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

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.

Navigating Promotion in Thoracic Surgery

The academic promotion process in thoracic surgery can appear nebulous to many young surgeons. However, at most institutions, clear promotion criteria exist for specific academic tracks, and they are based on factors such as clinical excellence, research/investigation, funding, education/teaching, service, health policy, diversity, equity, and inclusion (DEI), ethics, quality and safety, and health care delivery. A thorough understanding of the promotion process is the key to successful advancement in academia.

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.

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.

Could the altmetrics wave bring a flood of confusion for anatomists?

Altmetrics are non-traditional metrics that can capture downloads, social media shares, and other modern measures of research impact and reach. Despite most of the altmetrics literature focusing on evaluating the relationship between research outputs and academic impact/influence, the perceived and actual value of altmetrics among academicians remains nebulous and inconsistent. This work proposes that ambiguities surrounding the value and use of altmetrics may be explained by a multiplicity of altmetrics definitions communicated by journal publishers. A root cause analysis was initiated to compare altmetrics definitions between anatomy and medical education journal publishers' websites and to determine the comparability of the measurement and platform sources used for computing altmetrics values. A scoping content analysis of data from across eight publishers' websites revealed wide variability in definitions and heterogeneity among altmetrics measurement sources. The incongruencies among publishers' altmetrics definitions and their value demonstrate that publishers may be one of the root cause of ambiguity perpetuating confusion around the value and use of altmetrics. This review highlights the need to more deeply explore the root causes of altmetrics ambiguities within academia and makes a compelling argument for establishing a ubiquitous altmetrics definition that is concise, clear, and specific.

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.

Mentoring Medical Education Research: Guidelines from a Narrative Review

Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01565-2.

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.

Advancing our field by academically advancing pediatric rehabilitation medicine physicians

Academic promotion is desired by many faculty practicing at academic medical institutions, but the criteria for promotion often appear opaque to many physician faculty. In nearly all cases, evidence of scholarship is required regardless of academic track. Academic advancement can be stymied by unclear expectations, lack of protected time to engage in scholarly projects, insufficient evidence of dissemination, and limited guidance, mentorship and sponsorship. In addition to being important for promotion, scholarship is an essential aspect of academic medicine because it helps inform and advance the science. Pursuing academic excellence is an important goal for pediatric rehabilitation medicine faculty members because it helps advance the care of children with disabilities and the field itself. Pediatric rehabilitation medicine faculty in the clinician educator or clinician leader tracks are encouraged to understand the criteria for advancement, seek out mentorship, scholarize their career ikigai and identify opportunities to demonstrate academic excellence.

Winners and Losers in Academic Productivity During the COVID-19 Pandemic: Is the Gender Gap Widening for Faculty?

Background: The coronavirus pandemic accelerated academic medicine into the frontline of research and clinical work, leaving some faculty exhausted, and others with unanticipated time off. Women were particularly vulnerable, having increased responsibilities in both academic work and caregiving. Methods: The authors sought to determine faculty's responses to the pandemic, seeking predictors of accelerated versus decelerated academic productivity and work-life balance. In this survey of 424 faculty from a private Midwest academic medical center completed in August-September 2020, faculty rated multiple factors both "pre-COVID" and "during the COVID-19 lockdown," and a change score was calculated. Results: In a binary logistic regression model comparing faculty whose self-rated academic productivity increased with those whose productivity decreased, the authors found that controlling for multiple factors, men were more than twice as likely to be in the accelerated productivity group as women. In a similar model comparing partnered faculty whose self-rated work-life balance increased with partnered faculty whose work-life balance decreased, being in the positive work-life balance group was predicted by increased academic productivity, increased job stress, and having higher job priority than your partner. Conclusions: While the COVID-19 pandemic placed huge stressors on academic medical faculty, pandemic placed huge stressors on academic medical faculty, some experienced gains in productivity and work-life balance, with potential to widen the gender gap. As academic medicine evolves post-COVID, leaders should be aware that productivity and work-life balance predict each other, and that these factors have connections to work location, stress, and relationship dynamics, emphasizing the inseparable connections between work and life success.

The MedEdPORTAL Infinity Mirror: Conducting an Interactive Workshop on How to Develop an Educational Summary Report for MedEdPORTAL

INTRODUCTION

MedEdPORTAL is an open-access journal for health professions educators to publish their educational activities. The Educational Summary Report (ESR) is the manuscript that represents scholarly expression of those activities, aligned with Glassick's criteria for scholarship; however, prospective authors face challenges in writing ESRs, which can lead to rejection.

METHODS

We developed a conference workshop to teach health professions educators how to write an ESR by reviewing a sample ESR in small groups. The workshop began with a didactic on best practices in crafting each section of an ESR. We then divided participants into small groups to review an assigned section of a sample ESR using a reviewer's checklist and completing a templated flip chart. Each small group then reported out in a large-group discussion. A conference evaluation was distributed online to solicit perceptions of the workshop's effectiveness.

RESULTS

The 90-minute workshop was presented by separate teams of two facilitators at three national conferences. Approximately 35 participants attended the first workshop, and 50 attended the second and third workshops. Survey feedback from 19 respondents (38%) to the evaluation survey at the third workshop was representative of the previous two iterations and demonstrated that workshop content and materials were helpful.

DISCUSSION

A workshop enabling educators to serve as group peer reviewers of a sample ESR for a MedEdPORTAL submission was well received. Associate editors, faculty mentors, and other experienced faculty development leaders can use these materials to support future authors in submitting to MedEdPORTAL while providing opportunities for national presentations.

Developing a Novel 4-C Framework to Enhance Participation in Faculty Development

Phenomenon: Universities offer a variety of voluntary faculty development to ensure quality education, but face inconsistent faculty participation. Therefore, all Dutch universities require all faculty to obtain a teaching qualification certificate. Yet, like other medical centers, University Medical Center Utrecht continued to struggle with faculty nonparticipation. It has been postulated that clinician teachers may face unique challenges with responsibilities for patient care in addition to teaching and research, challenges that cannot be overcome by merely mandating faculty development or a teaching certificate. This project was conducted to gain insight into factors that hinder faculty participation and better understand what is needed to enhance faculty engagement in their professional development as teachers. Approach: UMC Utrecht has had a teaching certificate requirement for over 20 years. In 2015-2016, we conducted a local needs assessment, gathering faculty perspectives about the teaching certification process. To convey seriousness of purpose and promote commitment to change, we formally engaged key stakeholders from the outset, obtained grant funding for the needs assessment, and had an outside consultant lead the project. Faculty who were stalled or never started were questioned via semi-structured interviews. A focus group with those actively in the process of obtaining their certificate discussed perceived challenges in the process and recommended solutions. Faculty who obtained their teaching certificate completed an anonymous evaluation form. All evaluation comments and transcripts were thematically analyzed using open and axial coding. A literature review was performed to contextualize our findings and identify potential solutions. We compared our initial themes to these findings and found key challenge/solution categories, which we subsequently developed into a novel framework. Findings from the study and literature review were organized using this framework and shared with different stakeholders, all of whom engaged in problem-solving. Ideas and potential solutions were incorporated into a final report with recommendations for improving faculty support and provided to the institutional leadership. Findings: Of 23 faculty teachers approached, 8 (34.8%) agreed to be interviewed; 7 of 25 (28.0%) participated in the focus group; and 83 of 156 (53.2%) completed the evaluation. From the transcripts and evaluation comments, three themes emerged related to context and barriers: (a) skill development versus certification; (b) workplace priorities and culture, and (c) visibility and feasibility of the teacher's role. Triangulation of these themes with the literature revealed four challenge/solution categories - Competence, Context, Community, and Career. This 4-C framework facilitated communication of findings, structured the development of an action plan in response to the findings, and assured implementation of new initiatives for faculty support beyond competence development. Insights: Simply adopting requirements for faculty development may be insufficient and even invoke resistance. Improving faculty participation in faculty development and the quality of education requires institutional attention to not just faculty Competence needs, but also the factors of Context, Community, and Career that together comprise the culture experienced by faculty teachers. With institutional buy-in and commitment to change, the 4-C framework can help focus institutional attention on existing gaps in all four domains and guide the development of comprehensive solutions.