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What ranks and tracks are available? |
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What is the system for regular performance review and feedback? |
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How is performance review linked to salary, benefits, and resources? |
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Who has the best information? |
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Who REALLY has the best information? |
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Is tenure available to clinical faculty members? Are there plans to change? |
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What is the "track record" for primary care faculty members achieving tenure? |
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What is the relationship of tenure to salary? |
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What post-tenure review process is used? |
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Is tenure linked to a specific rank? |
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What is the probationary period and requirements about years credited? |
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Are there mechanisms for "clock-stopping"? |
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What are the criteria for promotion and award of tenure for clinicians? |
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What are the expectations for promotion and award of tenure for clinicians? |
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How many special tracks are available? Which one is right for my position? |
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What is the length of the contract and requirements for renewal? |
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Is the title modified? How is the title perceived in the institution? |
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Academic rights and privileges (e.g. voting, committee eligibility, sabbaticals)? |
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What are the criteria for academic promotion (especially in scholarship)? |
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What are the real expectations and track record for academic promotion on this track? |
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Model: "Personal Performance Improvement" |
Step #1: Develop your personal mission.
"Begin with the end in mind." (Covey)
Take a personal retreat to consider questions like:
"What do I want people to say about me at my funeral?"
"What are my greatest strengths?"
"What do I deeply enjoy doing?"
"What character qualities do I most admire in others?"
"Who has made the greatest positive impact on my life?" "Why?"
"If I had unlimited time and resources, what would I choose to do?"
Write down a personal mission statement and share it with a trusted friend.
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Step #2: Honestly assess where you are right now.
Study Covey’s four quadrants of activity.
Take Covey’s "Urgency Index©."
Complete Hummel’s "One-Week Time Log."
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Step #3: Make a plan.
"Put first things first and we get second things thrown in: put second things first and we lose both first and second things." (CS Lewis)
Focus on being effective rather than merely efficient.
Set personal goals that are principle-based: "the right thing, for the right reason, in the right way." (Covey)
Make professional goals align with personal goals.
Make both long- and short-term goals.
Make goals realistic yet challenging.
Look for synergy.
Include measurable objectives.
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Step #4: Follow up.
Begin to journal.
Revisit your mission statement and goals regularly; revise them as necessary.
Celebrate success.
Forgive yourself: learn and move on.
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Role: Physician Educator
Goals:
General: I will be prepared to apply for professor with tenure in five years.
Teaching: develop this strength; document activities; develop curriculum with focus on student evaluation and coordination with other departments; develop preceptors; present nationally; mentor others
Scholarship: at least two peer-reviewed publications per year; focus on education; grants; review for grants and publications; collaborate; mentor others
Service: synergize with teaching, scholarship, and personal growth; serve nationally; serve locally
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Role: Family Physician
Husband
Dad
Son, Son-in-Law
Brother, Brother-in-Law
Church Member
Neighbor
Friend
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Role: Sharpen the Saw
Goals:
Physical
Social/Emotional
Mental
Spiritual
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First Things First. Stephen R Covey, A Roger Merrill, Rebecca R Merrill (New York, Simon & Schuster, 1994).
Freedom from Tyranny of the Urgent. Charles E Hummel (Downers Grove, IL, InterVarsity Press, 1997).
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Academic Promotion and Tenure Systems:
Scholarship
Family Medicine, Generalists, Clinician-Educators
Documentation
Mentoring
Literature on academic promotion/tenure is diffuse and often overlaps or is immersed in literature on general faculty development (career issues) or that on the evolution of academic health centers (organizational and philosophical issues). Aspects of promotion and tenure also appear in the literature on education and teaching skills and research career development. For Family Medicine pertinent material names to watch for include Bland, Simpson, Irby, Morzinski, Hekelman, Hitchcock, Mygdal. The articles listed are the most recent – they build on much good earlier work so the references for each article are worth browsing.
The really compulsive can find bibliographies on the AAMC web site.
Boyer and Glassick are essential reading to understand how "scholarship" is being defined and assessed in most academic promotion and tenure systems.
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Jones RF, Gold JS. Faculty appointment and tenure policies in medical schools: a 1997 status report. Acad Med 1998;73:212-9.
A key reference on APT in US schools updating a 1994 report (Jones and Sanderson). The authors are at AAMC and are very helpful. They have data but may not provide further articles. The article’s focus is on tenure policies, special clinical tracks, and how these are playing out in terms of compensation and evaluation and related implications. The references to this article provide all the key articles in the field.
Beasley BW, Wright SM, Cofrancesco J et al. Promotion criteria for clinician-educators in the United States and Canada. JAMA 1997;278:723-8.
Survey of chairs of Promotion and Tenure Committees to ascertain how clinician-educators are evaluated. Optimistic that schools are following APT practices appropriate to the careers of clinician-educators. Huge range in what was measured and how. Wide variation in expected number of publications (0-33 mean @6). In general about half of the publications expected of a researcher. No correlations between several measures, especially number of publications, and type of school.
(contrast with Levinson* and Block*below)
Tenure in the medical school. Academe 1996;82:40-5
Report by a subcommittee of the AAUP (American Association of University Professors) Committee on Academic Freedom and Tenure (Poston LS, Fisher LE, Furtado D et al). Reviews the tenure debate and the conflicts/challenges regarding tenure and the current predicaments of academic health centers from the AAUP standpoint. Very dubious about the expansion of non-tenure positions, the extension of probationary periods, and the linking of salary to tenure and performance. Remains the official AAUP position and explains some of the situations that arise when universities seek to make "special arrangements" for medical school faculty.
White L. Legal issues in faculty affairs. Part 1: Tenure, compensation and related concepts. Plenary address to AAMC Faculty Affairs Professional Development Conference. July 1999.
Review of the history of tenure and related issues in the United States. Includes case law and trends in legal thinking on tenure, compensation of faculty, post-tenure review, buy-outs.
Several articles refer to academic promotion and tenure in the course of discussing how academic medical centers/school must change or are evolving. Examples include:
Griner PF, Blumenthal D. New bottles for vintage wines: the changing management of the medical school faculty. Acad Med 1998;73:720-4
Evans CH. Institutional challenges posed by faculty development. Acad Med 1997;72(6):477-480 (also Evans CH Acad Med 1995;70:14-20 and Bland’ reply)
Griner PF, Blumental D. Reforming the structure and management of academic medical center: case studies of ten institutions. Acad Med 1998;73:817-825
Pellegrin KL, Arana GW. Why the triple-threat approach threatens the viability of academic medical centers. Acad Med 1998;73:123-5
Arana GW, McCurdy L. Realigning the values of academic health centers: the role of innovative faculty management. Acad Med1995;70:1073-7
These and other articles stress the need for flexibility, the alignment of financial and academic rewards to the mission of the school, and the incompatibility of many aspects of traditional promotion and tenure with new political and financial realities for medical schools.
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Boyer EL. Scholarship reconsidered: priorities of the professorate. Princeton NJ: The Carnegie Foundation for the Advancement of Teaching, 1990. The "breakthrough" document and now the bible enabling non-classical research to be eligible as scholarship for academic promotion. Describes four types of scholarship (discovery, integration, application, teaching) and outlines criteria for excellence and the portfolio concept.
Glassick CE, Huber MT, Maeroff GI. Scholarship assessed: evaluation of the professorate. San Francisco,Ca: Jossey-Bass 1977
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Zyzanski SJ, Williams RL, Flocke SA, et al. Academic achievement of successful candidates for tenure and promotion to associate professor. Fam Med 1996;28:358-63.
Survey of STFM members at associate professor level or above. Mean year of appointment 1988. Huge variation in publication and scholarly publicity (@7+/-7 peer reviewed) and in hours for research. Half of research in work time. Productivity related to PhD, type of school and tenure status but not gender.
Williams RL, Zyzanski SJ, Flocke SA et al. Critical success factors for promotion and tenure in family medicine departments. Acad Med 1998;73:333-5. Survey results from 1993 of STFM members who were associate professors and 1994 of ADFM members
("leadership positions"). Identifies lack of protected time, mentors, resources, and experience with P&T process as significant obstacles to promotion. Also cites problems with P&T committees not appreciating/understanding family medicine. Identified six characteristics for success
Kohrs FP, Mainous AG . Retention of family medicine faculty development fellows in academic medicine. Fam Med 1999;30(1):23-7. Survey of early careers of fellows showing 75% in academia but only 12% in tenure track positions and over 30% anticipated leaving within 2yearsc. Lowest satisfaction reported with mentor and resources. Highest satisfaction with education and patient care activities.
Baldwin CD, Levine HG, McCormick. Meeting the faculty development needs of generalist physicians in academia. Acad Med. 1995;70:S97-103). Really a needs assessment of generalists but outlines obstacles to academic success. Manages to avoid reference to promotion and tenure either as a problem or mechanism that could contribute to alleviating some of the cultural and other problems articulated.
Levinson* W, branch WT, Kronke K. Clinician educators in academic medical centers: a two-part challenge. Ann Int Med 1998;129:59-64. Documents increasing numbers and roles of clinician educators but takes pessimistic view of career prospects. Identifies financial challenges, inappropriate promotion processes, and limited faculty development opportunities as key issues
Levinson* W, Rubenstein A. Mission critical- integrating clinician-educators into academic medical centers. NEJM 1999;341:840-3. Negative view of the promotion prospects for clinician educators. Calls in particular for elimination of requirements for national/regional reputation and publication in peer-reviewed journals for promotion. Caused quite a stir.
Lubitz RM, Guidelines for promotion of clinician-educators. J Gen Intern Med 1997;12 S71-7
Block* SD, Clark-Chiarelli N, Peters AS et al. Academia’s chilly climate for primary care. JAMA 1996;276:677-82. Depressing survey results from 1993-4 of students, residents, faculty and deans reflecting view that primary care physicians are less well trained than specialists and have lower research standards. By implication, reflects perspectives of academics
Oeffinger KC, Roaten SP, Ader DM, Buchanan RJ. Support and rewards for scholarly activity in family medicine: a national survey. Fam Med 1997;29:508-12) 1993 survey of directors and chairs reporting that @40% of community-based and @75% of university-based programs provided any protected faculty time for scholarship/research. Promotion ranked as a reward.
Other articles on the time-reward challenges for FP include Katerndahl DA. Associations between departmental features and departmental scholarly activity Fam Med 1996;28:119-27. Also worth remembering family medicine likes to consider itself "counterculture" – at least seven articles with that in the title!
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The Center for Ambulatory Teaching Excellence (CATE) – medical College of Wisconsin has great materials especially The Educator’s Portfolio and The Administrative Portfolio
Contact Mary Lourich 414-456-8527 mlourich@post.its.mcw.edu
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CATE mentoring guidebook (Bower D, Diehr S, Morzinski J, Simpson D) Practical and insightful. Has worksheets and diagrams. Also Faculty development through formal mentoring. Acad Med 1994;69:267-9 same authors
Sange KC, Hekelman FP. Mentoring needs and family medicine faculty. Fam Med 1990;22:183-5. Discusses the special need for mentors in family medicine and the particular challenges faced by junior faculty in this specialty. Encourages proactive approach and use of multiple mentors.
Hitchcock MA, Bland CJ, Hekelman FP, Blumenthal MG. Professional networks: the influence of colleagues on the academic success of faculty. Acad Med 1995;1108-1116 Encyclopedic review drawing several conclusions including that "distant" mentoring relationships and professional organizations (like STFM) may be even more important than classical mentoring within institution.
Palepu A, Friedman RH, Barnett RC et al. Junior faculty members’ mentoring relationships and their professional development in US medical schools. Acad Med 1998;73:318-323. Often cited as the classical study of the "prevalence" of mentoring but based on 1808 respondents to a survey (60%). Only 54% had mentor but these rated their research abilities higher than those without mentors leading to the conclusion that mentors were "essential".
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CHALLENGES to promotion and tenure for family medicine faculty:
- Lack of Mentors/Leaders
- Money
- Time Management
- Clinical Pressure
- Rebels!
- Step-Children
- Bar for Scholarship (Papers)
- Definition of Scholarship
- Academic Socialization
- Research Training
- Teaching Load
- Balance in P+T weight
- Sleep/Energy
- Committee Structure
- Research/Academic Tradition
- Department Focus/Vision
- Protected Time
- Leadership Experience in P+T/Academics
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STRATEGIES
1. Mentorship – Identify
- Assign for new faculty
- Start early – Before hire
- Track Choice
- ? Faculty development
- Formalize culture
- Keep relationship after they leave
- Opportunity for "mentee" to pick
- Formal communication forum multiple mentors/group (Agenda item)
- Mentors for different roles: Politics, Scholarship
2. Academic Socialization
- Do we want tenure?
- Don’t fit in entirely
- Change the rules
- Change tracks
- Participate in committee process
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Scott Moser, MD -- 5/12/2000 |
