Models of Faculty Involvement in Primary Care Residency Teaching Clinics

Through site visits to 42 teaching clinics associated with family and internal medicine residency programs during 2013-2018, the authors observed a spectrum of faculty involvement. In this Perspective, they describe and share examples of the 3 faculty models they identified. Some programs have a small, focused faculty whose members spend at least 5 half-day sessions per week seeing patients or precepting residents in the clinic. Others have a large, dispersed faculty with many faculty physicians who spend 1 or 2 half-day sessions per week in the clinic. Some use a hybrid model with a small focused faculty group plus other faculty with little clinic time. The dispersed model was observed only in university-based residencies, and the focused faculty model was commonly seen in community-based residencies. While faculty in both settings must juggle multiple responsibilities, several studies have confirmed the value of having faculty committed to ambulatory care and teaching. In site visit interviews, clinic leaders indicated focused faculty play an important role in teaching clinics by championing clinic improvement, improving continuity of care, and enhancing the resident experience. Faculty physicians who spend substantial time in the clinic know the residents' patients, provide greater continuity of care, anchor clinic teams, and coordinate coverage for residents when they are on other rotations. Clinic and residency program leaders generally favored a shift toward a focused or hybrid model. The authors view the hybrid model as a practical way to balance the challenges of having a focused faculty with the multiple responsibilities facing university- and community-based faculty.