A long history of general practice existed around the world when family medicine first emerged as a medical speciality in the 1960s.¹ Over the last 50 years, the discipline has grown and expanded, and is now recognised as a distinct medical speciality in many countries.² Family medicine plays a pivotal role in healthcare systems worldwide, providing comprehensive and patient-centred care across the lifespan.³ With its broad scope and focus on continuity of care, family medicine demands a unique skill set and a multifaceted approach to healthcare delivery. In some countries, the speciality is known as general practice, while in others, it is referred to as family medicine. In this article, we will utilise the term family medicine for both.⁴

In each country where it is practised, family medicine takes on a slightly different form in its training requirements and ultimate practice models. In countries where family medicine is recognised as a speciality, physicians spend 2–4 years in training after completing graduate studies. In other countries where family medicine is not formally recognised, generalist physicians are often regarded as family medicine physicians in their scope of practice. In some regions, family medicine is primarily an outpatient discipline, focusing exclusively on patient care through clinics. In others, family medicine provides surgical obstetrics and general surgical services within their communities.² Even within the same nation, two family medicine physicians may have very different scopes of practice.

Family medicine encompasses all the tenets of primary care and, therefore, forms a foundational element in primary health care-based models aimed at achieving universal health coverage.^4,5 As the importance and geographic reach of family medicine continue to grow, it is imperative to examine the foundational components that shape its quality and effectiveness, recognising the variations in ultimate practice. One critical aspect in this is the professional development of family medicine faculty – the educators and mentors responsible for shaping the next generation of family physicians.

Faculty development practices in family medicine, as in other medical specialties, hold the key to maintaining the highest standards of care, adapting to evolving healthcare needs, and advancing research and innovation. A few regional surveys have previously examined the resources for and roadblocks to family medicine faculty development.^6,7 One previous literature review has summarised the specific activities that comprise family medicine faculty development globally.⁸ At least three countries offer faculty development models informed by their national contexts.^9,10,11 The structures and outcomes of discrete faculty development programmes in family medicine within local and regional contexts have been published.^12,13 Yet, many family medicine training programmes, as well as national and regional professional bodies, lack a framework to identify and respond to faculty development needs. The World Organization of Family Doctors (WONCA) has recognised the value of such frameworks in the past, developing global standards for undergraduate and postgraduate education, as well as continuing professional development in family medicine.^14,15,16 These standards may serve as a scaffold that can be further adapted to meet the needs of individual national and regional contexts.

However, while there has been significant research into medical education and faculty development in various fields of medicine, there is not yet a comprehensive, global framework that specifically defines needed skills and approaches for educators in family medicine, recognising the variation that exists in clinical practice where graduates may go on to engage in different settings. Strengthening faculty development aligns with global and regional priorities for universal health coverage, as family medicine educators play a pivotal role in preparing clinicians to deliver comprehensive, community-based care.

This study aims to contribute to the body of knowledge that shapes the future of family medicine and its role in healthcare globally by establishing consensus on a common core of skills and principles in family medicine faculty development. It focuses on both the philosophical tenets and the technical components essential to family medicine educators.

An initial list of 32 family medicine faculty with experience or interest in faculty development was generated as described above. Four experts from each WHO region were invited to comprise an initial expert panel. If we had no initial response to our invitation or an invited expert declined, and we had another expert on our list from that region, we extended additional invitations. In total, 23 of those 26 (88.5%) invited agreed to participate in the study. Of those who initially agreed to participate in the Delphi panel, the response rate was 21 out of 23 (91.3%) to the first-round survey. Those 21 respondents were then invited to participate in the second round, and 17 of them (81%) responded (Figure 1). The demographics of the participants are shown in Table 1.

One participant requested a Spanish version of the survey, which we developed using a professional translator; responses were given in Spanish. The rest of the surveys were conducted in English.

In the first round of the Delphi study, participants were asked to prioritise skills, competencies and characteristics of a family medicine educator. Some items stood out as clearly higher priorities, and others as clearly lower, but the majority had no clear consensus on ranking. Based on the results of the first round of the Delphi, a proposed classification of some items in the framework was classified as higher/lower priority for round 2. However, at the end of round 2, no consensus was reached on how to prioritise various elements, and many respondents expressed that the prioritisation of elements in one setting might not accurately reflect the needs of another. Given this, prioritisation of different elements within the model was removed.

Additionally, participants in both rounds of the survey provided open-ended feedback regarding missing elements from the framework. Several of the overarching themes identified in the analysis, with representative quotes, are shown in Table 2. These themes were used to expand and modify the initial framework.

After two rounds, agreement was reached that the final model (Table 3, Table 4 and Table 5) captures the key elements of skills, competencies and characteristics of a family medicine educator. When asked if this model would be helpful to the respondent in identifying faculty development needs among an educator team, 15 out of 17 (88.2%) said yes, 0 out of 17 said no, and 2 out of 17 (11.8%) of respondents were unsure.

The final model conceptualises the key elements of family medicine faculty development in three separate domains, ensuring that: (1) a family medicine educator is able to do the tasks required of an educator, (2) their approach is informed by knowledge of systems and principles of practice, incorporates professional skills and professionalism and reflects analytical skills and the ability to research effectively and (3) they effectively serve as a professional role model through their own roles as a clinician and educator and self-directed personal development (Figure 2).

Family medicine is a unique medical speciality for many reasons. Family medicine physicians serve as front-line primary care providers, capable of providing holistic, integrated, patient-centred, continuous care across the lifespan. In many regions of the world, family medicine physicians provide that care across a variety of settings, from outpatient clinics to emergency rooms, inpatient hospital rooms, intensive care units and obstetrical and surgical wards.

Beyond these clinical settings, family medicine physicians often play a public health role, working to address distal socioeconomic, cultural, environmental and political determinants of health in their communities. They do this through partnership with community leaders and public health teams. Because of the wide range of roles that family physicians play and the diverse settings in which they practise, a framework for faculty development for family medicine educators must incorporate unique skills that extend beyond those of clinical educators in other specialties. This is particularly true with emerging threats from climate change, such as disease outbreaks, that call for a versatile and adaptable workforce.

When asked what was missing from existing models for clinical educator faculty development, respondents highlighted the unique philosophical approach of family medicine. As a medical speciality grounded in the spirit of generalism, family medicine educators are uniquely positioned to provide clinical education informed by the principles of community and public health, contextualised in an understanding of health across the lifespan and whole person care.²⁵

The family medicine faculty development experts whose expertise is reflected in this Delphi study represent this range of experience. Their alignment on the final elements of this framework suggests that the model is adaptable enough to be applied in different academic and community settings where family medicine education occurs. The framework is large and intentionally excludes prioritisation of elements, recognising that the prioritisation of different skills, knowledge, approaches and professional characteristics expected of the family medicine educator may differ depending on the setting in which they practise. In the United States and Canada, family medicine faculty development frameworks have been developed based on national priorities and needs. This new, globally developed framework offers a scaffold for family medicine academic units in a broad range of settings, facilitating prioritisation based on local/regional needs. We anticipate this will be particularly helpful as a starting point in places where no such framework exists.

This model outlines the philosophical tenets, technical components, and interpersonal competencies essential to family medicine educators, achieved through a gradual progression, from first focusing on technical skill acquisition to higher-level development of the educator as a role model. However, these may occur (and be facilitated) simultaneously in all three core areas.

Family medicine academic departments, community-based training programmes and individual practising family medicine preceptors and mentors in various settings across the globe may utilise this model to ensure quality and expertise. Educators may also utilise this framework as a tool for self-assessment to identify areas for needed professional development. Importantly, this framework is not intended to be a checklist of every aspect of knowledge, skills or expertise that every individual family medicine educator must have. The educators who train future family medicine physicians are as diverse as the speciality itself. A family medicine department or academic unit may utilise this framework to assess their entire team of educators and identify gaps in knowledge and/or expertise. Academic units and even family medicine professional associations may utilise this model to guide the creation of family medicine faculty development programming.

This study does have its limitations. The inclusion criteria limited participants to mid-to-late career family medicine faculty, excluding early career or recent family medicine graduates who may have been able to define their own needs better than existing ‘experts’. Additionally, there was some attrition of survey participants throughout the study, and it is possible that there was something unique about the knowledge and/or expertise of those participants. However, given the high response rate overall (ranging from 81% to 95.8%), we believe the impact of this is likely to be small.

Family medicine is a speciality practised in diverse healthcare systems in a globally evolving healthcare landscape, characterised by variations and changes in practice and technology, patient expectations and epidemiological landscape. It is not well understood how these variations and changes may impact the optimal approach to train faculty who teach new family medicine practitioners. Considering this, a study of faculty development practices in family medicine around the world is not only timely, but also essential.

Frameworks provide a scaffold representing a common core of skills and values which may be contextualised for individual settings as needed. We believe this updated framework for family medicine faculty development promises to provide a valuable resource for educators, institutions and policymakers in the family medicine field, with the goal of enhancing the quality of care, driving innovation and meeting the healthcare needs of diverse populations worldwide.