STFMReview

The American College of Graduate Medical Education (ACGME) issued guidelines in 2019 lacking formerly required protected time for teaching and supervision by residency leadership and designated core faculty 1 . In contrast, 2018 STFM Member Surveys suggested that workload and administrative burden were the biggest challenges reported by faculty respondents  8 . In response to the lack of protected time, the STFM Graduate Medical Education committee proposed the creation of a taskforce to develop joint guidelines for protected non- clinical time for Family Medicine Residency faculty, associate program directors and program directors. The objectives of the task force included providing review committees the autonomy to define the amount of time faculty need to meet their administrative responsibilities and accreditation requirements while also devoting adequate time to preparing residents for practice.  The significance of the task force may best be u­­­­­­nderstood by the co...

The guidelines in this document address the allocation of protected non-clinical time amongst program directors, associate program directors and core faculty of family medicine residency programs. They are intended to represent best practices in this time allocation in order to ensure that programs have the appropriate time to devote to the non-clinical duties of training and educating residents. This ensures compliance with ACGME program requirements while also promoting innovations in education, faculty well-being and faculty retention. During the creation of these recommendations, the task force took into consideration the wide variety of settings and situations in which training for family medicine residents occurs. Our intention was to create recommendations that are applicable to program leadership and faculty across all settings and in programs of all sizes. They allow for flexibility in protected non-clinical time allocation by the program director in order to address the s...

The creation of these guidelines is intended for the use of family medicine residency programs, universities, health care systems, accrediting bodies, and sponsoring institutions. They are intended to guide decision making about protected non-clinical time for program directors, associate program directors and core faculty within family medicine residency programs to ensure best practices in educating and training future family medicine physicians.  

Non-clinical time  is time dedicated to duties other than those related to patient care. It does include time spent in duties classified as clinical time (as described below). Non clinical time may include, but is not limited to: ·        Membership on the Clinical Competency Committee (CCC)  ·        Actively fostering relationships in the management of multiple clinical sites  ·        Actively monitoring the quality of the clinical learning environment, including regular assessments of adequate clinical volume  ·        Serving as a representative on clinical quality committees that are external to the program  ·        Participating in the Annual Program Review as Chair or member of the Program Evaluation Committee  ·        Implementing and analyzing the outc...

Review of existing guidelines: Our team first reviewed the existing guidelines for protected faculty time.  The American Academy of Family Physicians publishes  Residency Program Solutions , a highly-regarded collection of consensus-based best practices for family medicine GME programs ­ (5).  Furthermore, the group reviewed guidance the ACGME formerly provided to Designated Institutional Officers (DIOs) with specified minimum time allocations for faculty and program director based on specialty-specific review committee recommendations prior to 2019 (4,  (Accreditation Council for Graduate Medical Education, 2018) . Literature search strategy: A literature review was conducted.  A search of Pubmed database with the terms [“protected academic faculty time” OR “Protected administrative faculty time” OR “Protected nonclinical time”] was performed.  Over 1000 results were returned and abstracts read for relevance.  The bib...

Protected non-clinical time must not include administrative duties related to patient care. Justification Girod et al note that competing time demands and lack of support for their scientific work are a top reason for academic faculty leaving practice (33).  Many clinical teachers similarly note that they do not feel they have sufficient time to teach ( Schiekirka-Schwake et al,  Huwendiek et al ).  In a 2014 cross-sectional study of US physician work hour distribution, Woolhandler and Himmelstein note that family physicians spent approximately 8 hours or 17% of their time in administrative work (Woolhandler and Himmelstein).  Studies examining both outpatient ( Sinsky et al, Young et al) and inpatient (Kara et al) time use note similar amounts of administrative work stemming from direct patient care or resident supervision.  This time, which we define as “spillover time” or “work after clinic” must be considered separately from protected noncl...

Associate program directors and core faculty may be part-time employees, at the discretion of the program director. These individuals must meet the minimum FTE requirements as stipulated by these guidelines. Justification Part time faculty demonstrate similar clinical outcomes and patient satisfaction levels when compared with full-time colleagues (Fairchild et al, Parkerton et al, McMurray et al, Darbar et al, Pannatoni et al).  One study indicates that department chairs generally approve of faculty choosing to work part-time as well (Socolar and Kelman).  Although patients are generally satisfied with part-time clinicians, it should be noted that, as would be assumed, patients experience longer wait times prior to an appointment (Margolius et al, Pannatoni et al).  Academic productivity is difficult to measure and literature comparing academic productivity of part-time faculty to full-time faculty is limited; however, part-time clinicians often have lower a...

Recommendation 3: The program director must have at least 0.5 FTE protected non-clinical time to devote to the administration of the program. Justification: Review of the 2018-19 ACGME Ads data shows that program directors have, on average, used 60-75% of their time in non-clinical administrative work.  The recommendations from the RPS - Programs of Excellence call out the need for protected time and discuss the opportunity to share the administrative lift among the associate program director(s). Review of other specialties shows a varied level of required time for non-clinical work but emergency medicine, pediatrics and internal medicine require 0.5 FTE.(4)  Emergency medicine identified increased tenure with increasing levels of support for administrative load.(12)  As we continue to innovate in our programs the need for protected time is crucial.  The article from 2005 discussing the implementation of core competencies is an example of how our progr...

Recommendation 4: The associate program director must have a minimum of 0.4 FTE protected non-clinical time to devote to the administration of the program. Justification Associate program directors are integral to the functioning of the residency program. The duties of an APD including resident education and evaluation, recruitment, mentoring, and shared program administration requires a significant amount of protected non-clinical time. Residency Program Solutions (RPS) highlights the need for faculty to have protected non-clinical time to the residency education independent direct patient care. The administrative burden due to clinical responsibilities often erodes protected non-clinical time and contributes to faculty burnout and attrition. 1,2,3 APDs are core faculty, but should have additional protected non-clinical time to share the increasing program administrative responsibilities and program leadership with the program director. A survey a pediatric APDs found the major...

Recommendation 5: Each program must have at least one associate program director. Programs with 25 or more residents require additional associate program directors (see table). Recommendation for Minimum Protected Non-Clinical Time for PD/APD Number of Approved Resident Positions Minimum PD FTE Minimum number of APDs Minimum protected APD FTE Additional protected FTE* Minimum aggregate of PD and APD FTE less than 12 0.5 1 0.4 0 0.9 13-24 0.5 1 0.4 0.1 1.0 25-49 0.5 2 0.8 0.2 1.5 50 or more 0.5 3 1.2 0.3 2.0 *The program director must assign this FTE to themselves or to the APDs to meet the minimum aggregate FTE Justification Even small programs require a significant amount of program administration and leadership which can be shared between the PD and APD. Larger programs will require additional associate program directors to share in the increasing administrative responsibilities.

Recommendation 6: In programs with 13 or more residents, the program director and/or associate program director require additional protected non-clinical time above their minimum FTEs dedicated to the administration of the program (see table).  The program director must assign this FTE to themselves or to the APDs to meet the minimum aggregate FTE. Recommendation for Minimum Protected Non-Clinical Time for PD/APD Number of Approved Resident Positions Minimum PD FTE Minimum number of APDs Minimum protected APD FTE Additional protected FTE* Minimum aggregate of PD and APD FTE less than 12 0.5 1 0.4 0 0.9 13-24 0.5 1 0.4 0.1 1.0 25-49 0.5 2 0.8 0.2 1.5 50 or more 0.5 3 1.2 0.3 2.0 *The program director must assign this FTE to themselves or to the APDs to meet the minimum aggregate FTE.   Justification The role of the APD is not as clearly defined as the program director. RPS recommends that APD and PD pr...