Promotion 101

PROMOTION 101: Objectives

Share information about promotion

Emphasis: Promotion to

Associate Professor Clinician-educators

Other topics

TenureResearch titlesPromotion to full ProfessorAppointment types (at-will,

indeterminate)

Promotion 101: Questions

Who are the decision-makers? The Faculty Promotions Committee

What documents do they need? Beyond the CV Dossiers and portfolios

What are your chances? How many publications do you need? Myths and misperceptions

Revealing the secrets and mysteries Street lore Depression

Why “Promotion 101?”

PercentNever reviewed promotion criteria 25Limited/no understanding of criteria 38

Never discussed progress toward promotion with dept chair/div head 35Discussed progress once 31

* 2005 Faculty survey (Junior faculty, MD/PhD: n=512)

Faculty need information

The need for information

PercentDo not have a faculty mentor to assist in career development 48No mentor:

Clinicians (69%) vs. Scientists (32%)

Worried about promotion ?

Why don’t we know more?

Time is short

Establish laboratory, become independent investigator, supervise graduate students, obtain grants (impossible)

Clinical duties and patient “throughput” 70-90 percent of time in direct patient care Find time for scholarship, meet with colleagues For each 10 hrs of clinical time, odds of grant ↓23% SOM increasingly dependent on clinical revenues

2005-06: Clinical revenues > research grant revenues Managed care competition & health plan consolidation Reimbursement rates and profit margins are declining Rising uninsured

“Economic engine; glue holding SOM budget together”

Time is short

Develop courses, reform the curriculum

Comply with regulations & paperwork demands

Perform university and community service

Balance family and work

What ever happened to academic life?

Medical school faculty “can enjoy the element of repose, the quiet pursuit of knowledge, the friendship of books, the pleasures of conversations and the advantages of solitude”

Arnold Rice Rich. Archives of Johns Hopkins Medical Institutions. Quoted by Lundmere in Time to Heal.

When should career planning and promotion review begin?

MYTH: Review begins in the 6th year

TRUTH: Preparation begins early New appointment

Copy of the SOM Rules & discussionAssignment of mentor within 3 months of

hire

Mandatory faculty reviews

Annual review5-year professional planState-mandated Annual Performance

RatingMid-course comprehensive reviewPost-tenure reviewArticle & chart: Promotion 101

Syllabus

Use annual reviews wisely

Have input into teaching, clinical assignments

Identify gaps– between department’s needs and expectations – and yours

Negotiate for resources Verify you are on course

for promotion (Use Rules) Insist on meeting every 6

-12 months (Annual)

Not just your report card …but a bi-directional conversation about your career

Mid-course review

3RD – 4th year as Assistant Professor Dossier preparation and critique List of potential external referees Assessment of promotion readiness Written summary and recommendations

Mentoring Rule & Rationale

“All Instructors, Senior Instructors and Assistant Professors will be assigned at least one mentor (in writing) by the department chair… within 3 months of the start of the appointment period.”

Proven connection to research grants, publications and productivity, academic advancement, overall career satisfaction & retention in academic careers, and department vitality

The decision-makers

Department Chair Vote by DAC

FPC Executive

CommitteeChancellorRegents (Tenure)

Faculty Promotions Committee

Peer, school-wide committeeMYTH: The Faculty Promotions

Committee consists of 5 old, tenured, full professors, mostly bench scientists and Nobel laureates

Faculty Promotions Committee

15 membersAssociate or full ProfessorTenured/not-tenuredAffiliate & University-employed

facultyBalance:

Departments: 5 basic sciences, 10 clinical

Investigators & clinician-educators

MYTH: You have to be excellent in everything

MERITORIOUS* IN ALLTeachingClinical/serviceScholarship

*Praiseworthy…deserving of merit

EXCELLENT* IN ONETeachingResearchClinical activity

*Outstanding…of exceptional merit

MAJORS & MINORS

M E

Meritorious vs. excellent

FPC determines “meritorious” vs. “excellent” based on Information in the candidate’s dossier

(including external letters and the portfolios)

Specific reference to the matrices*

*Appendix, SOM Rules (and syllabus)

Meritorious vs. excellent

Active participation in teaching activities of the department, including (2 or more): presenting series of lectures, coordinating a course, advising students, attending on inpatient or outpatient service, mentoring students/fellows, seminar or laboratory group leader)…

Meritorious teaching evaluationsDevelopment, revision of teaching

materials for students, CME courses…

Invitations to present courses, lectures outside of department, give grand rounds

Greater than average share of teaching duties (e.g., course or fellowship director) …

Consistently receives outstanding teaching evaluations or teaching awards …

Develops innovative teaching methods, such as educational software, videotapes..

Provides educational leadership by writing syllabi, or assuming administrative roles

Consistent participation in national educational activities (RRC’s, board examiner)

Invitations to be Visiting Professor

TEACHING

Meritorious vs. excellent

Establishes an area of research in a clinical area

Collaborator on research, participation in multi-center trial

One or more such efforts are published in journals

Chapters, case reports, review articles … integrate knowledge, add perspective

Innovative QI activities, including documentation of intervention and outcomes

Multiple peer-review publications in area of expertise

Consistent funding for researchServes as national consultantNational or international

reputation

SCHOLARSHIP

Other lessons

No “splash over” All faculty must

teach All faculty must

participate in scholarship

Documentation is vital Teachers, clinicians,

scientists must document “excellence”

DOCUMENTATION

C.V. A list Not enough

Letter from chair Not enough

Supporting evidence Quality, importance,

impact, reach of your work

Dossiers

Letters (internal and external) Teaching evaluations Narratives describing focus, impact of your work

“The focus of my scholarship has been the development and evaluation of tools to ensure that national guidelines for hypertension and diabetes care are adopted and adhered to in this indigent care internal medicine practice.”

“As co-chair of the “Effective Antibiotic Use Task Force,” I led efforts to develop the national evidence-based recommendations for management of coughs, colds and bronchitis in outpatient settings”

Copies of scholarly “products” Annotated bibliographies Excerpts from matrices Well-organized portfolios: REQUIRED

Using the matrices

TeachingProvides

educational leadership by writing syllabi or textbooks or assuming administrative roles

Developed “Sports Medicine” module for orthopedics residents

Director, Combined Sports Medicine Fellowship (2003-6);

Chair, Orthopedics Student Education Committee

Member, National Sports Medicine Residency Curriculum Committee, American Academy of Orthopedics

Clinical & teaching portfolios

Describe what you do every day Take credit for achievementsAdd weight and parityPermits semi-structured evaluationMatch your activities to SOM rulesSee detailed formats (web, syllabus)

Clinical portfolios

Description of clinical activities Sites, numbers of

patients, weekly calendar

Leadership Committees, practice

director QI activities, patient

care pathways that improve patient care

Innovative practices Evidence of regional or

national reputation Quality measures:

Letters from referring colleagues, RN’s

Studies of outcomes, quality of care

Information from patients (letters, patient satisfaction surveys)

Teaching portfolio

Personal teaching goals What and how do you

teach? What is unique How do you assess

learning Classroom activities Clinical teaching activities Other didactic teaching Teaching administration

Course leadership National service (RRC,

board examiner)

Evaluations by learners Curriculum

innovation/products High quality syllabi, problem-

based learning, patient simulations, CD-ROM’s

Scholarship of teaching Outcomes, learning, methods

Mentorship and advising Self-study and improvement Teaching awards, recognition

Mentorship Record

Trainee (Dates)

Project Title

(My role)

Degree(Date)

Funding,Awards

Presentations &

Publications

Mary A. Bartlett

(2002-2004)

The role of acculturation factors in predicting high risk

injury behaviors(Thesis

supervisor)

MSPHJune 3, 2004

Colorado Dept

Transportation

(Project #2001-648-

98247)

Oral abstract presented at

the 32nd Annual

meeting of …

Manuscript:

xxxxx

Mentorship letters

Statements by current or former traineesInformation about your impact

Research methodology Writing and presenting Data analysis Research ethics Management & coordination of research team Professional role model

Scholarship: Required by Rules

All faculty are required to participate in scholarship

The products of scholarship must be in a format that can be evaluated, which would normally mean in a written format

Scholarship: Broadly Defined

Discovery, application, integration, teachingAccommodates almost anything in medicine,

science, writing, public health, ethics, quality improvement, education, health services, policy, community outreach, humanities …

Not just research discoveries, publicationsProducts that can be reviewed:

Publications, CDs, chapters, case reports, reviews, residency training manuals, policy “white papers,” clinical guidelines, evidence-based pathways

Examples: Alternative scholarship

Design of electronic medical record for outpatient setting that facilitated detection of medical errors

Created national guidelines to improve rating and documentation of impairment in occupational medicine practice Accepted by American College

Occupational/Environmental Medicine Used to develop CME program for physician

certification

Examples: Alternative scholarship

Computer-based simulations used widely to teach and assess cricothyrotomy, thoracotomy & other procedural skills

Innovative care system for HIV patients that led to declines in morbidity, mortality and rates of hospitalization

Innovative, competency-based curriculum for residents focusing on end-of-life care, pain palliation and spirituality

Alternative scholarship

Educational manual for students, residents focusing on principles of caring for uninsured patients in homeless and indigent care clinics

Guidebooks and charts for patients, physicians and pharmacists used statewide to improve prescribing and reduce drug resistance in HIV

Computerized, 150-item self-assessment curriculum in chest radiology for community based radiologists (adopted by American College of Radiology)

Alternative scholarship

Series of “white papers” on early recognition of functional decline in geriatric patients for professional societies, HMO’s and national foundations

Guidebooks for migrants and new immigrants to Colorado, focusing on health care access, teen reproductive services, expanded mental health services, diabetes screening (in collaboration with Secretary of Health in Mexico)

Alternative Scholarship

Diabetes management practice guidelines disseminated in Palm Pilot® format

Series of videos (peer-reviewed) and patient and physician education booklets about emotional experiences and stages of recovery in children with burns

Alternative Scholarship

These works justified promotion and were rated by Promotions Committee based on: Originality Grounding in scientific evidence Methodology Quality or outcome measures Use and acceptance by peers

Promotion Time Clock

Up-or-out in 7 years

But: No penalty for

part-time service Extensions

granted Revisions under

consideration

MYTH

Getting promoted “early” is almost impossible

The truth about early promotion

[From the SOM Rules]

“Review for promotion to Associate Professor may occur whenever the faculty member meets the criteria specified…”

“The concept of ‘early’ promotion was discontinued [1997].”

MYTH

Most Assistant Professors don’t get promoted At least not on the first

try

Promotion statistics (2002-2005)

Promotion to Associate Professor 177 candidates reviewed 170 approved (96 percent) Promotion rate for clinician-educators =

96%Promotion to Professor

83 candidates reviewed 77 approved (93 percent)

Tenure 39 candidates reviewed 33 approved (85 percent)

MYTH

Even for clinician-teachers … you need 39 1st-author, peer-reviewed research papers

Publication Totals2000-2005

Clinician Educators (Promotion to Associate Professor; n = 114)

1st/Sr. Peer

Other Peer

All Peer Chapter, etc.

Total Publicatio

ns

Minimum 0 0 0 0 1

Maximum 36 64 85 55 92

Mean 6.5 7.3 13.7 7.3 20.9

Median 4 5 11 6 18

25th Percentile

2 2 5.5 2 10

Promotion to professor

Not required at 7 years – or automaticMeritorious in:

Teaching & clinical activity/serviceExcellent in two:

Teaching, research or clinical activityPLUS

Excellence in scholarshipA national reputation

Final recommendations

Read the Rules (standards)Document everything:

Up-to-date CV Drop-in box Examine: matrices; scholarship

examples; portfolio guidelines Save teaching evaluations and obtain

lettersUse Annual Reviews wisely

Final recommendations

Periodically, write short “bullets” to summarize impact, importance of your work --- as investigator, clinician, educator, consultant, task force member, course director

Think about promotion frequently – not obsessively

Recommendations

Focus on career fulfillmentTake advantage of proven tools:

Mentors – “career incumbents” A network of productive colleagues A quick start Focus; specialized skills: burnout,

PAIDS Be active regionally & nationally

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