Education Columns

Gina G. Glass, MD, Inspira Family Medicine Residency Program, Woodbury, NJ

Many family medicine residency programs are undergoing challenging transitions with evolving health care systems and new accreditation requirements. Small, community-based programs often find it particularly difficult to overcome these challenges due to their limited number of faculty and lack of institutional resources. Faculty burnout can be a major concern, particularly in the current climate of family medicine residency faculty shortages.

Our 4-4-4 unopposed, community-based family medicine residency program had recently undergone the merger of our sponsoring hospital system, transition of our program leadership, and designation of our family health center as a FQHC. We are fortunate to have talented and dedicated core faculty members, but in order to re-energize our residency faculty and meet the challenges of our evolving program, we needed to maximize our functioning as a team.

A faculty survey to assess satisfaction with the current culture and to determine priorities for change identified the need for more protected faculty group time. This time was needed to discuss program issues, develop strategic plans, and monitor progress toward goals. Our monthly lunchtime faculty meetings no longer gave us sufficient time to address issues pertaining to both our residency program and family health center. We began by securing attending coverage for our hospital and outpatient services so the residency faculty could hold a day-long meeting. During this session, we re-focused our shared vision and determined priorities for faculty and residency development. We agreed upon the importance of regularly scheduled group time to follow-up on our progress, acquire necessary training, and decide upon next steps. Our first goal was to improve our evaluation of resident clinical competence while incorporating the milestones from the ACGME New Accreditation System. Our second goal was to develop a faculty peer feedback system.

Over the next several months, we held monthly half-day faculty work sessions. We researched best practices for the evaluation of clinical competence and agreed upon the implementation of regular direct observations during resident office hours. We decided to initially focus our feedback to one patient care and one communication skills milestone, adding other outpatient-oriented milestones as we became more comfortable with the process. Our goal was to perform at least one direct observation per precepting session, providing specific verbal feedback to the resident by the end of the session and documenting this feedback using Field Notes through our online evaluation system. We initially focused our efforts on our PGY-1s, with plans to expand to upper-year residents as our process became more standardized. At our monthly faculty sessions we assessed our progress, shared techniques we found effective, and brainstormed strategies to overcome barriers.

The implementation of peer faculty feedback challenged our faculty members to reach outside of our comfort zones as this had not been previously part of our faculty culture. However, we knew that constructive peer feedback was vital, not only for our individual professional development, but also for the strengthening of our faculty team. In addition, we wanted to role model the same willingness to be observed and receive feedback that we expected of our residents. As a first step, we began videotaping precepting encounters, simply with our personal smart phone cameras mounted on a tripod, focused on the preceptor. We each brought one videotaped precepting encounter to our next monthly faculty session for peer discussion using the One Minute Preceptor model as a reference point. The entire faculty responded positively to this first peer-review session and was very enthusiastic about continuing and expanding upon this initiative.

While we faced numerous obstacles with scheduling and coverage, this protected time together is now a program priority despite our limited resources. Our specific program initiatives are still a work in progress, but the most significant outcome has been the ongoing strengthening of our faculty team as we work together to improve the teaching and evaluation of our learners.