Association of Women Surgeons

Promotion to Professor - A Career Development Resource

The following is a general guide to obtaining promotion at the rank of full Professor. The University of Virginia guidelines [¹] have been used here but surgeons should familiarize themselves with the Faculty Handbook at their own institution as the rules and regulations vary significantly from one school to another. By the time a faculty member is being considered for promotion to full professor she will be about ten years out of residency training and will almost certainly have prior experience with the academic promotion process. The preparation for promotion to full professor should begin soon after promotion to associate professor. This is a time to reassess opportunities, resources, skills and career goals. The timing of promotion to full professor is usually less rigid than the time frame for promotion at lower ranks but schools vary in this regard.

Job Description

It is the responsibility of each faculty member to meet with the department chair and/or division chief to renegotiate the job description after each promotion or other change in status. The purpose of the meeting is to ensure that each has a clear understanding of the other’s goals and expectations. This process should be documented, as it will become the framework for further academic development and promotion. A job description should contain details of the percentage time devoted to teaching, research and clinical work and should be reviewed and updated periodically. The chair's letter recommending promotion and/or tenure must refer to the achievements in each of those areas, and relate these to the expectation implied in the initial or modified letter of appointment.

Clarification of Institutional Rules

It cannot be over emphasized that the promotion and tenure rules and regulations vary considerably from one institution to another. It is crucial to understand the relative importance of teaching, research, and clinical/service to promotion and tenure and to begin a promotion portfolio, early in academic practice. Faculty members must familiarize themselves with the institutional guidelines for promotion tracks, and tenure. Here are some questions that each faculty member should address in their institution:

1. What are the relative merits and requirements for different promotion tracks e.g. educator versus investigator? For example some institutions will not permit promotion to full professor on an educator track.
    
2. Is tenure mandatory or are non-tenure tracks available or desirable? It is usually possible to apply for promotion to professor from a non-tenure eligible track but faculty on tenure tracks may not be permitted to apply for promotion to professor without having already achieved tenure. Some institutions allow faculty to apply for tenure and promotion (to professor or associate professor) simultaneously.
    
3. What are the maximum probationary period and the consequences if promotion is denied? Is there an appeal process?
    
4. Is it possible to change from tenure to non-tenure track, or vice versa, at a later date?
    
5. Is “time off the clock” allowed for pregnancy or family leave? Are there penalties if you choose to work part time for part of your career? Faculty members availing of “time off the clock” must ensure that their job description is amended appropriately to reflect a period of reduced productivity.

As with promotion to associate professor [²] it is important to identify mentors. The process of mentoring can take many forms, including counseling, advising, facilitating introductions, providing constructive criticism of teaching, grant proposals, or a professional portfolio [³]. While such mentoring may cross departmental lines, the main mentor will usually be within the faculty member's primary department. If the institution is unhelpful in this regard consider contacting local member lists of the Association of Women Surgeons, the Association for Surgical Education, the local chapter of the American College of Surgeons or your specialty organization [^4-6]. Mentoring relationships evolve and mature over time therefore most people will identify more than one mentor in their careers [CDR Mentoring / CDR Associate Professor].

Preparing For Promotion to Professor and /or Tenure

Promotion and Tenure Committees commonly look at three areas of excellence: research, teaching, or clinical service. Usually excellence must be achieved and documented in at least two of these major areas of endeavor for promotion to professor and / or tenure. In addition, documented scholarship in one area is required. Regardless of the type of scholarship, it should possess the qualities of excellence, capability for review by peers, and dissemination in the public domain [^{7, 8}]. In preparing for promotion faculty need to:

1. Identify areas of excellence.
2. Work towards achieving excellence in the chosen area
3. Document areas of excellence

To merit promotion and/or tenure, the faculty member must provide strong evidence of achievement within the areas reflected in their portfolio. At the same time, since the proportion of total effort devoted to any one of the three focus areas may vary considerably from person to person, there will be substantial flexibility in how any one faculty member prepares his or her portfolio. However the proportion of time dedicated to each area must be consistent with the designated allocations in the faculty member’s job description.

Research

Documentation of excellence in research should reflect the ability to create new knowledge as evidenced by continued publication of substantive, original studies in peer-reviewed major journals. Such documentation of excellence in research could include:

1. Publication of original research in peer reviewed journals.
2. A strong record of national grant support awarded through peer review. Examples of granting bodies include:
   
   -- National Institutes of Health [⁹], National Science Foundation [¹⁰], or similar federal granting agency;
   -- American Cancer Society [¹¹]
   -- National Kidney Foundation [¹²]
   -- Bureau of Veterans Affairs [¹³]
   -- Robert Wood Johnson [¹⁴]
    
3. Invitations to hold endowed lectureships or invited lectures, particularly at major scientific meetings.
4. Participation on editorial boards or editorships of journals.
5. Participation on national study sections and scientific advisory boards.
6. Leadership roles in national or international scientific societies or meetings.
7. Consultancy participation, or institutional or program reviews.
8. Leadership or active participation in development of research programs, research-related administrative or committee activity, training grants, or postdoctoral training.

Teaching

A detailed description of documenting excellence in education is available in the Career Development on Education [¹⁵]. Each educational endeavor should contain documentation of effort (a description of the activity) and an outcome measure of effectiveness or excellence. Frequently the judgment of the members of the department will be given more weight in the evaluation of teaching than in the evaluation of other areas of excellence which are more easily quantified by objective means. Consideration will be given to leadership and major participation in departmental or institutional courses or educational programs, development and implementation of new courses or curricular content or important teaching materials: syllabi, computer-assisted instruction, films, or videotapes. Documentation of excellence in teaching could include:

1. Participation in the surgery clerkship, department teaching program, or resident lecture schedule.
2. Evidence of educational leadership e.g. Director of Residency Program or Clerkship Director.
3. Teaching in the research environment.
4. Educational committees in the University for example a clerkship or curriculum committee.
5. Advising responsibilities.
6. Invited presentations, visiting professorships, and lectureships.
7. Professional and educational leadership roles, e.g. program chair for a professional society.
8. Scholarships, authorship, editorship and publications in the area of education
9. Grants or fellowships related to medical education [^16,17]
10. Evidence of mentorship with names, accomplishments and current positions
11. Teaching awards received
12. Recognition by successful generations of students, residents, and fellows
13. Peer evaluation

Clinical Service

Excellence in clinical service includes extensive participation in patient care, but will also be manifest by recognition as a consultant through referrals of significant numbers of patients, by provision of unusual types of service not otherwise available in the region or institution, by the organization of new types of patient care programs, and by other clinical services in addition to routine supervisory assignments. Objective evaluation of patient care by medical faculty is at best difficult and in many ways impossible to quantify but documentation of excellence in clinical service could include:

1. Recognition by peers and patients as a physician's physician
    
2. A reputation within and outside the institution for excellence in medical practice
    
3. Patient referrals from other physicians and patients taking into account the geographical size of the referral area and specialty.
    
4. Percentages of referrals/consultations that are requested by other physicians rather than assigned.
    
5. Number and complexity of patients referred. More and more departments are looking at the number of faculty RVUs (Relative Value Units) and comparing these against national benchmarks for the region and the specialty [¹⁸].
    
6. Documentation of clinician excellence must include evidence of a positive impact by outcome measurement regarding mortality, morbidity and length of stay. The institutional Director of Quality should be able to provide these data. These data are also available through institutional participation in The American college of Surgeons National surgical Quality Improvement Program (NSQIP) [¹⁹] or similar national database.
    
7. Introduction of new skills or techniques, including clinical laboratory based technology, unique locally or regionally or special competencies that improve or extend clinical or training programs.
    
8. Development and maintenance of new clinical programs, or a laboratory service taking into account: the number of years the program has been in existence, and the impact of the program, based on the number of patients.
    
9. Clinical productivity in the group practice setting based on the volume of patients (outpatient and inpatient census), volume of procedures, and number of consultations.
    
10. Participation in research involving patients including clinical trials, and outcomes evaluations.
     
11. Leadership in clinical care e.g., membership on major clinical committees at local, regional, or national levels.
     
12. Administrative contributions associated with a major organization or reorganization of a Health Sciences Center department, center, or other administrative unit.
     
13. Initiation of or participation in health care delivery research that is oriented to rural and agricultural populations, minority or geriatric populations, or any other targeted population with documented health care needs.
     
14. Identification and coordination of responses to health needs in the surrounding communities, the state and the nation. Examples include increasing public awareness of disease prevention and health maintenance, and providing continuing medical education to practicing health care professionals.
     
15. Leadership in national and international groups dealing with health care policy, health care planning, health care reform, and health care legislation.
     
16. Membership on site visit teams for funding agencies such as the NIH or private foundations or regular participation in peer review activities for funding agencies and/or professional journals.
     
17. Community based service (professionally related) including guest lectures, preparation of materials for non-medical health care professionals.

Scholarship

In addition to evidence of excellence, the candidate must prove scholarship in at least one of the focus areas for promotion and tenure. While publications in peer-reviewed journals will continue to provide prominent evidence of scholarly activity, an expanded concept of scholarship is becoming more commonplace and should receive recognition in the promotion and tenure decision process. Such evidence may consist of publication, or similar communications for areas in which publication is not possible or appropriate. For example, documentation in teaching could consist of a widely used text or videotape or web based educational document. Documentation of research productivity is evidenced by publications in scientific journals. In service, such documentation could consist of published clinical reviews, reports of innovative treatment, editorials, or authorship of special reports by major commissions or committees concerning health-related issues. Regardless of the type of scholarship, it should possess the qualities of excellence, capability for review by peers, and dissemination in the public domain.

Service

Recognition that leadership roles (service) may signify excellence in reputation in teaching, research and scholarship will be considered. Performance or service, however exemplary, may not substitute for the primary criteria of teaching, scholarship, and research. Service is demonstrated by:

1. Active participation and/or leadership on committees at the departmental, hospital, medical school, or University level;
2. Active participation and/or leadership in local, regional, national, and international professional organizations;
3. Participation and administrative leadership in division and sections, including programmatic management;
4. Outreach programs such as local and rural community service related to teaching and applied medical science as appropriate.

Referees

Referees should be chosen with great care. Usually a candidate will need a specific number of referees from inside and outside the institution. Some institutions prohibit direct solicitation of letters of reference by the candidate so caution should be exercised before engaging a potential referee in conversation. It is best to choose referees who are familiar with academic tracks or the promotion process, and can speak to each area of excellence. The department chair may be asked to nominate independent referees who can provide an objective opinion of the candidate’s CV or dossier.

Portfolio Preparation

Each institution has specific rules about the preparation of a promotion portfolio and CV and these should be followed. The format will vary but usually includes:

1. Letter of recommendation from the chair based on the initial or modified letter of offer describing the performance expectations
2. Copy of job description
3. Current curriculum vitae.
4. Documentation of excellence and scholarship in the designated area (s)
5. Reprints of the three most substantive written contributions since the last promotion
6. Letters solicited by the dean including designated referees

Negotiating a New Contract as Professor

When an associate professor is applying for a position in a new institution it may be appropriate to negotiate entry at the full professor level. Some institutions will not award promotion until after the faculty recruit has been in post for a period of time and it is important to realize this, if entry at full professor is a critical requirement of the recruitment package. In order to be appointed as full professor the faculty recruit will need to clearly demonstrate that he / she was close to promotion in their prior institution. As with other issues pertaining to recruitment and job negotiation it is important to establish expectations in writing.

Conclusions

Promotion to full professor is difficult and represents the pinnacle of an academic career. Faculty who attain this rank will need to demonstrate evidence of a national and international reputation by active participation and leadership in professional societies. They will have demonstrated sustained excellence in a least two of the areas of education, research and clinical care, in addition to scholarship. Individuals at this level are expected to have a substantial quantity of publications, with the expectation that there will be a larger contribution as senior author since appointment or promotion to the rank of Associate Professor.

REFERENCES

1. University of Virginia Faculty Handbook.
http://www.healthsystem.virginia.edu/internet/about/policies.cfm/
Accessed 6/15/09

2. Association of Women Surgeons - Associate Professor CDR.

3. Association of Women Surgeons Mentorship Career Development Resource
http://www.womensurgeons.org/education/CDR/Mentor.htm
Accessed 6/15/09

4. Association of Women Surgeons
http://www.womensurgeons.org/
Accessed 6/15/09

5. Association for Surgical Education
http://www.surgicaleducation.com/
Accessed 6/ 15 /09

6. American College of Surgeons
http://www.facs.org/
Accessed 6/15/09

7. Boyer EL. Scholarship Reconsidered: Priorities of the Professorate. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching; 1990:37.

8. Glassick CE. "Reconsidering scholarship." J Public Health Manag Pract 2000; 6:4

9. National Institutes of Health
http://www.nih.gov/
Accessed 6/15/09

10. National Science Foundation
http://www.nsf.gov/
Accessed 6/15/09

11. American Cancer Society
http://www.cancer.org/docroot/res/res_0.asp?from=fast
Accessed 6/15/09

12. National Kidney Foundation
http://www.kidney.org/professionals/research/
Accessed 6/15/09

13. Bureau of Veteran Affairs
http://www.va.gov/
Accessed 6/15/09

14. Robert Wood Johnson Health Policy Fellowships
http://www.iom.edu/?id=32249
Accessed 6 /15/09

15. Association of Women Surgeons - Education CDR.

16. Association For Surgical Education Surgical Education Research Fellowship (SERF)
http://www.surgicaleducation.com/mc/page.do?sitePageId=28279&orgId=ase 
Accessed 6/16/09

17. Harvard Macy Institute Educational Development
http://www.harvardmacy.org/
Accessed 6/15/09

18. Medical Group Management Association
http://www.mgma.com/
Accessed 6/15/09

19. American College of Surgeons National Surgical Quality Improvement Program
https://acsnsqip.org/login/default.aspx
Accessed 6/15/09