Faculty development of family and community physicians in undergraduate education: a scoping reviewABSTRACT
Introduction: The consolidation of Family and Community Medicine (FCM) in undergraduate education, reinforced by the National Curriculum Guidelines (DCNs), requires faculty qualified not only technically but also pedagogically. However, training for medical teaching often occurs in an unsystematic and unintentional manner, requiring institutions to promote effective strategies for the development of these professionals.
Objective: To analyze the state of the art on faculty development for Family and Community Physicians (FCPs) in the context of undergraduate medical education, guided by the question: “What does the national and international literature indicate regarding faculty development for FCPs in undergraduate education?”.
Method: This is a Scoping Review following the PRISMA-ScR checklist, with a protocol registered on the Open Science Framework. The search was conducted in the VHL (BVS) and PubMed databases, using the descriptors “Family Practice” and “Faculty, Medical” in Portuguese, English, and Spanish. Study selection was performed by a pair of reviewers, with no date restrictions, resulting in the inclusion of 25 articles after full-text reading.
Results: Most publications are concentrated in North America, with Brazilian literature being incipient, comprising only one included article. The studies are divided between original articles (predominantly qualitative) and experience reports, revealing faculty development formats ranging from short workshops to longitudinal programs, including graduate courses. The results point to the need for programs that promote a reflective practice addressing the construction of the FCP educator identity and the social commitment of this practice, highlighting intersectionality and anti-racism as central to this teaching. Challenges such as the lack of protected time and excessive administrative demands are frequent barriers, evidencing that the sustainability of these initiatives depends on institutional support.
Conclusion: The Brazilian scenario lacks registration and evaluation of its own faculty development experiences aimed at FCPs. Given the expansion of the specialty in curricula, fostering national research capable of measuring the impact of these initiatives on the quality of teaching and care is a priority for strengthening the Unified Health System (SUS).
Keywords:
Family practice; Teaching; Faculty medical; Education medical undergraduate; Medical education
RESUMO
Introdução: A consolidação da medicina de família e comunidade na graduação, reforçada pelas Diretrizes Curriculares Nacionais (DCN), exige docentes qualificados não apenas tecnicamente, mas também pedagogicamente. Contudo, a formação para a docência médica ocorre muitas vezes de modo não sistemático e intencional, demandando que as instituições promovam estratégias efetivas para o desenvolvimento desses profissionais.
Objetivo: Este estudo teve como objetivo analisar o estado da arte sobre o desenvolvimento docente de médicos de família e comunidade (MFC) no contexto da graduação em Medicina, norteado pela questão: “O que a literatura nacional e internacional tem apontado sobre o desenvolvimento docente de MFC na graduação?”.
Método: Trata-se de revisão de escopo seguindo o checklist PRISMA-ScR, com protocolo registrado na Open Science Framework. A busca foi realizada nas bases de dados BVS e PubMed, utilizando descritores “medicina de família e comunidade” e “docentes médicos” nos idiomas português, inglês e espanhol. A seleção dos trabalhos foi feita por uma dupla de revisores, sem recorte temporal, resultando na inclusão de 25 artigos após leitura na íntegra.
Resultado: A maioria das publicações concentra-se na América do Norte, sendo a literatura brasileira incipiente, com apenas um artigo incluído. Os trabalhos dividem-se entre artigos originais (predominantemente qualitativos) e relatos de experiência, revelando formatos de desenvolvimento docente que variam de workshops curtos a programas longitudinais, incluindo cursos de pós-graduação. Os resultados apontam a necessidade de programas que promovam uma prática reflexiva que aborde a construção da identidade do MFC educador e o compromisso social dessa prática, apontando a interseccionalidade e o antirracismo como centrais para essa docência. Desafios como a falta de tempo protegido e o excesso de demandas administrativas são barreiras frequentes, evidenciando que a sustentabilidade das iniciativas depende de suporte institucional.
Conclusão: O cenário brasileiro carece de registro e avaliação de suas próprias experiências de desenvolvimento docente voltadas para os MFC. Diante da expansão da especialidade nos currículos, fomentar pesquisas nacionais capazes de mensurar o impacto dessas iniciativas na qualidade do ensino e do cuidado é prioritário para o fortalecimento do Sistema Único de Saúde.
Palavras-chave:
Medicina de Família e Comunidade; Docência; Docentes de Medicina; Educação de Graduação em Medicina; Educação Médica
INTRODUCTION
Teacher training has long been a subject of study. In the 1990s, initial and continuing teacher training was already the subject of reflection, highlighting the importance of constructing the professional identity of the teacher as the guiding axis in this discussion:
“mobilize the educational theory and didactic knowledge required to understand teaching as a social reality, and therein develop the ability to investigate the activity itself so as to constitute and transform their teaching know-how, in a continuous process of building their identities as teachers” 1 (p.75)
When reflecting on the act of educating as a social practice, the first step is to reflect on one’s own practice, emphasizing the importance of understanding this act within a given context and moment. In Pedagogy of Freedom2, Freire says that reflecting on daily practice is a challenge to be faced constantly, demonstrating the importance of a dialectical relationship between theory and practice for the exercise of teaching.
As an element of this relationship, the author points to criticality as a mediating principle, underlining that it is necessary to recognize what one knows - and the place one occupies - in order to build pedagogical practice3. This analysis can be complemented by understanding that, for the teaching-learning process, it is important to look at reality in different scenarios, establishing “relationships between subject and context, subject and subject, thinking and doing, theory and practice, reflection and action”4) (p. 80).
In the context of higher education, an oral history study with professors from different health courses sought to find the hallmarks of this kind of teaching. After interviewing eleven teachers, the author organized categories related to “becoming a teacher” and “outstanding teachers”. Some of the interviewees pointed to the monitoring spaces as a first initiation, while others said they “became a teacher overnight”. In this sense, he highlights that preparation for teaching often occurs neither systematically nor intentionally. With regard to outstanding teachers, he shows how examples of teachers who have shaped the teaching practice of the interviewees emerge from their speeches, both in terms of how they would like to be, as well as examples not to be followed5.
As regards teaching specifically for undergraduate medical courses, two aspects have been previously identified, one in relation to the technical medical knowledge to be passed on during the training of this professional and the other in relation to teaching itself, as well as its assumptions and theoretical bases6. It is common for doctors with an interest in teaching to give classes without necessarily having received specific training for teaching, generating the need to establish strategies that rethink health training so that these professionals establish new relationships with teaching7.
Harden and Lilley presented eight roles of the professor of medicine, which were adapted by a Brazilian study: Information provider/trainer; Learning facilitator/mentor; Curriculum planner; Evaluator; Role model for students in the classroom and in clinical practice; Leader, scholar and researcher; Manager; Professional who behaves as such in front of students8. These roles are directly related to the changing context of medical education in Brazil, with a tendency for traditional methods to give way to innovative methodologies, also culminating in changes in the role of teachers9.
Among the different medical specialties, Family and Community Medicine is a structuring factor for a universal health system. Its importance has been highlighted by international organizations such as the World Health Organization (WHO) and the World Organization of Family Doctors (WONCA)10. Accordingly, the 2001 National Curricular Guidelines (DCNs) for medical courses already signaled the importance of graduates having access to “content related to the entire health-disease process of the citizen, the family and the community”, despite not having specified Family Medicine as a specialty11. The 2014 DCNs, on the other hand, go a step further and, in addition to content, define the obligation that “internship activities focused on Primary Care should be coordinated and focused on the area of General Family and Community Medicine”, thus outlining the importance of the specialty in the training of new professionals12. The recently published 2025 DCNs keep the specialty in the spotlight, mentioning the minimum workload of 30% of the internship, correcting the name to Family and Community Medicine according to the records with the medical entities, despite removing the predominance of Family Medicine, foreseen in the 2014 document, in relation to Urgent and Emergency Care13.
When they made a diagnosis of the number of Family and Community Medicine (FCM) physicians, a group of these specialists pointed out that the number of professionals fell far short of the required staffing to improve health services. The authors point to the importance of policies to promote the training of FCM physicians as suggestions for changing this scenario, such as the expansion of vacancies in medical residencies in this specialty and its inclusion in undergraduate medical courses14. Since 2011, the Brazilian Association of Medical Education and the Brazilian Society of Family and Community Medicine have pointed out that “the participation of a doctor specialized in FCM among teachers is essential to adapt the pedagogical model to the health needs of the population”15 (p. 149).
However, the discussion about the inclusion of this specialist in undergraduate teaching, and in particular the faculty development of this professional, still seems to be incipient. This study sought to find out about the state of the art of FCM doctor teachers at undergraduate level, with a view to contributing to the development of these teachers. Thus, we asked “What has the national and international literature pointed out about the faculty development of FCM physicians in the context of undergraduate medical education?”
METHOD
In order to answer this question, we drew up a Scoping Review protocol, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist16 and incorporating the recommendations of the Brazilian group coordinated by Mattos et. Al17, since a Scoping Review is one that has the capacity to obtain an overview of the evidence and gaps in various fields of research18. The protocol for this review has been registered with the Open Science Framework, obtaining the DOI 0.17605/OSF.IO/T2PDJ.
To construct the research question, we used the acronym PCC (Population, Concept and Context), in which the population is FCM physicians who teach undergraduate medicine, the concept is teaching and teacher development in Family and Community Medicine and the context is the undergraduate curriculum. The different types of articles - original research, essays and experience reports - were included, with no date limitation, and with free access to the full text in Portuguese, English and Spanish. Duplicate articles and those that were not related to the theme of faculty development in undergraduate Family and Community Medicine were excluded. Gray literature was also excluded.
The DECS/MESH descriptors used were Medicina de Família e Comunidade, Family Practice, Medicina Familiar y Comunitaria e Docentes de Medicina, Faculty Medical, Docentes Médicos. The full search expression, including the Boolean operators, was (“Medicina de Família e Comunidade” OR “Family Practice” OR “Medicina Familiar y Comunitaria”) AND (“Docentes de Medicina” OR “Faculty, Medical” OR “Docentes Médicos”). This expression was applied to the Virtual Health Library (VHL) and PubMed databases.
The studies were extracted from each of the databases and entered into the Rayyann - Intelligent Systematic Review software in order to facilitate the exclusion of duplicates, as well as texts in languages other than those established in the review protocol. The articles were evaluated by their titles and abstracts by a pair of reviewers who, according to their suitability for the study and compliance with the inclusion and exclusion criteria, decided whether to include them in the review. Disagreements were worked out until a consensus was reached. After analyzing the first 25 articles, the pair of reviewers met to discuss the alignment needs for the selection. The articles selected in this first stage were read in full by the two reviewers to define the final corpus of the review.
The following information was extracted from the final corpus: type of article, author(s), year of publication, type of study, country of origin, main objective of the article, research participants, methodology used, results found, conclusion and recommendations proposed. The data obtained was analyzed using a descriptive approach in the light of the review’s objective.
RESULTS
The database search returned 1,977 articles. The Rayyann software identified 957 duplicate articles which were therefore excluded. A total of 1,020 articles were evaluated by the two reviewers using their titles and abstracts. Of these, 831 articles were not related to the study object of this review, another 119 articles did not have abstracts available and could not be determined from the title alone, and were also excluded. Finally, three articles had abstracts available only in languages not included in the protocol, so they were also excluded. This brought the initial corpus of the review to a total of 67 papers.
Of these, two studies focused on discussions of career promotion and tenure, without directly addressing the issue of teacher development. Another three papers were focused on the context of medical residency and graduate studies and were therefore also excluded. Five papers only mentioned teacher development, without going into depth in this discussion, and therefore failed to answer the research question. One of the articles discussed the development of health service preceptors who were not university professors (including nursing professionals, pediatricians and general practitioners), three papers focused on specific aspects, three articles were available in other languages and, finally, 25 papers were not available in full text (drawing particular attention to older papers that were not retrieved, since there was no time frame defined for this review). Thus, the final corpus of the review included 25 articles. The PRISMA flowchart is shown in Figure 1.
Table 1 shows the characterization of the final corpus by title, type of article and journal of publication.
The journal Family Medicine had the highest number of papers included, ten published works. With the second highest number of articles selected was the journal Canadian Family, with five, followed by the European Journal of General Practice, with three, and Academic Medicine, with two. The other journals had one paper each. The countries with the highest number of published works included were the USA and Canada. Some articles published by region, which do not specify countries, such as Sub-Saharan Africa and Europe, are noteworthy. Latin America is represented by a Brazilian article. In terms of the year in which the papers were published, 2017 had the highest number of published works, four. The most recent studies included in the review were from 2022, and no articles were found after this period that met the review’s inclusion criteria.
As regards the types of papers, three essays, nine experience reports and thirteen original articles were identified and, for the purposes of analysis, these were divided into two groups: the first, with thirteen papers, referring to the original articles, and the second, with twelve publications, referring to the experience reports and essays. With regard to the first group, eight papers were qualitative in nature, two of which used questionnaires to obtain answers and the other six used interviews. One work involved mixed methods, using a pre- and post-workshop questionnaire for quantitative evaluation and thematic group records for qualitative analysis. The four quantitative studies used questionnaires as research tools. The importance of qualitative research in discussing the subject of this review is therefore clear.
In the group of original articles, the majority involved participants in the initiatives (whether courses, workshops or master’s programs). One was aimed at family medicine department heads and one at participants in a specific event, the Society of Teachers of Family Medicine Annual Conference in the USA.
Evaluating the objects of the research carried out, thirteen papers were categorized into four thematic groups, the first of which is related to a diagnosis of teacher development programs for FCM physicians, pointing out regional contexts and the needs of the participants in these offers. The second group gathers works that research the initiatives and models already carried out in relation to teacher development. The third group is made up of studies whose object of research was the trajectory, identity and tools for the faculty development of FCM physicians, such as mentoring. The fourth group comprises two studies that focused on the discussion of teaching-service integration, thinking about teacher development also linked to the health service. Table 2 shows the main results of these four thematic groups related to the objects of the research.
As for the group of essays and experience reports, the findings were organized into eight dimensions: formats and structure of teacher development experiences, competencies targeted by the initiatives, methodological trends, specific content, social commitment, adaptation and profile, challenges and strategies. A summary of these findings is shown in Table 3.
DISCUSSION
In this review, the development of FCM physicians as teachers is presented as important and challenging, with a trend of published works in the last decade, influenced both by the fact that some older articles were not found in full, but also by the increase in research on the subject today. However, the fact that the most recent article included in the review is from 2022 raises questions about the production of this topic in recent years, possibly influenced by the pandemic with significant impacts on teaching practice in different areas of expertise44.
On the national scene, the 2014 DCNs already established the importance of the institution “maintaining a permanent Health Teaching Training and Development Program, with a view to valuing teaching work in undergraduate courses”. The 2025 recommendations call for the creation of “Pedagogical Support and Teaching Experience Centers dedicated to the continuing qualification of their peers and the promotion of academic excellence” as an alternative to contribute to the development of FCM teaching doctors12),(13. However, the vast majority of the studies included in this review are of international origin, especially from North America, which corroborates the initial perception of a lack of national literature.
Whereas in Brazil “becoming” a professor of medicine in an unsystematic manner has been reported5, international findings point to an advance in this discussion from an institutional point of view, linking it to career promotion and stability36),(40. The review showed that, in developed countries, teacher development is no longer just an individual quest for improvement but has become a formal demand, suggesting a way to strengthen the identity of Family Medicine in Brazilian medical schools, as the new DCNs already point out.
The results of this review highlighted a variety of teacher development formats, from “weekend” workshops to longitudinal programs, including a master’s degree course for FCM educators21),(24),(33. This diversity of strategies makes it possible to deepen reflections on practice by allowing teachers to move away from an isolated view of the classroom and connect with other experiences, valuing meaningful learning1),(2.
The fact that teachers demand “toolboxes”, exemplified by the strategies of small group work, dramatizations, narratives and project-based learning21),(25 for their professional practice, demonstrates the need to connect pedagogical theory with instrumentalization for everyday life, allowing the development of these pedagogical skills among FCM physicians. Thus, the choice of methodology to be used in teacher development is an instrument to reinforce the importance of a contemplative teacher45, streamlining teacher development programs away from being isolated events, to become continuous processes, including opportunities for teacher mentoring and the formation of communities of practice19),(40),(43).
Both the group of original articles and the group of essays and experience reports point out the challenges for the development of FCM physicians as teachers, highlighting that the sustainability of the initiatives depends on institutional support. In this sense, public policies become even more relevant, such as initiatives like Pró-Ensino na Saúde46),(47. In addition to the induction promoted by the state and exemplified in the Brazilian experience included in the review42, it is important to reinforce the role that educational institutions have in promoting faculty development, both because of its regulatory importance, since it is provided for in the DCNs for medical courses12),(13, and because of the responsibility attributable to institutions in relation to alleviating some of these challenges, such as the issue of allocating protected time and reducing the administrative demands of this group of teachers.
It is also worth noting that the expected competencies for graduates11 were in line with the desired competencies for teachers found in this review, so one might assert that in order to develop leadership among students, it is also important to develop this aspect among teachers. One interesting result is that, after moments of teacher development, the teachers became more involved in the leadership spaces of the institutions21, which can therefore be seen as an opportunity, especially at a time when new medical courses are opening in the country, with a consequent demand for teachers to lead these movements.
The importance of teacher professionalization returns us to the discussion that moments of teacher development become opportunities not only for technical updating, but also for collective reflection by these teachers48. This is because mastery of medical content is not enough for teaching practice; pedagogical knowledge is also necessary49. The findings of this study corroborate this discussion, even pointing to some themes such as teaching methods, evaluations, feedback and adult education itself as issues that may be present in the development of FCM physicians as teachers20.
More specifically, the construction of the identity of FCM physicians appears to be central to the faculty development of this specialty29),(42). This is anchored in the discussion brought up by Iza et al50 when they point out that the integration of knowledge is a dynamic process in the construction of a teacher’s identity. The incorporation of innovation and the appreciation of the health system in which they are inserted are elements that emerge as highlights in the construction of this identity of the FCM doctor as a teacher27),(33.
Within this discussion of the health system, teaching-service integration was one of the themes found when categorizing the objects of study of the original articles. On the national scene, the figure of the teacher who teaches in practice settings is often confused with that of the preceptor. Botti, in proposing an alignment between the different concepts, points out that the authors describe these possibilities (p. 365): Mills says that the preceptor is the “professional not from the faculty who plays a key role in the insertion and socialization of the new graduate in the work setting” and Ryan-Nichols says that he or she is “the teacher who teaches a small group of students or residents, with an emphasis on clinical practice”51),(52),(53.
Accordingly, when we defined the population of the review, we included undergraduate medical teachers, professionals who therefore have direct links with teaching institutions. There are studies that draw attention to the development of the pedagogical skills of the service network preceptor, who is often a central figure in the internship course54),(55. The need to develop actions for this public is also expounded in the 2025 DCNs, especially in the Family and Community Medicine internship, in a scenario where more of these specialists are still required, despite the efforts of different inductive policies in recent years56.
Another aspect that emerges centrally in this review is the social commitment of FCM physicians, reinforcing the importance of teacher development that discusses the demands and specific characteristics of minority groups22),(26. Bell Hooks already pointed out the importance of an educational space that promotes affection, that values the voice of historically marginalized subjects and, according to the “Pedagogy of Encounter”57, that teachers are able to recognize the multiple oppressions that run through the educational process. In this context, intersectionality constitutes a necessity for moments of teacher development, allowing this theme to be reflected in a posture that promotes a sense of belonging and person-centered care - or student-centered teaching. This reminds us that teaching is a political act and a form of resistance and social transformation58.
Furthermore, it is important to recognize that women are overburdened by the accumulation of academic tasks with demands on their family lives in a more impactful way, and that racial issues cross the teaching-care dimension, especially in practice settings. Therefore, initiatives such as the workshop on tackling racism should be increasingly incorporated into teacher development38),(41. We were unable to answer with this review whether this discussion is specific to the teacher training of FCM physicians, but at this point it seems important to point out that this is a very important issue for the specialty, precisely because of the ethical-political dimension that runs through the principles of Family Medicine.
Whereas developed countries are discussing the progress of already consolidated teacher training programs, pointing to the evaluation of initiatives - and therefore their impact - as an important gap35, Brazil still seems to still need to record its experiences in teacher training for FCM physicians. If in the care setting we already have evidence that the presence of FCM physicians improves the health outcomes of the population59, it will also be important to assess the impact of this presence in teaching environments.
FINAL CONSIDERATIONS
This scoping review allowed us to map the state of the art on the teacher training of FCM physicians in undergraduate courses, showing that the literature, although growing in the last decade, is still predominantly international, with a strong concentration in North America and a scarcity of national productions. The findings show that faculty development in the specialty goes beyond technical content and should take place longitudinally, focusing on building the identity of the FCM educator and providing an opportunity to use active methodologies. Teacher mentoring stood out as a strategy that could be used more.
One aspect that stands out in this review is the central focus of social commitment in the development of these teachers. We identified that the teacher training of FCM physicians must dialog with contemporary demands, incorporating themes of intersectionality, racial literacy and gender equity. We understand that preparing to teach in this area is inseparably a technical, pedagogical and political act, essential for training new professionals who are able to respond to the demands of the health system.
However, significant challenges remain. The review shows that the sustainability of these initiatives depends on structured institutional support, with protected time for teacher development and career development, so that they do not rely exclusively on the individual motivation of professionals. Furthermore, there is a significant gap in studies that assess the real impact of these initiatives on the acquisition of teachers’ pedagogical skills.
Given the Brazilian scenario, driven by the new DCNs of 2025, this review points to a strategic research agenda: there is a need to move forward with Brazilian studies that, in addition to describing national experiences, also assess the impact of teacher development on the quality of teaching and, consequently, health care. Rather than reproducing international models, Brazil has the opportunity - and the constitutional duty, since the Unified Health System must “organize the training of human resources”60 - to build teaching models that value and strengthen Family and Community Medicine.
ACKNOWLEDGMENTS
Douglas Vinícius Reis Pereira thanks Isabel Brandão Correia for her supportive partnership and Professor Nildo Alves Batista for his insightful and supportive mentorship. This work was made possible by the Center for the Development of Higher Education in Health (Cedess) and the Federal University of São Paulo (Unifesp).
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Research data is available in the body of the document
Source: prepared by the authors.