Roles and Relationships Between Family Medicine Faculty and Residents.

Abstract

Family medicine residency faculty occupy multiple roles with residents, including teacher, adviser, evaluator, and supervisor. Faculty also might fill noncurricular roles in social settings and in providing health care services to residents. These overlapping responsibilities create potential for dual relationships that may blur boundaries and cause ethical concerns. While national guidelines prohibit overtly inappropriate relationships, little guidance exists for common noncurricular interactions. This study examined the prevalence, types, and consequences of faculty-resident dual relationships and assessed faculty awareness of related policies. We conducted a convergent mixed-methods survey of US family medicine faculty that included demographic items, questions about specific dual relationships and policy awareness, and an open-ended prompt concerning boundary crossings. Quantitative data were analyzed using descriptive statistics and χ2 tests; qualitative responses underwent thematic analysis. We received 213 responses. Frequently reported dual relationships included social comingling (68%), provision of minor medical or behavioral services (54%), and personal relationships (36%); financial or contractual ties were rare (≤3%). We observed significant differences by faculty type: Behavioral health faculty were more likely to provide minor services (P = 0.004), while physician faculty more often provided intensive services (P = 0.011). Awareness of residency policies was low. Qualitative responses highlighted boundary crossings with negative impacts on residents, faculty, and programs. Dual relationships are common in family medicine residencies, yet policy guidance is limited. Stronger institutional and professional guidelines would support resident wellness, faculty objectivity, and professional boundaries.