technology Director
Clinical Partners and
Facilities
•Family Medical Practice
• Hospital
• Community Faculty
Fig. 40.1 An emerging community of collaborators
Community
• Individual Patients
• Local Community-based
Organizations, Public
Health, and Governing
Bodies
No one group or collaborator is
at the center; mission, vision,
and relationships are at the
center
Founders and Sponsors
• Sponsoring Institution or
Affiliated Medical School (if
separate from corporate
leadership)
•Philanthropic Organizations
I. A. Gutierrez et al.
Learners
• Medical Students
•Residents
•Interprofessional Students
Program Leadership
•Program Director
•Residency Coordinator
•Core Faculty
between all collaborators, creating a network that enhances
the practical training experiences for residents, becoming an
integral part of the local healthcare ecosystem. It contributes
to improved access, community health education, and a more
profound understanding of the social determinants of health.
This collaborative approach not only strengthens the program’s impact but also reinforces its commitment to producing family physicians who are attuned to the specic needs
of the communities they serve. It also contributes to the sense
of community ownership that assures sustainability.
The inclusion of Patients in the development of a family
medicine residency program can be transformative and
enrich the educational experience for future healthcare physicians. By actively engaging patients in the planning process and subsequent implementation, the residency program
gains valuable insights into the patient experience, preferences, and expectations. Involving patients in the development of the curriculum helps instill a patient-centered
mindset important to patient care in aspiring family medicine
physicians, fostering empathy, cultural competence, and a
commitment to personalized care.
For family medicine in particular, the engagement of
Learners, especially medical students as future residents, in
the development of the program is a strategic and forwardthinking approach that ensures the program resonates with
the expectations and aspirations of the next generation of
healthcare professionals. Involving them and their perspectives in the planning phase allows program developers to tap
into their rsthand experiences, preferences, and insights in
the evolving landscape of medical education. Medical stu-
dents can offer valuable input on curriculum design, clinical
rotations, and the support structures that contribute to a positive and effective learning environment. Furthermore, their
involvement fosters a sense of ownership and investment in
the program, raises the visibility of the program in future
recruitment, and creates a seamless transition from medical
school to residency.
At the heart of establishing a successful residency program is the pivotal role played by the residency Program
Director. Serving as the linchpin connecting vision and execution and as a hub for stakeholder engagement, the program
director, even if only an acting program director or “program
director in development,” can bring a wealth of experience
and expertise to the developmental phase. The Program
Director spearheads the recruitment of faculty members,
ensuring a team that not only possesses clinical excellence
but also shares a commitment to the program’s educational
philosophy. Beyond administrative duties, the best program
directors cultivate a positive and supportive learning environment for residents. By actively engaging with the
ACGME, the Program Director guides the program through
the rigorous accreditation process, ensuring compliance with
national standards.
The role of a Program Coordinator is also integral to the
development of a new residency program. Program coordinators can bring organizational expertise and develop a deep
understanding of the administrative intricacies involved in
establishing a residency. From the initial planning stages to
the program’s implementation, coordinators are instrumental
in coordinating logistics, managing timelines, ensuring com-
40 Starting aNew Program: Asking Good Questions
469
pliance with accreditation standards, and serving as liaisons
between program leaders, faculty, and various collaborators,
facilitating effective communication and collaboration.
Program coordinators are key to the recruitment processes,
helping select qualied faculty and supporting the onboarding of administrative staff. As a backbone for administrative
functions, program coordinators contribute to the smooth
operationalization of the residency, allowing other collaborators to focus on educational and clinical aspects. A residency
coordinator with attention to detail and commitment to
compliance ensures that the new family medicine residency
program is well-positioned for success from its inception.
Faculty Members are important architects in the development of a thriving family medicine residency program. The
multifaceted role of Core Faculty encompasses shaping the
educational framework, crafting the curriculum, and imparting invaluable clinical knowledge to aspiring family medicine physicians. Beyond their role as educators, faculty
members contribute signicantly to the program’s ethos,
infusing it with their diverse clinical experiences and perspectives. Their commitment to fostering a culture of continuous learning and scholarly activity elevates the program,
creating an environment where residents not only acquire
essential clinical skills but also cultivate a deep understanding of the humanistic aspects of patient care. Faculty development is important well before the residency program
starts.
Clinical Partners and Facilities are indispensable in the
development of a robust family medicine residency program
and extend beyond providing physical spaces for clinical
training. They represent collaborative alliances that expose
residents to diverse patient populations and a broad spectrum
of medical cases. The integration of clinical partners ensures
that residents gain practical, real-world experience, honing
their diagnostic and patient management skills. Through
these collaborations, residents are exposed to various practice settings and specialties, enhancing their adaptability, and
preparing them to meet the diverse healthcare needs of
communities.
Program Founders and Sponsors stand as a critical cornerstone in the development of a robust and sustainable family medicine residency. Often visionary individuals or
organizations, they play an important role in conceiving and
further developing the program’s mission, vision, and overall
objectives. Their commitment to addressing healthcare needs
within the community can provide an important driving
force. Sponsors, whether hospitals, academic institutions, or
healthcare systems, contribute essential nancial and logistical support necessary to the program’s viability. From securing funding to determining the program’s overarching vision,
the active involvement of program founders and sponsors
can set a trajectory for a family medicine residency that is
not only academically rigorous but also aligned with the
broader healthcare landscape it aims to serve.
Involvement of the healthcare entities’ C-suite, including
Chief Executive Ofcers (CEOs), Chief Medical Ofcers
(CMOs), and other high-ranking executives, is essential in
the development of a family medicine residency program.
Their leadership and strategic vision, or lack thereof, can signicantly impact the success and sustainability of the program. Executives at the C-suite level bring a comprehensive
understanding of the healthcare organization’s mission, values, and long-term goals. Their involvement increases the
likelihood that the residency program aligns seamlessly with
broader organizational objectives, fostering a collaborative
relationship between education and clinical service delivery
and playing a crucial role in securing nancial support and
resource allocation for the residency program.
By actively engaging Chief Financial Ofcers (CFOs)
and nance teams from the outset, the residency program can
establish a solid nancial foundation, mitigating potential
challenges, aligning nancial planning for the institution
with the program’s educational goals, fostering an environment conducive to scal responsibility and sustainability,
and facilitating a resilient and thriving family medicine residency. They play a key role in budgetary planning, ensuring
that the program’s nancial framework is transparent,
accountable, and compliant with regulatory standards.
Moreover, the nance team needs to collaborate in mutual
problem-solving with program leaders, assessing the economic feasibility of the residency, and considering factors
such as faculty compensation, administrative costs, and
investment in technology.
In an era of stringent healthcare regulations, Legal and
Regulatory Experts play a necessary role in ensuring compliance with legal requirements, licensure standards, and
government payors. Legal experts guide program founders
and directors through the intricacies of state and federal regulations, addressing issues such as contractual agreements,
liability considerations, and the establishment of ethical and
legal frameworks for medical education. Regulatory experts,
on the other hand, can help the program align with the stringent standards set by bodies such as Joint Commission, the
State department of health, and the local zoning commission,
among others.
The active involvement of Quality Improvement Teams is
paramount in all phases of a residency program. These teams,
comprised of experts in healthcare quality, process improvement, and outcomes measurement, bring a systematic and
data-driven approach to rening the program’s structure and
function. From the outset, quality improvement teams can
collaborate with program leaders to establish measurable
objectives and program evaluations, assess existing processes, and identify areas for enhancement.