Faculty Development in New and Emerging Rural Residency Programs Open Access

In 2019, the US Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORHP) began funding the Rural Residency Planning and Development (RRPD) awards¹  to aid rural communities in residency development. Barriers these new programs face include faculty recruitment, training, and retention.^2,3  One proven strategy for training and retention⁴  and to facilitate program success^3,5  is faculty development. This can be particularly challenging to implement for rural health facilities with thinner financial margins, lower academic infrastructure, and fewer preexisting local faculty development opportunities. Nevertheless, faculty development is a critical component to maintain accreditation and equip medical educators to be better teachers, administrators, and scholars. Understanding the opportunities available for rural faculty development can guide other rural health facilities, both hospitals and health centers, working to implement similar initiatives.

The objectives of this study were to characterize the types of faculty development activities and programs that new rural residency programs are using, to describe the structures of these programs, and to assess differences in faculty development, based on characteristics of these new residency programs, including specialty, region, size, and program structure.

All active RRPD grant recipients report annually to FORHP. These data were shared with the RRPD Technical Assistance Center (TAC), including members of the study team, for purposes of evaluating RRPD award outcomes.

We used fiscal year 2023 (FY23) report data because it is the largest sample size of grant recipients to date. It included 43 RRPD grant recipients across 4 award cycles. Data from FY23 included more extensive questions about faculty development than previous years, including questions about whether the program utilized structured faculty development training programs or other activities, followed by a series of questions about the composition of the various offerings, such as number of faculty trained (see Table 1 for specific variables). The FY23 performance report data were merged with data on grant recipient characteristics previously collected by the TAC, specifically program specialty, region, size, rural track structure, RRPD grant cohort year, and current program development score, which is a measure of progress toward an accredited and sustainable program, based on grant recipient quarterly self-assessment of a series of objectives across stages of program development informed by the previously published RRPD roadmap.⁶ 

“Structured training programs” and “other faculty development activities” were not further defined in the FORHP data so we defined “structured” programs as those with multiple, usually longitudinal, touch points and we determined that one-time workshops, trainings, and conferences should be categorized as “other activities.” With these definitions we recategorized 10 conferences from the “structured” into the “other activities” category and one “institute” from an “activity” to a “structured program.” We excluded 6 “activities” from one grant recipient that indicated they trained 60 to 100 faculty in training activities because these large numbers suggested they were providing training external to faculty in their program. The study team categorized each of the structured programs as local, regional, or national.

We characterized the descriptive statistics of the sample using Microsoft Excel and used SPSS Statistics 28.0 for bivariate analysis of faculty development offerings and characteristics of the new residencies, including specialty, region, size, rural track structure, RRPD grant cohort year, and program development score.

The study received an exemption determination from the University of North Carolina Institutional Review Board (22-0425).

We report on data from 43 grant recipients (“residency programs”); characteristics of the sample can be found in Table 2. Twelve of 43 residency programs (27.9%) indicated they had conducted no faculty development-related activities in FY23; the others are described below.

Among the 16 of 43 residency programs (37.2%) who reported structured faculty development programs, there were 178 total faculty who completed 32 unique faculty development programs (Table 1). Most (20 of 32, 62.5%) of the programs focused the majority of their time on developing competencies for educators (median=75% time), and these programs ranged from 15 minutes longitudinally (“weekly micro-learning”) to 416 hours (the Veterans Affairs Rural Interprofessional Faculty Development Initiative), with a median of 7 hours invested per faculty development program and a total time investment of 2238 hours. Most offerings were local (15 of 32, 46.9%) and included programs’ faculty development series, while regional offerings (7 of 32, 21.9%) included programs specific to a particular geographic area or an institution. Examples of national programs are noted in the online supplementary data. Additional summary data about the structured programs are included in Table 1.

Among the 22 of 43 residency programs (51.2%) that indicated they had a “faculty development activity,” there were 68 listed activities; most were professional conferences (52, 76.5%) and in-person “classroom-based” (51, 75.0%). Most residency programs listed more than one activity, and many mentioned the same offerings. Collectively, there were a total of 260 individuals trained over a total of 1931 hours. Specific data are included in Table 1.

Residency programs with lower development scores (mean score 48.25 vs 85.42 for those with faculty development, analysis of variance, P<.001) and in later cohorts (chi-square, P=.045) were more likely to report no faculty development. No other characteristics, including program specialty, region, size, or rural track structure were associated with quantity or type of faculty development and no characteristics were associated with number of faculty development offerings.

Residency programs that received RRPD grants are engaged in a variety of longitudinal and one-time opportunities for faculty development.⁶  These opportunities include a wide range of time investments, competency foci, and delivery modalities.

The Accreditation Council for Graduate Medical Education Common Program Requirements require faculty development annually to enhance the individual’s skills in education, evaluation, clinical care, quality improvement, and fostering well-being.⁷  Professional development is an important component for medical educators’ evolution into master adaptive learners with the ability to flex and customize teaching based on situational needs.^8,9  Studies show that faculty development improves faculty retention, and faculty attrition is directly linked to inadequate faculty development.⁴  Funding for faculty development is often limited, but given that recruitment for a clinician can cost more than $250,000 per faculty member,¹⁰  investing in faculty development is financially prudent. Private, state, and federal grants and scholarships are available to support faculty development.^11,12  For example, the University of North Carolina’s Faculty Development Fellowship secured HRSA funding for a Primary Care Training Enhancement grant¹²  which, over 5 years, has supported 18 community-based primary care residency educators in their professional development. Framing faculty development as a return on investment is a useful strategy for programs needing to enhance budgetary support.

For programs looking to implement or improve faculty development and in search of a pragmatic source of ideas, we compiled a list of the more commonly cited national opportunities, both in this study and in the work of our TAC team, shared as online supplementary data. New programs should consider their needs and resources as well as the available opportunities, particularly those available locally or regionally. Regional and national opportunities can consolidate time away and improve networking options. Longitudinal virtual options are less expensive and require less time away from clinical care but may lack networking opportunities. Specific programs also exist based on needs, such as to aid in the development of skills for a new program director or a faculty member overseeing a particular curricular area. Programs may want to consider an overall development strategy; for example, some may wish to give each faculty member specialized training while others may train one master educator to teach others.

Institutions that train nursing, pharmacy, and other allied health disciplines in addition to medical residents often provide multidisciplinary faculty development programs. Content from these programs can apply to rural residency faculty. The West Virginia University Health Sciences Teaching Scholars Program is an example of a well-established longitudinal development program that is open to faculty at the main medical center and community providers alike.¹³  Mountain Area Health Education Center is an example of a multidisciplinary training site that embeds faculty development as part of a robust continuing professional education program while serving rural Western North Carolina.¹⁴  Finding relevant programs, such as these that are simple to engage in, is an important goal for retaining and growing faculty at all stages.

Study limitations include data collection from a single fiscal year, lower representation from specialties outside of family medicine, a lack of data on total number of faculty to better compare the denominator, and an inability to characterize the value of faculty development programs to residency programs.

This study is, to our knowledge, the first to measure faculty development in rural residency program development. The results are generalizable to rural graduate health education, including rural nurse practitioner, physician assistant, and pharmacy programs. Future studies to address limitations of this report should include a multiyear review of a larger sample size as well as more qualitative assessments of the perceived value of faculty development activities and feedback from faculty and residents on the quality of faculty teaching after development programs.

New and developing residency programs in the RRPD program, regardless of program characteristics, are engaged in faculty development through a myriad of activities, including structured longitudinal programs as well as conferences and other one-time workshops and trainings.

The authors would like to acknowledge the RRPD Technical Assistance Center team, program advisors, and all others who have been involved in supporting the RRPD grantees as they start up new residency programs in rural places around the United States.

The online supplementary data contains common faculty development options for new and developing programs.

Disclaimer: The contents of this article are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the US Government.

Funding: All authors have part of their time funded by the Rural Residency Planning and Development Technical Assistance Center (RRPD-TAC), which provides technical assistance support to the RRPD grantees described in this article. The RRPD-TAC is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under cooperative agreement #UK6RH32513.

Conflict of interest: The authors declare they have no competing interests.