Bridging Roles, Building Teams: Resident and APP Collaboration in Outpatient Internal Medicine.

Abstract

The USA faces a worsening shortage of primary care physicians, increasing reliance on team-based models with integrated advanced practice providers (APPs). Yet internal medicine residency training has lagged in preparing trainees for this workforce reality. Most residents graduate without structured preparation for collaboration with or supervision of APPs within interprofessional teams, leading to uncertainty around roles and responsibilities. In this perspective, we describe the current landscape, barriers, and emerging models of resident-APP collaboration in outpatient internal medicine. Current practice is highly variable, with few residency programs including APPs in resident continuity clinics and limited guidance from the ACGME on interprofessional education. Barriers include discontinuous resident presence in outpatient settings, lack of supervisory training, hierarchical culture, residents' views on APP independent practice, and disparate APP scope-of-practice laws across states. Nonetheless, several innovative models demonstrate that deliberate co-learning can impact team functioning. To prepare residents for effective collaboration with APPs, we propose the following: (1) foster interprofessional teams, (2) cultivate leadership and supervisory skills among residents, (3) support APP colleagues as integral team members, and (4) implement curricula on interprofessional care. This resident training is essential to developing competent physician leaders for modern primary care.