The continued evolution of faculty appointment and tenure policies at U.S. medical schools

Building Career Paths for Ph.D., Basic and Translational Scientists in Clinical Departments in the United States: An Official American Thoracic Society Workshop Report

Rationale: To identify barriers and opportunities for Ph.D., basic and translational scientists to be fully integrated into clinical units. Objectives: In 2022, an ad hoc committee of the American Thoracic Society developed a project proposal and workshop to identify opportunities and barriers for scientists who do not practice medicine to develop successful careers and achieve tenure-track faculty positions in clinical departments and divisions within academic medical centers (AMCs) in the United States. Methods: This document focuses on results from a survey of adult and pediatric pulmonary, critical care, and sleep medicine division chiefs as well as a survey of workshop participants, including faculty in departmental and school leadership roles in both basic science and clinical units within U.S. AMCs. Results: We conclude that full integration of non-clinically practicing basic and translational scientists into the clinical units, in addition to their traditional placements in basic science units, best serves the tripartite mission of AMCs to provide care, perform research, and educate the next generation. Evidence suggests clinical units do employ Ph.D. scientists in large numbers, but these faculty are often hired into non-tenure track positions, which do not provide the salary support, start-up funds, research independence, or space often associated with hiring in basic science units within the same institution. These barriers to success of Ph.D. faculty in clinical units are largely financial. Conclusions: Our recommendation is for AMCs to consider and explore some of our proposed strategies to accomplish the goal of integrating basic and translational scientists into clinical units in a meaningful way.

Ethical decision-making and role conflict in managing a scientific laboratory

Scientists who manage research laboratories often face ethical dilemmas related to conflicts between their different roles, such as researcher, mentor, entrepreneur, and manager. It is not known how often uncertainty about conflicting role obligations leads scientists to engage in unethical conduct, but this probably occurs more often than many people would like to think. In this paper, we reflect on ethical decision-making in scientific laboratory management with special attention to how different roles create conflicting obligations and expectations that may produce moral uncertainty and lead to violations of research norms, especially when combined with self-interest and other factors that increase the risk of misbehavior. We also offer some suggestions and guidance for investigators and research institutions.

Team science criteria and processes for promotion and tenure of Health Science University Faculty

Although team science has expanded with far-reaching benefits, universities generally have not established criteria to recognize its value in faculty promotion and tenure. This paper recommends how institutions might weigh a faculty member's engagement in team science in the promotion and tenure process. Seventeen team science promotion and tenure criteria are recommended based on four sources - an evaluation framework, effectiveness metrics, collaborative influences, and authorship criteria. Suggestions are made for adaptation of the 17 criteria to committee guidelines, faculty team science portfolios, and the roles of individuals and institutions participating in large, cross-disciplinary research projects. Future research recommendations are advanced.

Rank and Tenure Amongst Faculty at Academic Medical Centers: A Study of More Than 50 Years of Gender Disparities

PURPOSE

To investigate progress toward gender equality in academic medicine through a longitudinal analysis of gender parity among faculty at medical schools.

METHOD

The authors conducted a retrospective analysis of Association of American Medical Colleges Faculty Roster data on gender, tenure status, and academic rank of faculty in basic science (BSc) and clinical science (CSc) departments from 1966 to 2019. They expressed data as whole numbers and percent female. A trend analysis projected time to gender parity across rank and tenure categories, and cross-tabulation analysis revealed the relative odds of females being in a rank and tenure position relative to males.

RESULTS

A 12-fold increase in the number of faculty occurred from 1966 to 2019, driven largely by increases in non-tenure track faculty. Female tenured and tenure track numbers increased at consistent rates (121 and 174 per year; P < .001). Female non-tenure track rates mirrored those for males, both changing in 2000. Odds ratios in 2019 for BSc and CSc females to be in tenure track versus non-tenure track positions compared with males were 0.83/0.98 and to be tenured were 0.63/0.44. Odds ratios in 2019 for BSc and CSc females to be full professors versus assistant or associate professors compared with males were 0.55/0.42. BSc assistant and associate professor percent female rates increased linearly from 1966 to 2019, while full professor rates increased in 1986. Transition points between periods of linear change were seen later in CSc departments (1977, 1980, 1985, 1994). Best fit line models indicated gender parity will be reached for BSc/CSc faculty in 2034/2023, 2047/2033, and 2065/2053 for assistant, associate, and full professors, respectively.

CONCLUSIONS

These findings suggest large historical changes in medical school expansion, medical education, and economics have shifted gender curves at all academic ranks. To achieve gender parity, additional national changes are needed.

Challenges and solutions for the promotion of medical sciences faculty members in Iran: a systematic review

INTRODUCTION

The faculty promotion system is expected to benefit the faculty, institute, and profession and lead to the sustainable and comprehensive development. This present systematic review aims to investigate the challenges and solutions for the promotion of medical sciences faculty members in Iran.

METHOD

This study was a systematic review conducted by searching in PubMed, Scopus, Eric, Web of Science, Cochrane, SID, Magiran, and https://irandoc.ac.ir/line with Persian and English terms in the period from 2015 to 2020. Study selection and data extraction were performed independently by reviewers.

RESULTS

Thirteen articles were included. Challenges and solutions for the promotion of medical sciences faculty members were reviewed and grouped into five main categories: 1. The general regulations for the promotion of faculty members, 2. Cultural, disciplinary, and social activities, 3. Educational activities, 4. Research-technology activities, and 5. Scientific-executive activities.

CONCLUSION

Despite several modifications to regulations for the promotion of medical sciences faculty members in Iran, this process still encounters challenges because of its complex nature. This article provides tips to policymakers on regulations of promotion for educational activities.

Traversing academic rank promotion for nurse practitioner faculty

ABSTRACT

The relatively rapid increase of nurse practitioner (NP) programs across the United States has necessitated schools and colleges of nursing to hire and support NP faculty through the promotion process to sustain their programs. Nurse practitioner faculty engaged in clinical practice often face barriers in obtaining rank promotion. The purpose of this article was to provide NP faculty an evidence-based pathway to support academic rank promotion. An additional aim was to recognize implicit biases and barriers, while offering guidance for overcoming challenges. Using Boyer (1990) and American Association of Colleges of Nursing (2018) as a foundation, this article outlines a pathway to synergistically highlight and weave clinical practice experiences within academic expectations of promotion. The categories of academic rank promotion identified and highlighted within this article include scholarship, teaching, practice, and service. The Stager & Douglass Pathway to Preparation for Traversing Academic Rank for Clinical Faculty provides steps for a well-developed plan and comprehensive dossier in supporting successful promotion. These steps include understanding institutional promotional guidelines, developing focused priorities, defining the clinical practice role in the progression of promotion, partnering with a mentor, gathering supportive materials early, and developing a comprehensive dossier, leading to a successful academic rank promotion process. Preparing the dossier early leverages time for the NP faculty to strategize with academic leaders and colleague mentors to develop focused priorities. In addition, identified biases and barriers may be mitigated to support successful academic rank promotion.

Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

OBJECTIVE

Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.

STUDY SELECTION

All original studies reporting faculty rank stratified by gender worldwide were included.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.

RESULTS

Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).

CONCLUSIONS

Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.

PROSPERO REGISTRATION NUMBER

CRD42020197414.

Perspectives of scientists on disseminating research findings to non-research audiences

BACKGROUND

Little is known about practices used to disseminate findings to non-research, practitioner audiences. This study describes the perspectives, experience and activities of dissemination & implementation (D&I) scientists around disseminating their research findings.

METHODS

The study explored D&I scientists' experiences and recommendations for assessment of dissemination activities to non-research audiences. Existing list serves were used to recruit scientists. Respondents were asked three open-ended questions on an Internet survey about dissemination activities, recommendations for changing evaluation systems and suggestions to improve their own dissemination of their work.

RESULTS

Surveys were completed by 159 scientists reporting some training, funding and/or publication history in D&I. Three themes emerged across each of the three open-ended questions. Question 1 on evaluation generated the themes of: 1a) promotional review; 1b) funding requirements and 1c) lack of acknowledgement of dissemination activities. Question 2 on recommended changes generated the themes of: 2a) dissemination as a requirement of the academic promotion process; 2b) requirement of dissemination plan and 2c) dissemination metrics. Question 3 on personal changes to improve dissemination generated the themes of: 3a) allocation of resources for dissemination activities; 3b) emerging dissemination channels and 3c) identify and address issues of priority for stakeholders.

CONCLUSIONS

Our findings revealed different types of issues D&I scientists encounter when disseminating findings to clinical, public health or policy audiences and their suggestions to improve the process. Future research should consider key requirements which determine academic promotion and grant funding as an opportunity to expand dissemination efforts.

Restructuring of Academic Tracks to Create Successful Career Paths for the Faculty of Rutgers Biomedical and Health Sciences

Background

We report faculty affairs lessons from the formation and academic restructuring of Rutgers Biomedical and Health Sciences. Our approach may be a blueprint for development of a new track system that can be adapted by other institutions, after consideration of their own special circumstances.

Methods

We created new Appointments and Promotions guidelines consisting of one Tenure Track and four Non-Tenure Tracks, each with different missions. We restructured faculty performance evaluations to include mission-based criteria, an expanded rating scale, and specific expectations. After negotiating these new processes with our faculty union, we enacted central oversight to ensure uniform application of these processes and their associated criteria. We communicated the guidelines and the evaluation system widely. We created programs for universal mentoring, publishing education, diversity, and faculty development.

Results

All faculty in our seven schools went through track selection. Anxiety and incomplete understanding improved after implementation. Evaluations with expectations for the following year and an expanded scale for more nuanced assessment served as mentoring tools. Requirements for mentor assignments and diversity education created an atmosphere of nurturing and inclusion. Publications, extramural support, and faculty satisfaction increased after implementation of the guidelines.

Conclusion

Lessons included the need to review and learn from guidelines at other institutions, to create tracks that align with different jobs, the necessity for central oversight for uniform application of criteria, the need for extensive and frequent communication with faculty, and that fear of change is only reduced after evidence of success of a new structure. The most important lesson was that faculty rise to expectations when clear, ambitious criteria are delineated and universally applied.

Scholarly productivity of faculty in primary care roles related to tenure versus non-tenure tracks

BACKGROUND

Increasing the number of primary care physicians is critical to overcoming the shortage of healthcare providers. Primary care physicians are increasingly called upon to address not only medical concerns but also behavioral health needs and social determinants of health which requires ongoing research and innovation. This paper evaluated scholarly productivity of faculty in tenure versus non-tenure tracks in primary care roles, defined as family medicine, internal medicine, internal medicine/pediatrics and pediatrics.

METHODS

The study included physician faculty in the clinical departments of Brody School of Medicine serving between the 2014-2015 and 2018-2019 academic years. Department, track, and rank at the beginning of each academic year (e.g., 2014-2015) were correlated with having any publications in the following calendar year (e.g., 2015), as determined from a search of the Scopus database.

RESULTS

A total of 1620 observations and 542 unique faculty were included in the analysis. As of 2018-2019, 19% percent of primary care faculty were either tenured or on tenure track, as compared to 41% of faculty in other departments (p < 0.001). Primary care departments were also disproportionately staffed by junior faculty (60% as compared to 48% in other departments; p = 0.087). The proportion of faculty with any publications was significantly higher for faculty on the tenure track compared to those not on the tenure track (34% vs. 14%, p < 0.001).

CONCLUSIONS

Academic productivity was lower among non-tenure-track physician faculty, as measured by publication in peer-reviewed journals. This was exacerbated among faculty in primary care departments, who were also more likely to hold non-tenure-track appointments. The loss of tenure-track positions disproportionately impacts scholarly activity in primary care and may be limiting progress in care-oriented research. Findings suggest that providing non-tenure faculty the time and resources to be involved in research, in addition to their clinical work, as well as access to research collaborators and mentors can promote scholarly activity among this group.

Current status of clinician-educator tracks in internal medicine residency programmes

BACKGROUND

Residents in internal medicine programmes lack formal training in leadership, curriculum development and clinical teaching. Residency programmes created clinician-educator tracks (CETs) to formally teach residents to become effective educators and to involve them in the science of medical education. However, the curricula in these tracks are often locally developed and remain at the discretion of the individual programmes.

METHODS

This survey evaluates the frequency of CETs in internal medicine residency programmes in the USA and descriptively analyses their logistical and curricular content. During the academic year 2017-2018, directors of all Accreditation Council for Graduate Medical Education (ACGME) accredited internal medicine residency programmes in the USA were invited to participate in this survey (n=420). We developed a web-based 22-question survey to assess the logistics and curricular content of CET programmes.

RESULTS

A total of 150 programmes responded to the survey invitation (response rate=35.7%). Only 24% (n=36) of programmes offered a CET, the majority of which have been available for only 5 years or less. The track is most frequently offered to postgraduate year (PGY)-2 and PGY-3 residents. Only a minority of participating faculty (27.8%) have protected time to fulfil their CET role. Bedside teaching, feedback, small group teaching and curriculum development are the most commonly taught topics, and faculty mentorship and small group teaching methods are the most commonly used types of instruction.

CONCLUSIONS

CETs are offered in only 24% of internal medicine residency programmes in the USA. The curricula of these tracks vary across programmes, and their success is often countered by logistic and financial challenges.

Innovation in Education Research: Creation of an Education Research Core

Within academic medical centers, there is increasing interest among physicians to pursue education as a promotion pathway. Many medical schools and universities offer professional development opportunities for these individuals such as workshops and certificate and advanced degree programs. However, there exists a need for a more personalized support for clinician-educators to be successful in educational scholarship in the health care setting. In 2017, a departmental level educational research community was established within Anesthesiology and Critical Care Medicine at Johns Hopkins University to support faculty, staff, and trainees in creating, completing, and publishing educational scholarship. The research infrastructure includes administrative and institutional review board submission assistance, internal grant support, database management, statistical analysis, and consultation with professional educators. Also, integral to the education core is monthly education lab meetings that allow an opportunity for education researchers to present work in progress, conceive new projects, discuss relevant literature, and cultivate and sustain a community of educational scholars.This innovation in education demonstrates feasibility at a departmental level to successfully support educational research. We have initiated education meetings with a cohort of core education faculty who are interested in an educational promotion track. We present several metrics that can be used to evaluate the effectiveness of the programs similar to this innovation.

A Qualitative Evaluation of a Clinical Faculty Mentorship Program Using a Realist Evaluation Approach

OBJECTIVE

Clinically focused faculty (full-time clinical faculty and clinician educators) comprise an increasing proportion of academic faculty, yet they underutilize mentorship nationally. The aims of this study were to test and refine a program theory for an institutional mentorship program for junior clinically focused faculty and to understand the facilitators and barriers of sustained participation.

METHODS

We conducted a qualitative study using a realist evaluation approach. Between July and December 2017, we performed in-depth semistructured interviews of 2 participant groups from a junior faculty mentorship program at our institution: 1) those who attended more than two thirds of the program sessions; and 2) those who only attended 1 session. We used inductive thematic analysis to identify key context and program mechanisms that led to meaningful outcomes for faculty mentorship.

RESULTS

We interviewed 23 junior faculty representing 15 pediatric specialties. We identified 4 contextual themes (past personal experience, current competing priorities, institutional culture, and gaps in support and resources), 3 mechanisms (connecting with faculty, sharing ideas and strategies, and self-reflecting), and 3 outcomes (sense of community, acquired tools and skills, and broadened perspectives), which we organized into a programmatic theory representing the program's impact on participants. Themes that emerged were consistent between both groups.

CONCLUSIONS

A mentorship program that provided junior faculty with opportunities to connect, share ideas and strategies, and self-reflect led to improvement in meaningful outcomes for clinically focused faculty. Our program theory provides a basis for institutions seeking to build a mentorship program targeted towards this increasing proportion of junior faculty.

Promotion and tenure policies for team science at colleges/schools of medicine

INTRODUCTION

Advancing understanding of human health promotion and disease prevention and treatment often requires teamwork. To evaluate academic medical institutions' support for team science in the context of researchers' career development, we measured the value placed on team science and specificity of guidance provided for documenting team science contributions in the promotion and tenure (P&T) documents of Colleges/Schools of Medicine (CoMs) in the National Center for Advancing Translational Sciences' Clinical and Translational Science Award (CTSA) program.

METHOD

We reviewed complete P&T documents from 57 of 63 CTSA CoMs to identify career paths defined by three dimensions: academic rank (associate versus full professor), tenure eligibility (tenure track versus not), and role (research, clinical, education, and administrative), and we rated team science value and documentation guidance for each path. Multilevel models were estimated to compare team science value and documentation guidance as a function of the three career path dimensions while accounting for the clustered data (N = 357 career paths within 57 CoMs).

RESULTS

Team science value was greater for associate than full professors, non-tenure-eligible versus tenure-eligible positions, and roles prioritizing clinical, education, and administrative responsibilities versus those prioritizing research. Guidance for documenting team science achievements was more explicit for roles that prioritized research.

DISCUSSION

Although P&T policies at most CTSA institutions express value for team science, inconsistent within-institutional patterns of recognition and reward across career paths may have implications for researchers' involvement in team science. We discuss the implications of our findings for research and for P&T policies that promote team science.

Sex Differences in Faculty Rank Among Academic Surgeons in the United States in 2014

OBJECTIVE

The aim of this study was to evaluate sex differences in full professorship among a comprehensive, contemporary cohort of US academic surgeons.

SUMMARY OF BACKGROUND DATA

Previous work demonstrates that women are less likely than men to be full professors in academic medicine, and in certain surgical subspecialties. Whether sex differences in academic rank exist across all surgical fields, and after adjustment for confounders, is not known.

METHODS

A comprehensive list of surgeons with faculty appointments at US medical schools in 2014 was obtained from Association of American Medical Colleges (AAMC) faculty roster and linked to a comprehensive physician database from Doximity, an online physician networking website, which contained the following data for all physicians: sex, age, years since residency, publication number (total and first/last author), clinical trials participation, National Institutes of Health grants, and surgical subspecialty. A 20% sample of 2013 Medicare payments for care was added to this dataset. Multivariable regression models were used to estimate sex differences in full professorship, adjusting for these variables and medical school-specific fixed effects.

RESULTS

Among 11,549 surgeon faculty at US medical schools in 2014, 1692 (14.7%) were women. Women comprised 19.4% of assistant professors (1072/5538), 13.8% of associate professors (404/2931), and 7.0% of full professors (216/3080). After multivariable analysis, women were less likely to be full professors than men (adjusted odds ratio: 0.76, 95% confidence interval: 0.6-0.9).

CONCLUSION

Among surgical faculty at US medical schools in 2014, women were less likely than men to be full professors after adjustment for multiple factors known to impact faculty rank.

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

Background: In recent years, educational leaders have proposed domains of educational excellence and corresponding metrics to objectively measure contributions of clinician-educators for promotion and tenure (P&T). The purpose of this study was to explore whether P&T committees in United States (US) have incorporated these recommendations into practice. Method: The authors conducted a survey of P&T leaders across institutions in US. Items included questions related to institutional tracks for P&T, domains included in promotional packets, metrics for their measurement, and use of an Educator's Portfolio (EP). Results: Respondents from 55 institutions completed the survey. The presence of a teaching academy/society was associated with the presence of a promotion track for clinician-educators (p = 0.04). Only teaching activities (91%), assessment of learners (55%), and educational scholarship (51%) were required by a majority of institutions. Few institutions used objective methods for measuring impact and less than half (47%) required an EP. Discussion: These results highlight both progress in the recognition of clinician-educators while also suggesting discordance in the perspective of educational leaders and the practice of P&T committees. The authors advocate for establishing a national community of expert medical educators who may assist P&T committees in adopting consensus-based criteria and metrics to evaluate clinician-educators' contributions.

An Academic Research Coach: An Innovative Approach to Increasing Scholarly Productivity in Medicine

BACKGROUND

Academic faculty who devote most of their time to clinical work often struggle to engage in meaningful scholarly work. They may be disadvantaged by limited research training and limited time. Simply providing senior mentors and biostatistical support has limited effectiveness.

OBJECTIVE

We aimed to increase productivity in scholarly work of hospitalists and internal medicine physicians by integrating an Academic Research Coach into a robust faculty development program.

DESIGN

This was a pre-post quality improvement evaluation.

SETTING

This was conducted at the University of Washington in faculty across three academic-affiliated hospitals and 10 academic-affiliated clinics.

PARTICIPANTS

Participants were hospitalists and internists on faculty in the Division of General Internal Medicine at the University of Washington.

INTERVENTION

The coach was a 0.50 full time equivalent health services researcher with strong research methods, project implementation, and interpersonal skills. The coach consulted on research, quality improvement, and other scholarship.

MEASUREMENTS

We assessed the number of faculty supported, types of services provided, and numbers of grants, papers, and abstracts submitted and accepted.

RESULTS

The coach consulted with 49 general internal medicine faculty including 30 hospitalists who conducted 63 projects. The coach supported 13 publications, 11 abstracts, four grant submissions, and seven manuscript reviews. Forty-eight faculty in other departments benefited as co-authors.

CONCLUSION

Employing a dedicated health services researcher as part of a faculty development program is an effective way to engage clinically oriented faculty in meaningful scholarship. Key aspects of the program included an accessible and knowledgeable coach and an ongoing marketing strategy.

Best practices and inclusion of team science principles in appointment promotion and tenure documents in research intensive schools of nursing

BACKGROUND

Nurse scientists are highly sought after and find satisfaction in serving as members of interdisciplinary research teams. These teams also tend to be highly productive. However, nurse scientists in academia also have to reach certain productivity milestones to be promoted and receive tenure that may be incongruent with team science principles.

PURPOSE

This study therefore sought to examine whether APT documents in research intensive nursing schools incorporate team science principles.

METHODS

Qualitatively analyzed the appointment, promotion and tenure documents of 18 U.S. based research intensive schools of nursing with over $2 million in NIH funding in fiscal year 2014.

FINDINGS

The study found that only 8 of 18 documents included any reference to team science principles and even these mentions were largely negligible. There were few best practices to recommend across documents. By not recognizing team science within these documents, nursing risks marginalization within the larger scientific community by limiting mentorship and learning opportunities for early career nurse scientists.

DISCUSSION

Schools of nursing should revisit their promotion and tenure criteria and include a greater commitment to encouragement of team science.

Tenure Appointments for Faculty of Clinical Departments at U.S. Medical Schools: Does Specialty Designation Make a Difference?

PURPOSE

To describe differences and trends among clinical specialty departments in number and percentage of tenure-related appointments for full-time faculty.

METHOD

Association of American Medical Colleges Faculty Roster annual snapshot reports were used to calculate percentages of full-time faculty holding tenure-related appointments in each of the database's 17 groupings of clinical specialty departments. Faculty numbers and percentages by track were compared to investigate trends for 2006 to 2016.

RESULTS

In the decade 2006-2016, the number of individuals on tenure-related tracks in clinical departments declined by 0.8% (276/33,610), but those on nontenure appointments increased by 60.5% (36,444/60,195). The number reporting "tenure not available" rose by 58.9% (4,467/7,574). Currently, 62% to 82% of full-time faculty in clinical departments are on nontenure tracks. Specialties differ significantly in current percentage and in rate of change in both numbers and percentage of tenure-related appointments. In 2016, faculty on tenure-related tracks ranged from 34.5% (295/855) in public health and preventive medicine to 13.5% (654/5,654) in family medicine. The most significant drops in percentage of tenure-related appointments in 2006-2016 were in surgery, pediatrics, and internal medicine.

CONCLUSIONS

Dramatic changes in size and track distribution of faculty are occurring at significantly different rates across clinical specialty departments. The number of individuals on tenure-related tracks remains relatively stable, but the percentage of such faculty in clinical specialty departments continues to drop dramatically in almost all specialties. The growing dominance of nontenure appointments has important implications for career development and academic promotion policies and practices in all specialties.

The Clinician-Educator Pathway in Radiology: An Analysis of Institutional Promotion Criteria

PURPOSE

To provide radiology departmental promotional committees and vice chairs of education with a more global perspective on the types of academic activity valued by institutions to aid in their faculty mentoring and standardizing of the Clinician-Educator (ClinEd) pathway.

METHODS

Ninety-two research schools were ranked into three tiers. Ranking was correlated with the presence of a ClinEd track. Thirty promotion documents (ten from each tier) were analyzed to identify common criteria. Differences in guidelines between tiers were assessed by the frequency distribution of criteria.

RESULTS

Tier 1 had a significantly greater proportion of schools with a ClinEd track than tier 2 (73% versus 44%, p < 0.05). Thirty-nine criteria were identified and organized into four categories teaching (13), scholarship (12), service/clinical excellence (7), and research (7). The top five included meeting presentations, trainee evaluations, leadership in committees, development of teaching methodologies and materials, and publication of book chapters. First and second tier schools were most similar in frequency distribution.

CONCLUSIONS

The criteria for the ClinEd promotion track still vary across institutions, though many commonalities exist. A handful of innovative criteria reflect the changing structure of modern health care systems, such as incorporation of online teaching modules and quality improvement efforts. As health care changes, guidelines and incentive structures for faculty should change as well. The information gathered may provide promotion committees with a more global perspective on the types of academic activity valued by modern-day institutions to aid in the national standardization of this pathway and to assist in faculty mentoring.

Sex Differences in Faculty Rank Among Academic Cardiologists in the United States

BACKGROUND

Studies demonstrate that women physicians are less likely than men to be full professors. Comprehensive evidence examining whether sex differences in faculty rank exist in academic cardiology, adjusting for experience and research productivity, is lacking. Therefore, we evaluated for sex differences in faculty rank among a comprehensive, contemporary cohort of US cardiologists after adjustment for several factors that impact academic advancement, including measures of clinical experience and research productivity.

METHODS

We identified all US cardiologists with medical school faculty appointments in 2014 by using the American Association of Medical Colleges faculty roster and linked this list to a comprehensive physician database from Doximity, a professional networking website for doctors. Data on physician age, sex, years since residency, cardiology subspecialty, publications, National Institutes of Health grants, and registered clinical trials were available for all academic cardiologists. We estimated sex differences in full professorship, adjusting for these factors and medical school-specific fixed effects in a multivariable regression model.

RESULTS

Among 3810 cardiologists with faculty appointments in 2014 (13.3% of all US cardiologists), 630 (16.5%) were women. Women faculty were younger than men (mean age, 48.3 years versus 53.5 years, P<0.001), had fewer total publications (mean number: 16.5 publications versus 25.2 publications; P<0.001), were similarly likely to have National Institutes of Health funding (proportion with at least 1 National Institutes of Health award, 10.8% versus 10.4%; P=0.77), and were less likely to have a registered clinical trial (percentage with at least 1 clinical trial, 8.9% versus 11.1%; P=0.10). Among 3180 men, 973 (30.6%) were full professors in comparison with 100 (15.9%) of 630 women. In adjusted analyses, women were less likely to be full professors than men (adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.94; P=0.02; adjusted proportions, 22.7% versus 26.7%; absolute difference, -4.0%; 95% confidence interval, -7.5% to -0.7%).

CONCLUSIONS

Among cardiology faculty at US medical schools, women were less likely than men to be full professors after accounting for several factors known to influence faculty rank.

Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines

BACKGROUND

Faculty departure can present significant intellectual costs to an institution. The authors sought to identify the reasons for clinical and non-clinical faculty departures at one academic medical center (AMC).

METHOD

In May and June 2010, the authors surveyed 137 faculty members who left a west coast School of Medicine (SOM) between 1999 and 2009. In May and June 2015, the same survey was sent to 40 faculty members who left the SOM between 2010-2014, for a total sample size of 177 former faculty members. The survey probed work history and experience, reasons for departure, and satisfaction at the SOM versus their current workplace. Statistical analyses included Pearson's chi-square test of independence and independent sample t-tests to understand quantitative differences between clinical and non-clinical respondents, as well as coding of qualitative open-ended responses.

RESULTS

Eighty-eight faculty members responded (50%), including three who had since returned to the SOM. Overall, professional and advancement opportunities, salary concerns, and personal/family reasons were the three most cited factors for leaving. The average length of time at this SOM was shorter for faculty in clinical roles, who expressed lower workplace satisfaction and were more likely to perceive incongruence and inaccuracy in institutional expectations for their success than those in non-clinical roles. Clinical faculty respondents noted difficulty in balancing competing demands and navigating institutional expectations for advancement as reasons for leaving.

CONCLUSIONS

AMCs may not be meeting faculty needs, especially those in clinical roles who balance multiple missions as clinicians, researchers, and educators. Institutions should address the challenges these faculty face in order to best recruit, retain, and advance faculty.

Tenure and the Faculty Physician

Academic tenure, introduced by the American Association of University Professors in 1915, is a status that protects employed faculty members from summary dismissal and, thereby, intends to preserve their academic freedom. Initially tied to financial security through salary guarantees, academic tenure has evolved into a concept associated less with monetary support and strict scholarly productivity than at its inception, primarily owing to the growing number of clinician educators with highly competitive salaries at university-affiliated academic health centers. Achievement of tenure continues to require significant additional time and effort, but modifications in the requisite probationary period and the allowance at some institutions of tenure for part-time faculty have offset some costs, while still maintaining leadership opportunities for the individual and academic benefits for both the individual and the institution. How institutions balance their own financial risk and the demands on faculty members is likely to determine the future of tenure.

Post-tenure Review at U.S. Medical Schools

PURPOSE

To assess post-tenure review policies at U.S. medical schools by examining how prevalent post-tenure review is, what models of post-tenure review are employed, and what outcomes result from post-tenure review processes.

METHOD

In late 2014, a Web-based survey was sent to the associate dean for faculty affairs (or equivalent) at each U.S. medical school accredited by the Liaison Committee on Medical Education (N = 141). The survey addressed elements of post-tenure review policies, including whether a policy was in place, the frequency of the review, and the review outcomes. Descriptive statistics were calculated.

RESULTS

Of the 94 responding schools with a tenure system, 39 (41%) had an established post-tenure review policy. Although these policies showed great variability across schools in duration, having been in place from 1 to 50 years, 12 (31%) were established within the last 5 years. The outcomes of post-tenure review also varied. Superior performance ratings generally resulted in notations in the faculty member's personnel file and notifications to school leadership. Conversely, when a faculty member received an unsatisfactory rating, a remediation or development plan was sometimes required.

CONCLUSIONS

At least 40% of medical schools with a tenure system have post-tenure review, and it is becoming more common. These findings about the prevalence and use of post-tenure review across institutions can assist medical school leaders as they strive to shape policies to facilitate faculty engagement and productivity. They also can provide the foundation for future evaluative studies on the effectiveness, outcomes, and impact of post-tenure review.

Influences of faculty evaluating system on educational performance of medical school faculty

PURPOSE

The promotion of educators is challenged by the lack of accepted standards to evaluate the quality and impact of educational activities. Traditionally, promotion is related to research productivity. This study developed an evaluation tool for educational performance of medical school faculty using educator portfolios (EPs).

METHODS

Design principles and quantitative items for EPs were developed in a consensus workshop. These principles were tested in a simulation and revised based on feedback. The changes of total educational activities following introduction of the system were analyzed.

RESULTS

A total of 71% faculty members answered the simulation of the system and the score distributed widely (mean±standard deviation, 65.43±68.64). The introduction of new system significantly increased the total educational activities, especially in assistant professors.

CONCLUSION

The authors offer comprehensive and practical tool for enhancing educational participation of faculty members. Further research for development of qualitative evaluation systems is needed.

Status of Tenure Among Black and Latino Faculty in Academic Medicine

Tenure has been used for years to recruit, promote, and retain faculty in higher education and has been associated with job security and academic freedom. Absence of tenure and not being in tenure-earning tracks is grouped with the challenges faced by underrepresented minorities in academic medicine. Those challenges include being found at the assistant professor rank more often, having more clinical responsibilities, and not being in leadership positions as often as compared to non-minority faculty. The role of tenure and tenure tracks is unclear as it relates to the presence of minority faculty. This article presents a look at the status of tenure among black and Latino faculty in academic medicine at US medical schools.

Training the teachers. The clinician-educator track of the University of Washington Pulmonary and Critical Care Medicine Fellowship Program

The University of Washington was the first pulmonary and critical care medicine fellowship training program accredited by the Accreditation Council for Graduate Medical Education to create a dedicated clinician-educator fellowship track that has its own National Residency Matching Program number. This track was created in response to increasing demand for focused training in medical education in pulmonary and critical care. Through the Veterans Health Administration we obtained a stipend for a clinician-educator fellow to dedicate 12 months to training in medical education. This takes place predominantly in the second year of fellowship and is composed of several core activities: fellows complete the University of Washington's Teaching Scholars Program, a professional development program designed to train leaders in medical education; they teach in a variety of settings and receive feedback on their work from clinician-educator faculty and the learners; and they engage in scholarly activity, which may take the form of scholarship of teaching, integration, or investigation. Fellows are guided throughout this process by a primary mentor and a mentoring committee. Since funding became available in 2009, two of the three graduates to date have successfully secured clinician-educator faculty positions. Graduates uniformly believe that the clinician-educator track met their training goals better than the research-based track would have.

Do Family Responsibilities and a Clinical Versus Research Faculty Position Affect Satisfaction with Career and Work-Life Balance for Medical School Faculty?

BACKGROUND

Balancing career and family obligations poses challenges to medical school faculty and contributes to dissatisfaction and attrition from academics. We examined the relationship between family setting and responsibilities, rank, and career and work-life satisfaction for faculty in a large U.S. medical school.

METHODS

Baseline faculty surveys were analyzed from the first year of a 4-year National Institutes of Health-funded study to evaluate awareness, knowledge, attitudes, and use of family friendly policies and career satisfaction. The study focus was on the impact of family responsibilities and characteristics of the faculty position (rank, clinical vs. nonclinical, and academic series) in multivariate comparisons between primary predictors and outcomes of interest.

RESULTS

Both clinical and family responsibilities for children under 18 play a major and interacting role in satisfaction with career and work-life balance. Clinical faculty respondents without children at home reported significantly greater career satisfaction and better work-life balance than their nonclinical counterparts. Nonclinical faculty respondents with children reported greater satisfaction and better balance than counterparts without family responsibilities. However, the advantage in career satisfaction and work-life balance for clinical faculty respondents disappeared for those with responsibility for young children. No gender-based differences were noted in the results or across faculty rank for respondents; however, for women, reaching associate professor resulted in greater career satisfaction.

CONCLUSION

This study suggests that both work-related factors and family responsibilities influence satisfaction with career and work-life balance, but the predictors appear to interact in complex and nuanced ways. Further research is needed to delineate more clearly these interactions and to explore other factors that may play important additional roles.

Defining "faculty" in academic medicine: responding to the challenges of a changing environment

Academic medicine in the United States is at a crossroads. There are many drivers behind this, including health care reform, decreased federal research funding, a refined understanding of adult learning, and the emergence of disruptive innovations in medicine, science, and education. As faculty members are at the core of all academic activities, the definition of "faculty" in academic medicine must align with the expectations of institutions engaged in patient care, research, and education. Faculty members' activities have changed and continue to evolve. Academic health centers must therefore define new rules of engagement that reflect the interplay of institutional priorities with the need to attract, retain, and reward faculty members. In this Commentary, the authors describe and explore the potential effects of the changing landscape for institutions and their clinical faculty members. The authors make a case for institutions to adapt faculty appointment, evaluation, and promotion processes, and they propose a framework for a standardized definition of "faculty" that allows for individual variability. This framework also provides a means to evaluate and reward faculty members' contributions in education, research, and clinical care. The authors propose a deliberate national conversation to ensure that careers in academic medicine remain attractive and sustainable and that the future of academic medicine is secure.

Toward a common understanding: supporting and promoting education scholarship for medical school faculty

CONTEXT

Education scholarship (ES) is integral to the transformation of medical education. Faculty members who engage in ES need encouragement and recognition of this work. Beginning with the definition of ES as 'an umbrella term which can encompass both research and innovation in health professions education', and which as such represents an activity that is separate and distinct from teaching and leadership, the purpose of our study was to explore how promotion policies and processes are used in Canadian medical schools to support and promote ES.

METHODS

We conducted an analysis of the promotion policies of 17 Canadian medical schools and interviews with a key informant at each institution. We drew on an interpretive approach to policy analysis to analyse the data and to understand explicit messages about how ES was represented and supported.

RESULTS

Of the 17 schools' promotion documents, only nine contained specific reference to ES. There was wide variation in focus and level of detail. All key informants indicated that ES is recognised and considered for academic promotion. Barriers to the support and recognition of ES included a lack of understanding of ES and its relationship to teaching and leadership. This was manifest in the variability in promotion policies and processes, support systems, and career planning and pathways for ES.

CONCLUSIONS

This lack of clarity may make it challenging for medical school faculty members to make sense of how they might successfully align ES within an academic career. There is a need therefore to better articulate ES in promotion policies and support systems. Creating a common understanding of ES, developing guidelines to assess the impact of all forms of ES, developing an informed leadership and system of mentors, and creating explicit role descriptions and guidelines are identified as potential strategies to ensure that ES is appropriately valued.

Medical education scholarship: an introductory guide: AMEE Guide No. 89

Abstract This AMEE Guide provides an overview of medical education scholarship for early career scholars, based upon a summary of the existing literature and pragmatic advice derived from the experience of its authors. After providing an introduction to the principles of scholarship and describing questions that the Guide addresses, the authors offer a conceptual description of the complementary traditions of teaching and educational discovery, and advocate for the development of educational scholars with both traditions. They then describe the attributes of effective mentor-mentee relationships and how early career scholars can identify potential mentors who can fulfill this role. In the subsequent sections, they describe the appropriate development of scholarly questions and other components of a complete scholarly plan, including how to use conceptual frameworks in guiding such plans. From here, they describe methods that align with both the teaching and discovery traditions and provide concrete examples of each. They then provide guidelines for assessing the impact of scholarship, identify the various opportunities for sharing it, and how to effectively interpret and describe it. Additionally, they provide practical advice on how appropriately to demonstrate the scholarship in a promotional packet, including the principle of reflectivity in scholarship. Finally, they address the principles of applied research ethics for educational scholarship and when to consider soliciting approval for scholarly activities by a human research board.

Academic plastic surgery: faculty recruitment and retention

BACKGROUND

A critical element of a thriving academic plastic surgery program is the quality of faculty. A decline in recruitment and retention of faculty has been attributed to the many challenges of academic medicine. Given the substantial resources required to develop faculty, academic plastic surgery has a vested interest in improving the process of faculty recruitment and retention.

METHODS

The American Council of Academic Plastic Surgeons Issues Committee and the American Society of Plastic Surgeons/Plastic Surgery Foundation Academic Affairs Council surveyed the 83 existing programs in academic plastic surgery in February of 2012. The survey addressed the faculty-related issues in academic plastic surgery programs over the past decade. Recruitment and retention strategies were evaluated. This study was designed to elucidate trends, and define best strategies, on a national level.

RESULTS

Academic plastic surgery programs have added substantially more full-time faculty over the past decade. Recruitment efforts are multifaceted and can include guaranteed salary support, moving expenses, nurse practitioner/physician's assistant hires, protected time for research, seed funds to start research programs, and more. Retention efforts can include increased compensation, designation of a leadership appointment, protected academic time, and call dilution.

CONCLUSIONS

Significant change and growth of academic plastic surgery has occurred in the past decade. Effective faculty recruitment and retention are critical to a successful academic center. Funding sources in addition to physician professional fees (institutional program support, grants, contracts, endowment, and so on) are crucial to sustain the academic missions.

Gender distribution of U.S. medical school faculty by academic track type

PURPOSE

Over the past 30 years, the number and type of academic faculty tracks have increased, and researchers have found differences in promotion rates between track types. The authors studied the gender distribution of medical school faculty on the traditional tenure track (TTT) and clinician-educator track (CET) types.

METHOD

The authors analyzed gender and academic track type distribution data from the March 31, 2011, snapshot of the Association of American Medical Colleges' Faculty Roster. Their final analysis included data from the 123 medical schools offering the TTT type and the 106 offering the CET type, which excluded any schools with 10 or fewer faculty on each track type.

RESULTS

The original dataset included 134 medical schools representing 138,508 full-time faculty members, 50,376 (36%) of whom were women. Of the 134 medical schools, 128 reported at least one of four track types: TTT, CET, research track, and other. Of the 83 medical schools offering the CET type, 64 (77%) had a higher proportion of female than male faculty on that track type. Of the 102 medical schools offering the TTT type, only 20 (20%) had a higher proportion of female than male faculty on that track type.

CONCLUSIONS

Medical schools offering the CET type reported higher proportions of female faculty on that track type. Given that faculty on the CET type lag behind their TTT colleagues in academic promotion, these findings may contribute to continued challenges in gaining academic and leadership parity for women in academic medicine.

Increased co-first authorships in biomedical and clinical publications: a call for recognition

There has been a dramatic increase in the number and percentage of publications in biomedical and clinical journals in which two or more coauthors claim first authorship, with a change in some journals from no joint first authorship in 1990 to co-first authorship of >30% of all research publications in 2012. As biomedical and clinical research become increasingly complex and team-driven, and given the importance attributed to first authorship by grant reviewers and promotion and tenure committees, the time is ripe for journals, bibliographic databases, and authors to highlight equal first author contributions of published original research.

An adaptive approach to facilitating research productivity in a primary care clinical department

Efforts to foster the growth of a department's or school's research mission can be informed by known correlates of research productivity, but the specific strategies to be adopted will be highly context-dependent, influenced by local, national, and discipline-specific needs and resources. The authors describe a multifaceted approach-informed by a working model of organizational research productivity-by which the University of Minnesota Department of Family Medicine and Community Health (Twin Cities campus) successfully increased its collective research productivity during a 10-year period (1997-2007) and maintained these increases over time.Facing barriers to recruitment of faculty investigators, the department focused instead on nurturing high-potential investigators among their current faculty via a new, centrally coordinated research program, with provision of training, protected time, technical resources, mentoring, and a scholarly culture to support faculty research productivity. Success of these initiatives is documented by the following: substantial increases in the department's external research funding, rise to a sustained top-five ranking based on National Institutes of Health funding to U.S. family medicine departments, later-stage growth in the faculty's publishing record, increased research capacity among the faculty, and a definitive maturation of the department's research mission. The authors offer their perspectives on three apparent drivers of success with broad applicability-namely, effective leadership, systemic culture change, and the self-awareness to adapt to changes in the local, institutional, and national research environment.

Promotion rates for assistant and associate professors in obstetrics and gynecology

OBJECTIVE

To estimate promotion rates of physician faculty members in obstetrics and gynecology during the past 30 years

METHODS

Data were collected annually by the Association of American Medical Colleges from every school between 1980 and 2009 for first-time assistant and associate professors to determine whether and when they were promoted. Data for full-time physician faculty were aggregated by decade (1980-1989, 1990-1999, 2000-2009). Faculty were included if they remained in academia for 10 years after beginning in rank. Data were analyzed by constructing estimated promotion curves and extracting 6-year and 10-year promotion rates.

RESULTS

The 10-year promotion rates (adjusted for attrition) declined significantly for assistant professors from 35% in 1980-1989 to 32% in 1990-1999 to 26% in 2000-2009 (P<.001), and for associate professors from 37% to 32% to 26%, respectively (P<.005). These declines most likely resulted from changes in faculty composition. The most recent 15 years saw a steady increase in the proportion of entry-level faculty who were women (now 2:1) and primarily on the nontenure track. The increasing number of faculty in general obstetrics and gynecology had lower promotion probabilities than those in the subspecialties (odds ratio 0.16; P<.001). Female faculty on the nontenure track had lower promotion rates than males on the nontenure track, males on the tenure track, and females on the tenure track (odds ratio 0.8 or less; P<.01).

CONCLUSION

A decline in promotion rates during the past 30 years may be attributable to changes in faculty composition.

LEVEL OF EVIDENCE

II.

Developing future faculty: a program targeting internal medicine fellows' teaching skills

INTRODUCTION

The increased demand for clinician-educators in academic medicine necessitates additional training in educational skills to prepare potential candidates for these positions. Although many teaching skills training programs for residents exist, there is a lack of reports in the literature evaluating similar programs during fellowship training.

AIM

To describe the implementation and evaluation of a unique program aimed at enhancing educational knowledge and teaching skills for subspecialty medicine fellows and chief residents.

SETTING

Fellows as Clinician-Educators (FACE) program is a 1-year program open to fellows (and chief residents) in the Department of Internal Medicine at the University of Iowa.

PROGRAM DESCRIPTION

The course involves interactive monthly meetings held throughout the academic year and has provided training to 48 participants across 11 different subspecialty fellowships between 2004 and 2009.

PROGRAM EVALUATION

FACE participants completed a 3-station Objective Structured Teaching Examination using standardized learners, which assessed participants' skills in giving feedback, outpatient precepting, and giving a mini-lecture. Based on reviews of station performance by 2 independent raters, fellows demonstrated statistically significant improvement on overall scores for 2 of the 3 cases. Participants self-assessed their knowledge and teaching skills prior to starting and after completing the program. Analyses of participants' retrospective preassessments and postassessments showed improved perceptions of competence after training.

CONCLUSION

The FACE program is a well-received intervention that objectively demonstrates improvement in participants' teaching skills. It offers a model approach to meeting important training skills needs of subspecialty medicine fellows and chief residents in a resource-effective manner.

Pathways to success for psychologists in academic health centers: from early career to emeritus

Careers in academic health centers (AHCs) come with a unique set of challenges and rewards. Building a stable and rewarding career as a psychologist in an AHC requires the efforts of a whole team of players and coaches. This paper outlines the characteristics of AHCs and the general skills psychologists need to thrive in this type of setting. Advice specific to each stage of career development (early, mid, and late) is offered, highlighting the themes of coaching and teamwork that are critical to success in an AHC.

The importance of organizational justice in ensuring research integrity

The professional behavior of scientists, for good or ill, is likely associated with their perceptions of whether they are treated fairly in their work environments, including their academic department and university and by relevant regulatory bodies. These relationships may also be influenced by their own personal characteristics, such as being overcommitted to their work, and by the interactions between these factors. Theory also suggests that such associations may be mediated by negative or positive affect. We examined these issues using data from a national, mail-based survey administered in 2006 and 2007 to 5,000 randomly selected faculty from biomedical and social science departments at 50 top-tier research universities in the United States. We found that perceptions of justice in one's workplace (organizational justice) are positively associated with self-report of "ideal" behaviors and negatively associated with self-report of misbehavior and misconduct. By contrast, researchers who perceive that they are being unfairly treated are less likely to report engaging in "ideal" behaviors and more likely to report misbehavior and misconduct. Overcommitment to one's work is also associated with negative affect and interacts with perceptions of unfair treatment in ways that are associated with higher self-report of misbehavior. Thus, perceptions of fair treatment in the work environment appear to play important roles in fostering-or undermining-research integrity.