15. Areas For Future Research

Several specialties, including family medicine, have released policy statements emphasizing the importance of protected non-clinical time.^1-3 However, much of the literature on this topic time are derived from low-quality studies from other specialties. A family medicine centered approach in future research on this topic is vital. There are a number of areas that should be explored in order to guide future recommendations: 

1) One of the goals of these recommendations is to reduce the growing issue of academic faculty burnout.⁴ Lack of protected non-clinical time is a common reason faculty leave academic medicine. Examining how these guideline changes impact faculty burnout and well-being is an important outcome that will need to be investigated.

2) Family medicine research and scholarly activity has increased over time, but a recent study showed only 15% of family medicine faculty actually publish.⁵ The 2019 ACGME guidelines added specific language on the importance faculty demonstrated scholarly activity (IV.D.2). Health systems and family medicine departments will want evidence on how these changes effect physician non-clinical productivity. Examining core faculty non-clinical productivity including scholarly activity will help provide help justification for adding specific protected non-clinical time. 

3) Learner outcome data like scholarly activity output and board pass rates will be important to analyze based on these guidelines changes. A 2018 systematic review and meta-analysis identified lack of time due to clinical responsibility as the biggest obstacle when implemented resident research.⁶ A 2011 national survey on family medicine residency scholarly activity showed that increases in resident scholarly activity requirements did not show increased scholarly output.⁷ Future research should focus on examining the effect of these guidelines on resident scholarly activity.

4) Another goal of protected non-clinical time is to enhance curriculum development, resident teaching, and mentorship. Resident feedback on the residency program and on individual faculty is important. Looking at the impact of the guideline changes on the residency program from the resident’s perspective is important.

5) Comparing the recommended protected non-clinical time vs. the actual protected non-clinical time will be important to examine how the recommendations are impacting actual faculty time.