How are clinician-educators evaluated for educational excellence? A survey of promotion and tenure committee members in the United States

Promotion Criteria for Medical Educators: Are We Climbing a Ladder with Invisible Rungs?

OBJECTIVE

In 2006 the Association of American Medical Colleges recommended standardization of documentation of the contributions of medical educators and guidelines for their academic promotion. The authors characterized current United States (US) medical school promotion guidelines for medical educators.

METHODS

Authors collected publicly available data from medical school promotion websites from March through July 2022 after determining categories by traditional-set domains as well as peer-reviewed standards. Extracted data were analyzed using descriptive and inferential statistics, and frequencies were calculated for nominal and categorical data.

RESULTS

Of 155 medical schools identified, promotion criteria were publicly available for 143 (92%) schools. Ninety-one (64%) schools identified a distinct educator track. Of those with a defined educator track, 44 (48%) schools consider workshops or other media when evaluating candidates for promotion, and only 52 (57%) of schools with a specified educational track require additional documentation of teaching or education as part of their promotion process. Notably, 34 (37%) of the 91 schools with an educator track specifically require an Educational Portfolio, compared to 27 (52%) of the 52 schools that do not have a specific educator track for promotion.

CONCLUSION

This study describes the current lack of clarity and consistency of the promotion criteria for medical educators and indicates that the guidelines proposed by the Association of American Medical Colleges over 15 years ago have not been widely adopted. These data amplify previous calls for a more objective set of criteria for evaluating and recognizing the contributions of medical educators.

Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine

PURPOSE

Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work.

METHODS AND MATERIALS

We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together.

RESULTS

In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program.

CONCLUSIONS

Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.

Faculty Experiences Related to Career Advancement and Success in Academic Medicine

Phenomenon: Faculty career success in academic medicine is complex. Dynamic interactions among faculty and between faculty and their socio-cultural working environments contribute to the mystique of academic advancement. There are few empirical studies that analyze the social practice of faculty career advancement in academic medicine, especially those that focus on relations between individual and environmental contexts. This study aimed to investigate various faculty members' experiences around career advancement in a medical school. Through the analytical lens of Bourdieu's theory of practice, we focused on the relationship among individuals, positions, and environmental contexts.Approach: Following a general process of interpretive grounded theory, we collected faculty members' perceptions and experiences related to their career development and advancement via in-depth semi structured-interviews of 23 faculty at a medical school in the United States. We analyzed the interview transcripts using thematic and constant-comparison analyses, informed by Bourdieu's theory of practice emphasizing the concepts of habitus, field, doxa, illusio, and capital.Findings: While there was a general perception of collaborative success in the school, access to resources seemed to be unequally distributed and linked to faculty positions. Career opportunities, such as leadership and promotion, were mostly granted by leaders based on interpersonal relationships (social capital). Clinical faculty's limited access to professional development activities (cultural capital), including research, limited their likelihood for promotion (symbolic capital) at the school. An institutional emphasis on clinical productivity reinforced clinical faculty's constraints on academic scholarship, which led to perceived inequities by clinical faculty. Participants also perceived subtle gender bias and an unequal distribution of power among the specialties, which contradicted a culture of collaboration and support in the school.Insights: Complex power structures influence faculty career success. Unequal access and differential power among faculty positions resulted in disparities in career advancement. Greater transparency, equity, and inclusivity are obvious suggestions for change to allow all faculty to benefit from essential resources and career building opportunities. Furthermore, building high-quality relationships between leaders and faculty and mutual respect between specialties are essential to sustaining an organizational culture conducive to career success for all faculty. Faculty will benefit from a greater awareness of the structural and normative aspects of a medical school that are less obvious and more difficult to change. This is the value of applying Bourdieu's theory of practice to the socio-cultural dynamics of the medical school.

Analysis of Teaching-Related Criteria Within Promotion and Tenure Documents from US Pharmacy Schools

OBJECTIVE

To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy.

METHODS

PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution.

RESULTS

PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled.

CONCLUSION

Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators.

Fostering Success and Promoting Professional Development of Clinician Educator Mentees: A Workshop for Mentors

Introduction

The goal of academic mentoring relationships is to enable the mentee to identify/achieve professional advancement. Although mentors of clinician educators (CEs) must understand the criteria for successful career advancement, few have received formal CE mentor training.

Methods

The National Research Mentoring Network convened an expert panel to develop a 90-minute module for training CE mentors. This module included individual development plans, case studies involving challenges for CE faculty, and examples of the broadened scope of scholarly activity. The workshop was delivered to 26 participants across four institutions and evaluated by a retrospective pre/post survey.

Results

Using a 7-point scale (1 = very low, 4 = average, 7 = very high), participants rated the overall quality of their CE mentoring as slightly below average preworkshop (M = 3.9) and as above average postworkshop (M = 5.2, p < .001). Areas of greatest self-perceived change in skills on a 7-point scale (1 = not at all skilled, 4 = moderately skilled, 7 = extremely skilled ) included setting clear expectations of the mentoring relationship (pre M = 3.6, post M = 5.1, p < .001), aligning mentor expectations with those of mentees (pre M = 3.6, post M = 5.0, p < .001), and helping mentees set career goals (pre M = 3.9, post M = 5.4, p < .001).

Discussion

This module trains CE mentors using an interactive and collective problem-solving approach. Workshop participants better defined demonstrable markers for CE progression with potential to impact tailored guidance for mentees.

Educator's blueprint: A guide for clinician-educators to achieve promotion in emergency medicine

Promotion and tenure (P&T) can be a complex process, which many junior faculty in academic emergency medicine may struggle navigating. This paper presents perspectives and key considerations to guide faculty through the promotions process. We explore tips through three key phases: plotting the course for a successful academic career, collecting data to support academic advancement, and packaging materials into a compelling application portfolio. This resource can inform faculty and faculty developers when planning for P&T.

Mission Critical: Reimagining Promotion for Clinician-Educators

Academic clinician-educators who teach health professions trainees and lead educational programs have been penalized by the mismatch between their daily contributions to the academic mission and traditional promotion criteria focused on peer-reviewed publications and external reputation. Despite two decades of incremental approaches, inconsistency and inequity persist in the promotion process for clinician-educators. The authors propose five steps to mark a new approach to academic advancement for clinician-educators: (1) elevate the scholarly approach to teaching over peer-reviewed publications; (2) allow clinician-educators to identify an area of focus; (3) broaden the evidence for educational excellence; (4) prioritize internal referees; and (5) increase clinician-educator representation on promotion committees. Achieving meaningful change requires transforming entrenched traditions and policies at multiple levels. Changes that advance equity are necessary to retain academic faculty members who train the next generation of health professionals.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review

BACKGROUND

Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.

METHODS

We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.

RESULTS

We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.

CONCLUSIONS

The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Documenting Educational Impact in the Promotion Dossier with an Enhanced Curriculum Vitae

ABSTRACT

Faculty with a career focus on education in the health professions often have difficulty representing their academic accomplishments for due consideration in promotion decisions at their respective institutions. This problem occurs because the traditional curriculum vitae (CV) format which is most often used tends to focus on peer-reviewed accomplishments easily presented in lists, such as grants and publications. In some institutions, an educator portfolio is required in place of or in addition to the CV. However, creating or reviewing such a narrative-oriented document takes large amounts of time-time that most faculty or reviewers do not have. Having to use an educator portfolio also calls out the educator as different from the traditional research faculty member. To address this problem, we propose the solution of an Enhanced CV. The Enhanced CV includes much of what is presented in an educator portfolio but in a format closer to the traditional CV. Unlike a traditional CV, the Enhanced CV includes categories inclusive of educational contributions (eg, teaching, mentoring, and course leadership) and includes brief descriptions and/or impact statements to clarify the significance of the listed accomplishments. The Enhanced CV has been adopted at two very different institutions, where evidence is accumulating regarding the viability of the Enhanced CV as a solution to educators' problem of presenting their accomplishments for promotions. The lessons learned from these institutions illustrate how the Enhanced CV can increase the ability of educators to present their accomplishments and advance in rank in their academic careers.

A Guide to Basic Statistics for Educational Research

INTRODUCTION

Clinician-educators often need to produce scholarship for academic promotion. While some programs exist to help with faculty development skills, few provide adequate statistical training to help educators evaluate their work.

METHODS

From January 2020 through January 2021, faculty at three academic centers attended one of five in-person or virtual seminars with dedicated statistical training for medical education interventions. These 90-minute seminars included a 45-minute PowerPoint presentation of common statistical tests used for educational interventions followed by small breakout groups to help attendees work on additional practice examples. After each seminar, surveys were distributed in person or virtually to obtain feedback.

RESULTS

Forty-three faculty attended the five seminars, with a range of surgical and nonsurgical specialties represented. Of these attendees, 38 (88%) completed session evaluations. The majority of respondents (n = 34, 90%) rated the session as extremely useful in helping them know how to use statistics in their scholarly work. Most participants agreed or strongly agreed they had adequate time to practice skills (n = 30, 79%). Self-rated confidence in using statistics was significantly higher after the session compared to before (3.00 post vs. 1.97 pre, p < .0001). Most participants (n = 32, 84%) rated the session as excellent and the small-group practice as most useful (n = 16, 42%), but many (n = 26, 69%) wanted more skills practice.

DISCUSSION

This intervention shows that dedicated training on biostatistics used in educational interventions can help clinician-educators improve self-rated confidence and knowledge in choosing statistical tests in educational scholarship.

Academies in Health Professions Education: A Scoping Review

PURPOSE

Thirty years ago, academies were conceived as a sociocultural approach to revitalize the teaching mission of medical schools and to promote educators' career advancement. The academy movement has grown rapidly and now reaches a broad range of health professions education organizations. The authors conducted a scoping review to map the literature and describe the evidence that guides the formation of new academies and justifies the continuation of existing ones.

METHOD

The authors searched MEDLINE (via Ovid), Embase (via Elsevier and Ovid), CINAHL (via EBSCOhost), and Web of Science (via Clarivate Analytics) from inception through March 6, 2020, for publications regarding academy-like organizations. They mapped the relevant literature using logic modeling as an organizing framework and included the mission, resources, activities, output, outcomes, and impact of the included academies.

RESULTS

Of the 513 publications identified, 43 met the inclusion criteria, the oldest of which was published in 2000. Most publications were either case reports or perspective/opinion pieces (26, 57.8%), while studies presenting empirical findings were less common (11, 24.4%). Publications showed that academies were diversifying and increasingly were part of a broad range of organizations, including departments, hospitals, health science campuses, and national organizations. The mission, resources, and activities were similar across academies. Evaluation studies were largely limited to process measures, and rigorous studies examining outcomes (i.e., changes in academy participants) and impact on the organization at large were rare.

CONCLUSIONS

The increase in the number of academy-related publications parallels the accelerating speed of the academy movement. To sustain this movement, rigorous studies must provide evidence that academies contribute to the revitalization of organizations' teaching mission and bring about an academic culture where educators thrive and where education is a legitimate career path.

Fostering Careers in Medical Education

Many careers are available to psychiatrist-educators, and residents should learn about these pathways in addition to developing a core set of teaching skills regardless of their intended career trajectory. Clinician-Educator Programs offer structured opportunities for residents to explore advanced concepts, practice teaching skills, pursue scholarship, and receive mentorship in medical education. Women and persons from minority groups, particularly people of color and gender-diverse individuals, have long been passed over in the promotions process, and correction of these inequities is essential to creating a robust workforce of clinician-educators.

A Systematic Scoping Review on Portfolios of Medical Educators

BACKGROUND

Heralded as a teaching, assessment and reflective tool, and increasingly as a longitudinal and holistic perspective of the educator's development, medical educator's portfolios (MEP)s are increasingly employed to evaluate progress, assess for promotions and career switches, used as a reflective tool and as a means of curating educational activities. However, despite its blossoming role, there is significant dissonance in the content and structure of MEPs. As such, a systematic scoping review (SSR) is proposed to identify what is known of MEPs and its contents.

METHODS

Krishna's Systematic Evidenced Based Approach (SEBA) was adopted to structure this SSR in SEBA of MEPs. SEBA's constructivist approach and relativist lens allow data from a variety of sources to be considered to paint a holistic picture of available information on MEPs.

RESULTS

From the 12 360 abstracts reviewed, 768 full text articles were evaluated, and 79 articles were included. Concurrent thematic and content analysis revealed similar themes and categories including: (1) Definition and Functions of MEPs, (2) Implementing and Assessing MEPs, (3) Strengths and limitations of MEPs and (4) electronic MEPs.

DISCUSSION

This SSR in SEBA proffers a novel 5-staged evidence-based approach to constructing MEPs which allows for consistent application and assessment of MEPs. This 5-stage approach pivots on assessing and verifying the achievement of developmental milestones or 'micro-competencies' that facilitate micro-credentialling and effective evaluation of a medical educator's development and entrust-ability. This allows MEPs to be used as a reflective and collaborative tool and a basis for career planning.

An Inter-Institutional External Peer-Review Process to Evaluate Educators at Schools of Veterinary Medicine

Despite its fundamental importance, the educational mission of most schools of veterinary medicine receives far less recognition and support than the missions of research and discovery. This disparity is evident in promotion and tenure processes. Despite the frequent assertion that education is every college's core mission, there is a broad consensus that faculty are promoted primarily on the basis of meeting expectations relative to publications and grant funding. This expectation is evident in the promotion packets faculty are expected to produce and the criteria by which those packets are reviewed. Among the outcomes is increasing difficulty in hiring and retaining faculty, including young clinicians and basic scientists who are drawn to academic institutions because of the opportunity to teach. The Regional Teaching Academy (RTA) of the West Region Consortium of Colleges of Veterinary Medicine initiated an inter-institutional collaboration to address the most important obstacles to recognizing and rewarding teaching in its five member colleges. Working from the medical education literature, the RTA developed an Educator's Promotion Dossier, workshops to train promotion applicants, and an external review process. Initial use has shown that the reviews are efficient and complete. Administrators have expressed strong support for the product, a letter of external review that is returned to a promotion applicant's home institution. The overall result is an evidence-based, structured process by which teaching-intensive faculty can more fully document their achievements in teaching and educational leadership and a more rigorous external review process by which member colleges can assess quality, impact, and scholarly approach.

A review of U.S. Medical schools' promotion standards for educational excellence

Phenomenon: Given the growing number of medical science educators, an examination of institutions' promotion criteria related to educational excellence and scholarship is timely. This study investigates the extent to which medical schools' promotion criteria align with published standards for documenting and evaluating educational activities. Approach: This document analysis systematically analyzed promotion and tenure (P&T) guidelines from U.S. medical schools. Criteria and promotion expectations (related to context, quantity, quality, and engagement) were explored across five educational domains including: (i) teaching, (ii) curriculum/program development, (iii) mentoring/advising, (iv) educational leadership/administration, and (v) educational measurement and evaluation, in addition to research/scholarship and service. After independent review and data extraction, paired researchers compared findings and reached consensus on all discrepancies prior to final data submission. Descriptive statistics assessed the frequency of referenced promotion criteria. Findings: Promotion-related documents were retrieved from 120 (of 185) allopathic and osteopathic U.S. medical schools. Less than half of schools (43%; 52 of 120) documented a well-defined education-related pathway for advancement in academic rank. Across five education-specific domains, only 24% (12 of 50) of the investigated criteria were referenced by at least half of the schools. The least represented domain within P&T documents was "Educational Measurement and Evaluation." P&T documents for 47% of schools were rated as "below average" or "very vague" in their clarity/specificity. Insights: Less than 10% of U.S. medical schools have thoroughly embraced published recommendations for documenting and evaluating educational excellence. This raises concern for medical educators who may be evaluated for promotion based on vague or incomplete promotion criteria. With greater awareness of how educational excellence is currently documented and how promotion criteria can be improved, education-focused faculty can better recognize gaps in their own documentation practices, and more schools may be encouraged to embrace change and align with published recommendations.