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Academic Promotion for Clinician-Educators Paul A. Hemmer, Col, USAF, MC Professor of Medicine Vice Chairman for Educational Programs Uniformed Services.

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Presentation on theme: "Academic Promotion for Clinician-Educators Paul A. Hemmer, Col, USAF, MC Professor of Medicine Vice Chairman for Educational Programs Uniformed Services."— Presentation transcript:

1 Academic Promotion for Clinician-Educators Paul A. Hemmer, Col, USAF, MC Professor of Medicine Vice Chairman for Educational Programs Uniformed Services University July 2010

2 Acknowledgements, etc. Louis Pangaro, MD –Professor and Chairman, DOM Academic Medicine September, 2000

3 Goals Define Clinician-Educators (CE) National trends USU model for CE promotion –Scholarship for CE –Clinical prefix vs. non-prefixed appoint Summary

4 USU Model for CEs Review of USU 1100 Tracks (Tenure, Non-tenure) Expectations –Scholarship, Teaching, Prof Service, Citizenship Pathways/Ranks/Clinical Prefix Promotion Criteria Process for Appointment and Promotion What You Should Do

5 Bottom Line Up Front (BLUF)

6 Moving from Asst to Assoc Prof Clinician-Educator, Non-Prefixed, Non-Tenure Basics > 4yrs clinical teaching Excellence Teacher Innovation, Reputation beyond Institution Scholarship Teaching Level 2 Application Diligence/excellence in pt care Prof Service Institution/broader Citizenship Supporting Documentation of Teaching Roles List of work/products Pubs, Materials Letters 2 internal (DOM) 1-2 External Portfolios

7 Moving from Associate to Professor Clinician-Educator, Non-Prefixed, Non-Tenure Basics > 3 yrs as Associate Substantial contribution (papers, texts) Broad Reputation (natl/intl) Recognition (editorial positions, visiting prof) Scholarship Outstanding achievement in Teaching (Level 3) and Application Dissemination of work Close review of writings and professional communication Evidence of community impact Supporting Documentation of Teaching Roles List of work/products Pubs, Materials Letters 5 letters Portfolios

8 Moving from Asst to Clinical Assoc Clinician-Educator, Prefixed, Non-Tenure* Basics > 6yrs clinical teaching Role model for peers Excellence Teacher Excellence Clinical Care Teaching EXCEEDS routine contributions to USU educational programs Admin accomplishments (if part of usual job) Institutional recognition as clinician and clinical teacher Supporting Letter from USU Chair, explaining and supporting request Faculty members CV (should highlight excellence as teacher and clinician) Letter of support (1) from faculty member of senior academic rank in applicants specialty Endorsement by faculty members Commanding Officer *Requires: CAPT Chair/subcomm concurrence; Deans endorsement; BOR review; USU President action

9 Moving from Assoc to Clinical Professor Clinician-Educator, Prefixed, Non-Tenure* Basics > 10yrs as Asst and/or Assoc Service-wide or National recognition as clinician and clinical teacher Excellence Teacher Excellence Clinical Care Teaching EXCEEDS routine contributions to USU educational programs Admin accomplishments (if part of usual job) Supporting Letter from USU Chair, explaining and supporting request Faculty members CV (should highlight excellence as teacher and clinician) Letter of support (1) from faculty member of senior academic rank in applicants specialty Endorsement by faculty members Commanding Officer *Requires: CAPT Chair/subcomm concurrence; Deans endorsement; BOR review; USU President action

10 Faculty Tracks Tenure: civilian, full-time Non-tenure: uniformed, some civilian

11 Pathways in Non-tenure Track –Clinician-Investigator Education, Research, Clinical, Prof service –Clinician-Educator Education, Clinical, Professional service –Research prefix: focus = science –Clinical prefix: focus = clinical teaching and clinical practice Tenure ineligible only

12 USU Expectations Qualifications for Faculty Membership Scholarship –Peer Review Teaching Professional Service Institutional Citizenship

13 Scholarship (Boyer) Scholarship Reconsidered: Priorities for the Professorship, Carnegie Foundation, Discovery (original, disciplined research) Integration (innovative thinking which combines and connects various disciplines) Teaching (communicates understanding) Application (engagement with society, building bridges between theory and practice) Teaching and Application are the scholarship domains emphasized for non-prefixed appointments for Clinician-Educators

14 Elusiveness of Scholarship of Teaching Glassick CE. Acad Med. 2000;75: To be scholarship, work (teaching) must: –Be made public –Be available for peer review and critique according to accepted standards –Be able to be reproduced and built on by other scholars Schulman L. The Scholarship of Teaching. Change. 1999;31(5):11.

15 Scholarship in Teaching Fincher R. et.al. Acad Med. 2000;75: Teaching…can be scholarly if appropriate evidence is presented to show that defined standards have been met. Products: Web-based materials, textbook publications, curriculum units or teaching modules, CME presentations, curricular change, community education –Challenge: provide the evidence

16 Scholarship of Application Shapiro ED, Coleman DL. Acad Med. 2000;75: Application of clinical expertise alone does not constitute scholarship; it does when –Systematically assess effectiveness of techniques –Communicate it to allow others to benefit Service is scholarship when –Assess pt satisfaction and communicate it Common Aspect of Scholarship of Application –Dissemination of useful, testable, reproducible information to others

17 Peer Recognition of Scholarly Activity (1) Original manuscripts, review articles, case reports, books, chapters Principal authorship or significant contribution to position papers, field manuals, practice guidelines Patent applications Acquisition of external funding 1100:7.2.1

18 Peer Recognition of Scholarly Activity (2) Invited presentations (meetings, other institutions) Institutional utilization of educational materials Service on study sections, research review boards, editorial boards, reviewer 1100:7.2.1

19 Peer Recognition of Scholarly Activity (3) Election to learned societies, organizational awards Selection as military specialty consultant Selection as teaching chief, residency director, educational director 1100:7.2.1

20 Expectations Qualifications for Faculty Membership Scholarship –Peer Review Teaching Professional Service Institutional Citizenship

21 Teaching Level 1 –Individual Classroom, Departmental Level 2 –Institutional Teaching, USUHS as a whole –Grand rounds at other institutions, regional CME, new curriculum, course/residency director Level 3 –Disseminated, well-recognized –Beyond parent institution –Publications, grants, visiting scholar, national educational activities (RRC, re-certification) 1100:7.3

22 Level 1 Teaching Department teaching involving: –Presenting series of lectures, one or more topics –Primary instructor in a course –Advising students –Attending or precepting on inpatient or outpatient –Mentoring students and fellows –Seminar or journal club organizer –Small group or laboratory teacher –Coverage of specified curriculum content and of the standard teaching load of the department –Meritorious teaching evals from students/ peers

23 Level 2 Teaching Moving to Associate Professor Development/redevelopment of teaching materials for students, continuing education courses and/or faculty Writing clinical case material for teaching Invitation to present Grand Rounds/seminars at primary departments and other institutions Invitations to present courses outside of primary dept Written documentation of novel techniques in teaching on the delivery of care Leadership roles in teaching (course director, residency or fellowship director)

24 Level 2 Teaching (2) Moving to Associate Professor Consistently receives outstanding teaching evaluations or teaching awards, recognition as outstanding role model for students Develops innovative teaching methods –Software, video, packaged courses, or workshops Provides continuing educ at local, national meetings Develops new educational materials Successfully runs regional continuing education Creates a new course or curriculum

25 Level 3 Teaching Moving to Professor Favorable peer reviews or significant adoptions of innovative published or circulated instructional materials Strong record of publications in health prof education Evidence of systematic experimentation on, or scholarly analysis and evaluation of, alternative and innovative teaching approaches or materials Peer reviewed grant funding. Provides educational leadership by writing syllabi, textbooks, or assuming an institutional level policy making administrative role.

26 Level 3 Teaching (2) Moving to Professor Consistent participation in national educational activities Invitations to be a visiting scholar at another institution. Established reputation beyond the institution as an innovative educator –External letters of reference –Invitations to lecture or demonstrate at national conferences on teaching –Organizing national meetings –National consultant on editorial boards of journals –Serve on national or international committees on teaching, curriculum, or evaluation.

27 Teaching and Clinical Prefix Clinician-Educators Documented excellence in teaching –E.g., learner evaluations, teaching awards Must achieve Level 1 consistently –Teaching must exceed routine contribution Academic promotion--recognition –Clinical Assoc: Institutional (~Level 2) –Clinical Prof: Service-wide/National (~Level 3)

28 Expectations Qualifications for Faculty Membership Scholarship –Peer Review Teaching Professional Service Institutional Citizenship

29 Professional Service Scholarship of Application Service to uniformed service, fed depts Professional, Educational, Scientific, or community organizations at local, state, national, or international levels Common Aspect of Scholarship of Application –Dissemination of useful, testable, reproducible information to others

30 Institutional Citizenship Administrative, committee involvement

31 Faculty Ranks, Promotion Clinician-Educators

32 Faculty Ranks Teaching Fellow Instructor Assistant Professor Associate Professor* Professor* *Prefixed (clinical) or non-prefixed

33 Teaching Fellow Residents: PGY 2, 3 Ward supervision of Students Recommendation of Chief Brief CV

34 Instructor Fellows* Teaching in Clinic, Consult Service, or Physical Diagnosis Recommendation of Chief or Service Chief CV *not GIM fellows

35 Assistant Professor* Full-time staff physicians (including GIM Fellows and Chief Residents) Active participation in core teaching: –Precepting, attending on general medicine ward, student in clinic, ICMs Recommendation of local Chief of Med Structured CV –http://www.usuhs.mil/med/sampleCV.htmhttp://www.usuhs.mil/med/sampleCV.htm *There is no Clinical prefix for Asst Prof

36 Appointment Process Assistant Professor Physician Discusses with Hospital Chief Preparation of CV Recommendation to Chair, DOM, USUHS by Hospital Chief, or Recommendation by USUHS Clerkship/Course Director Approval by Hospital Commander Chair submits to Dean

37 Associate Professor of Medicine (Non-Tenure, Non-Prefixed, Clin-Ed) Criteria for assistant professor PLUS Sustained involvement in clinical teaching (> 4 years, 6-7 typical) Documented excellence as teacher Innovation, reputation in education …evidence of an established reputation beyond the parent institution

38 Associate Professor of Medicine (Non-Tenure, Non-Prefixed, Clin-Ed) Scholarship of Teaching: Level Two, extra-mural: –Grand rounds at other institutions, regional CME, new curriculum, course/residency director Scholarship of Application: diligence and excellence in patient care - clinical knowledge and humanistic skills should be described in supporting letters

39 Associate Professor of Medicine (Non-Tenure, Non-Prefixed, Clin-Ed) Professional service: institution and broader Institutional Citizenship –Leadership of or major contributions to SOM and/or their hospital committees

40 Professor (Non-Tenure, Non-Prefixed, Clin-Ed) Outstanding achievement in the two areas of scholarship Dissemination of their work through a close evaluation of their professional writings and other forms of professional communication…evidence of community impact

41 Professor (Non-Tenure, Non-Prefixed, Clin-Ed) Criteria for associate professor PLUS Greater contribution to field (papers, texts) Letters (non-tenure 5; tenure 6) International reputation Recognition (editorial positions, visiting professorships)

42 Clinical Prefix: Appointments Non-tenure, Clinician-Educator

43 Clinical Prefix and Clinician-Educator Pathway NOTE: Clinical prefix is NOT synonymous with Clinician in Clinician-Educator In the CE pathway, there may be faculty with: –Non-prefixed appts (Associate Professor) –Prefixed appts (Clinical Associate Professor)

44 Clinical Prefix May be used by USU Chair for Assoc, Prof Tenure ineligible faculty only Primary contributions –Clinical teaching –Clinical practice, or –Clinical administration Appts and promotion to be judged based on achievements and recognition in teaching, clinical practice and clinical administration

45 Clinical Assoc Professor of Med (Non-Tenure, Clinician-Educ) Criteria for assistant professor PLUS > 6yrs clinical teaching Serves as professional role model for peers Excellence as a Teacher Excellence in Clinical Care Teaching EXCEEDS routine contributions to USU educational programs Admin accomplishments (if part of usual job) Institutional recognition as clinician and clinical teacher

46 Clinical Professor of Medicine (Non-Tenure, Clinician-Educ) Criteria for Clinical Associate Prof PLUS At least 10 yrs in rank as an assistant and/or associate professor Service-wide or National recognition as a clinician and clinical teacher

47 Academic Promotion Non-tenure, Clinician-Educator

48 Promotion Process Associate Professor and Professor Initiation (individual or dept review) DOM Executive Committee Review –Productivity, time in grade Candidates Responsibility –References and personal statement Chairs Responsibility –Collate for CAPT, Board of Regents

49 Supporting Materials (1) Documentation of teaching roles –quantity –quality –level (designing and planning) [i.e., Engagement with community] List of written work, products –publications –curricular materials

50 Supporting Materials (2) Letters of Support –Assoc: internal (2) and external (1-2) –Prof: internal (2) and external (5) –Letters MUST be from individuals at/above rank to which applying Portfolios –teaching (critiques, awards) –documents of mentoring (abstracts) –curricular materials

51 Academic Promotion: Clinical Prefix Non-tenure, Clinician-Educator

52 Clinical Associate or Professor Academic Promotion Letter from USU Chair explaining and supporting the request Faculty members CV Letter of support (1) from faculty member of senior academic rank in applicants specialty Endorsement by members Commanding Officer or designee Concurrence by CAPT Chair or subcommittee, Deans endorsement, Board of Regents review/recommendation

53 Other Documents and Information For non-prefixed and prefixed appointments

54 Teaching Portfolio Awards and citations Recommendations for awards Educational products, materials* Clinical projects - what role did you play?* Copies of articles, abstracts* 1100:7.3.1 *Important for non-prefixed appointments

55 Teaching Portfolio (2) Critiques of teaching (peer and student) Courses taught, curricular materials Electronic teaching materials/simulations* Individuals mentored 1100:7.3.1 *Important for non-prefixed appointments

56 USUHS DOM Faculty Review Every other yr review by exec committee –Annually for outside NCA sites Teaching (activity sheet, student/resident critiques) CVawards, recognition, scholarship Service Contribution (school and hospital committees)

57 Steps You Can Take Look at the APT document (1100) Choose a Track/Pathway Find Area for Productivity (YOUR strengths, interests) Find a Mentor: –USUHS Website: Faculty, Faculty Mentoring Pick projects, collaborators Allocate time (e.g., 1/2 day twice a month) –This may be after hours

58 What Else Should You Do? Keep a Portfolio (Document EVERYTHING) Seek Responsibility –institutional –national organizations Engage in activities that support your track –Eg., Clinical supervision PIM with ABIM MOC IF YOU LEAVE CORE USU facility –Get LOCAL med school faculty appointment

59 Organize Your CV Keep current (and dated) Keep headings clear Group your activities Separate publications by type Delete old abstracts? Dont list your CME!

60 CV Do not mix abstracts, presentations, and publicationskeep in separate sections Publicationsorganize them –Peer reviewed –Non-peer reviewed (e.g., commentaries) –Invited

61 Moving from Asst to Assoc Prof Clinician-Educator, Non-Tenure Basics > 4yrs clinical teaching Excellence Teacher Innovation, Reputation beyond Institution Scholarship Teaching Level 2 Application Diligence/excellence in pt care Prof Service Institution/broader Citizenship Supporting Documentation of Teaching Roles List of work/products Pubs, Materials Letters 2 internal (DOM) 1-2 External Portfolios

62 Moving from Associate to Professor Clinician-Educator, Non-Tenure Basics > 3 yrs as Associate Substantial contribution (papers, texts) International Reputation Recognition (editorial positions, visiting prof) Scholarship Outstanding achievement in Teaching (Level 3) and Application Dissemination of work Close review of writings and professional communication Evidence of community impact Supporting Documentation of Teaching Roles List of work/products Pubs, Materials Letters 5 letters Portfolios

63 Moving from Asst to Clinical Assoc Clinician-Educator, Prefixed, Non-Tenure* Basics > 6yrs clinical teaching Role model for peers Excellence Teacher Excellence Clinical Care Teaching EXCEEDS routine contributions to USU educational programs Admin accomplishments (if part of usual job) Institutional recognition as clinician and clinical teacher Supporting Letter from USU Chair, explaining and supporting request Faculty members CV (should highlight excellence as teacher and clinician) Letter of support (1) from faculty member of senior academic rank in applicants specialty Endorsement by faculty members Commanding Officer *Requires: CAPT Chair/subcomm concurrence; Deans endorsement; BOR review; USU President action

64 Moving from Assoc to Clinical Professor Clinician-Educator, Prefixed, Non-Tenure* Basics > 10yrs as Asst and/or Assoc Service-wide or National recognition as clinician and clinical teacher Excellence Teacher Excellence Clinical Care Teaching EXCEEDS routine contributions to USU educational programs Admin accomplishments (if part of usual job) Supporting Letter from USU Chair, explaining and supporting request Faculty members CV (should highlight excellence as teacher and clinician) Letter of support (1) from faculty member of senior academic rank in applicants specialty Endorsement by faculty members Commanding Officer *Requires: CAPT Chair/subcomm concurrence; Deans endorsement; BOR review; USU President action

65 Other information from 1100 document

66 Pathways Clinician-Investigator In addition to documentation of research activities, individuals in this pathway must be an integral component of the departments clinical and teaching programs. 1100:5.5.1

67 Pathways Clinician-Educator …must be an integral component of the departments clinical and teaching programs…encouraged to assume administrative responsibility for medical education and related clinical are activities… 1100:5.5.2

68 Level 1 Teaching Ability to provide the effective transfer of knowledge and/or skills to medical, graduate, postdoctoral students, postgraduate physician trainees, faculty, other members of the scientific and medical community and the general public Ability to show students how to think critically and purposefully, broaden the students areas of interests, and most importantly encourage and help develop the skills for self-learning Department teaching involving: –Presenting series of lectures covering one or more topics –Primary instructor in a course, advising students, attending or precepting on inpatient or outpatient service,mentoring students and fellows, seminar or journal club organizer, small group or laboratory teacher –Coverage of specified curriculum content and of the standard teaching load of the department –Meritorious teaching evaluations from students and peers

69 Level 2 Teaching Development/redevelopment of teaching materials for students, continuing education courses and/or faculty training Writing clinical case material for teaching Successful supervision of postgrad students and willingness to supervise major honors postgrad research projects Invitation to present Grand Rounds/seminars at primary departments and other institutions Invitations to present courses outside of primary dept Written documentation of novel techniques in teaching on the delivery of care Leadership roles in teaching (course director, residency or fellowship director)

70 Level 2 Teaching (2) Consistently receives outstanding teaching evaluations or teaching awards, recognition as outstanding role model for students Develops innovative teaching methods such as educational software, videotapes, packaged courses, or workshops Provides continuing education at local and national meetings Develops new educational materials Successfully runs regional continuing education courses Creates a new course or curriculum

71 Level 3 Teaching Receives favorable peer reviews or significant adoptions of innovative published or circulated instructional material. A strong record of publications in health professional education including but not limited to methodology, outcome assessment, competency, and curriculum reform. Evidence of systematic experimentation on, or scholarly analysis and evaluation of alternative and innovative teaching approaches or materials, such as the development of inclusive curricula. Peer reviewed grant funding. Provides educational leadership by writing syllabi, textbooks, or assuming an institutional level policy making administrative role.

72 Level 3 Teaching (3) Consistent participation in national educational activities (e.g., Residency Review Committee, programs sponsored by professional organizations, re-certification, workshops and symposia). Invitations to be a visiting scholar at another institution. An established reputation beyond the institution as an innovative educator as evidenced by external letters of reference and invitations to lecture or demonstrate at national conferences on teaching, organizing national meetings, serving as a national consultant, on editorial boards of journals or to serve on national or international committees on teaching, curriculum, or evaluation.

73 Level 3 Teaching Moving to Professor Evidence of peer review and acceptance of new or integrated knowledge through the dissemination of the results Publishes articles on health professional education with emphasis on hypothesis-driven research Develops educational material in media other than print (video, computer programs, Internet) that demonstrate expanded peer recognition through utilization by institutions, educators, and clinicians outside of the USUHS.

74 Tenure Criteria Scholarship –publications, expertise, reputation –grants Contributions –teaching –service USU is typical in tenure rules

75 Associate Professor of Medicine (Tenure) …will have demonstrated the clear capacity for sustained achievement and productivity in three of the four areas of scholarship. …evidence of an established reputation beyond the parent institution within the discipline...area...specialty

76 Associate Professor (Tenure) criteria for assistant professor PLUS sustained productivity as a scholar (papers, grants) over several years (4 - 8yrs.) national reputation supporting letters (tenure > 4) personal letter on theme of scholarly work

77 Research Portfolio papers, abstracts your contribution (if not first author) grant proposals –ratings if unfunded documentation of reviewer, directorial status

78 Selected References/Articles

79 Promotion Criteria for CEs JGIM 2003;18: Survey of DOM Chairs; 82% response What do Chairs emphasize for CEs? –Teaching Skills (awards, trainee evals) –Clinical Skills (peer/trainee evals) –Agrees with Promotion Cte Chairs* Expected publications: 5 –Make it count twice--Levinson *Beasley BW, Wright SW. JAMA 1997;278:723-28

80 Promotion Criteria for CEs: DOM Chair recommendations Document/track ALL activities Achieve reputation for excellence Publish all scholarly activity Mentor: set and meet goals Develop area of expertise Be involved in research Get involved in promotion process Develop curricula or other educ projects

81 Looking Forward to Promotion Prospective Study of Promotion in Academia JGIM 2003;18: assistant professors in DOMs –58% CEs, 34% CIs 75% CEs felt had to produce research Seen written promotion criteria –51% CE, 72% CI CIs met regularly with Division chiefs > 10% protected time for scholarship –37% CE, 79% CI

82 Looking Forward to Promotion What Matters? CE views –Clinical Research –Written Scholarship –Reputation –Teaching Skills –Curric Development Chairs of CAPT views –Teaching skills –Clinical Skills –Mentoring –Coord Programs –Reputation Why the Differences? CE: dont know criteria? CAPT Chairs: politically correct?

83 Looking Forward to Promotion Recommendations Teaching portfolio –Any/all data related to teaching Effectiveness as a clinician Know what is expected for promotion Mentors Meet with division chief every 6 months Create environment for scholarship

84 A Time to be Promoted Prospective Study of Promotion in Academia Beasley B, et.al. JGIM. 2006; 21: Follow-up of 185 CEs –Median time to Associate Prof: 6.0 yrs –CIs: 62% promoted at 6 yrs in rank (Asst) –CEs: 42% promoted at 6 yrs in rank (Asst) Factors NOT associated with promotion –Gender, race, marital status –US News Medical school ranking –AOA, size of med school faculty, secretarial support, statistical support, research in med school

85 Variables Independently Associated with Promotion JGIM. 2006; 21: % Research < 5% FTE Manuscript review service available Never meeting with Chair/Chief re: promotion Lower 1/3 job satisf Being from Northeast (Midwest protective) $ k pay range Working > 60 hr/wk Career mentor Having grant office available NegativePositive Cox proportional hazard model

86 Integration of Clinician-Educators Levinson W, et.al. Acad Med. 2000;75: Problems with current recognition system –Reg/natl reputation requirement is unfair –Lack of valid measures of teaching/pt care –Lack of training opportunities Solutions –Clinician-Educator Researcher Pathway –Drop reputation and publication requirement

87 Advancing educators and education by defining the components and evidence associated with educational scholarship Medical Education 2007: 41: 1002–1009 Consensus conference of AAMC 5 areas of educational activity –Teaching, Curriculum –Advising and/or mentoring –Educational leadership and/or administration –Learner assessment Scholarly approach: documenting how draw from others Scholarship: documenting public display, peer review, dissemination

88 Advancing educators and education Medical Education 2007: 41: 1002–1009 Q 2 Engage –Quality –Quantity –Engagement with Community

89 Teaching Portfolios Acad Med. 2004;79: Aspects –Personal statement/philosophy for context –Summarize major accomplishments/activities –Summarized evidence regarding quality and effectiveness of activities Teaching scholarship is incomplete unless communication to peers and other scholars occurs… (Beattie, Acad Med. 2000;75:871-6.)


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