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

Abstract

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

INTRODUCTION

In academic medicine, promotion in rank is important to both the individual and their department. Climbing these ranks may be associated with increased salary and greater leadership opportunities within the department and institution. Additionally, increasing the number of associate and full professors within emergency medicine (EM) can improve perceived credibility in the academic community. This is particularly important as it has been shown that EM physicians are promoted at lower rates than many other specialists within the medical community. ¹

Promotions and tenure (P&T) in academic medicine has its roots in university‐based traditions and in many institutions is governed by university policies and guidelines. However, traditional paths balancing research, education, and clinical practice are becoming increasingly rare, and many institutions are introducing more comprehensive promotion processes involving “tracks.” ² , ³ These tracks and their specific promotion criteria are often institution dependent. A review of national trends within P&T found that there are five generally utilized tracks (Table 1) although the specific nomenclature for these tracks may differ. ⁴ Classically, faculty focused on research have been promoted at higher rates than those focusing on education, which may have been related to inconsistent measurements of “educational excellence.” ⁴ , ⁵ , ⁶ , ⁷ , ⁸ , ⁹ These tracks can help differentiate career paths and more clearly outline goals. Additionally, there has been an increase in clinical tracks commensurate with a higher focus on revenue‐generating patient care activities.

TABLE 1.

Promotion track types and descriptions.

Track type	Description	Breakdown of time (approximate)
Investigator	“Traditional” academic position. Usually tenure eligible.	50%–80% spent in research The rest in clinical care, teaching, and administration
Research	More likely to be occupied by a PhD. Less likely tenure eligible. May have modified title “research professor.”	85%–100% spent in research None or minimal time in other activities
Clinician‐ educator	Primary focus is clinical work with secondary focus of education. Minimal research focus. May have modified title “clinical professor.”	>50% spent in clinical care 10%–20% spent in education 5%–10% spent in research
Clinical	Generally all or most of time is dedicated to patient care.	90%–100% spent in clinical care
Educator	Spend majority time in educational activities such as course directing, creating educational content. Most research may be related to educational research.	>50% spent in educational activities.

Note: Adapted from Coleman and Richard. ⁴

The P&T process can be daunting for junior faculty. Many do not realize what accomplishments are highly valued by promotions committees or understand how best to plan for successful advancement. Therefore, it is important to utilize strategies early in the process to maximize the likelihood that one's efforts are efficiently leading toward promotion. This paper describes methods for preparing a faculty promotion portfolio based on existing literature and expert advice from faculty developers who have been extensively involved in the P&T process.

PLOT THE COURSE FOR A SUCCESSFUL ACADEMIC CAREER

Junior faculty should begin their planning process by thoroughly reviewing any institutional documents describing available tracks and promotion requirements for each track. When determining which track to pursue, faculty should consider their overall career goals and reflect on their academic focus and “educator's philosophy” (a self‐reflective statement of one's beliefs about teaching and learning). ¹⁰ As part of this process, faculty should consider their current strengths and areas for growth. This work should be conducted at the outset so one can be thoughtful about how to spend nonclinical time and ensure alignment with activities and roles needed for career advancement. While not an all inclusive list, Table 2 may help an early clinician avoid filling one “bucket” with extraneous things and failing to tend to the categories. It should be noted that institutions may weigh different activities more significantly than others. For instance, a leadership position on a national committee may carry higher regard than local and a peer‐reviewed, original research publication may be seen as more impactful than an editorial.

TABLE 2.

Categories for promotion and associated activities.

Category for promotion	Sample activities
Education	Teaching classroom didactics/lectures Invited lectures to other residency programs b Invited presentations at regional professional meetings a Invited lectures at national professional meetings (e.g., SAEM, ACEP, AAEM, CORD) b Mentorship of students, residents (institutional or through national organizations b ) Interprofessional education Development of novel educational resources Development of class curricula Directorship of courses Education awards (institutional or through national organizations b ) Board examiner or question writer b Participation in development courses such as: ACEP teaching fellowship ALiEM Faculty Incubator Harvard Macy Program for Educators in Health Professions AAEM speaker development group Medical Education Research Certificate through the AAMC SAEM Junior Faculty Development Forum SAEM ARMED MedEd
Service	Active membership, participation committees with demonstrated outcomes (institutional, local, a or national b ) Leadership on committees, particularly if peer selected (institutional, local, a or national b ) Leadership in planning and developing programs Leadership in planning infrastructure Participation in clinical advisory boards Course directorship Administrative responsibilities Community outreach Participation in development courses such as: SAEM leadership forum AACEM chair development program AAEM leadership academy
Clinical	Improve quality of patient care delivered Diminish adverse patient outcome events Improve resource utilization Improve patient throughput Facilitate multidisciplinary/interdisciplinary patient care Integrate technology or new devices/methods Develop/implement new patient care models Creation of clinical practice guidelines for professional societies b
Research/scholarship	Peer‐reviewed publications b CME publications b Writing for newsletters b Textbook chapters b Review or editorial board participation b Production of guideline, policies, procedures for institution Course document/curriculum creation Poster and abstract presentations b Invited oral presentations b Media interviews b Podcast and social media platform dissemination of scholarly work b

Abbreviations: AACEM, Association of Academic Chairs of Emergency Medicine; AAEM, American Academy of Emergency Medicine; AAMC, Association of American Medical Colleges; ACEP, American College of Emergency Physicians; ALiEM, Academic Life in Emergency Medicine; ARMED MedEd, Advanced Research Methodology Evaluation and Design in Medical Education; CORD, Council of Residency Directors; SAEM, Society for Academic Emergency Medicine.

^a Enhances regional recognition for expertise outside of local health system.

^b Enhances both regional and national recognition for expertise outside of local health system.

Faculty should work through this self‐reflection with mentor(s) to generate strategies for career development. Because details of dossier preparation are specific to each institution, identifying a local mentor is important. Some departments may have a faculty member who is the de facto mentor for promotions (e.g., vice chair of academics, director of faculty development). Once identified, the mentee should seek guidance from this mentor as soon as feasible (ideally within the first year) and check in annually. Faculty should review their list of activities with their mentor to ensure they are utilizing their time wisely and plan for what additional efforts would have the highest impact when reviewed by a P&T committee. Often, multiple mentors may be needed. An effective mentor–mentee relationship does not need to be restricted by geographic proximity, given the modern era of virtual meetings and platforms. ¹¹ , ¹² , ¹³

Faculty can also benefit from attending local or national workshops on career advancement to develop the skills needed and expand their networks. ¹⁴ , ¹⁵ Specialty specific national organizations provide offerings at annual conferences, through formal courses (Society for Academic Emergency Medicine Advanced Research Methodology in Medical Education ¹⁶ ; American College of Emergency Physicians Teaching Fellowship; Academic Life in Emergency Medicine Faculty Incubator ¹⁷ , ¹⁸ ) or through toolkits. ¹⁹ These networks can be crucial for developing professional recognition of expertise outside of their institution. Academic advancement guidelines often state that “regional recognition” is required for promotion to associate professor and that “national/international recognition” is needed to reach professor. For many of these activities (Table 2), the level of engagement, demonstrable outcomes, nature of the organization hosting the activity, and the duration and longevity of involvement can all determine whether the impact supports regional versus national recognition.

Developing a “niche” or a topic of focus for academic work can lead to national recognition faster than trying to cover a vast array of topics. By aligning one's scholarly work with existing education and quality improvements efforts, one can extrapolate work and multiply their productivity with less effort. ²⁰ , ²¹ , ²² , ²³ Additionally, social media has become an avenue for faculty to expand their presence and increase readership of their scholarly products. ²¹ , ²⁴ One should discuss digital scholarship with their mentor to determine how it may be weighed and received by their institutional P&T committee when deciding how to best balance their efforts.

When structuring these career activities, engage with colleagues, learners, and organizations outside of the local work environment. Initially, involvement may entail attendance at regional/national meetings, poster presentations, or volunteering to serve on a committee ²⁵ Later, this can lead to awards for recognition of efforts, opportunities to lead committees, and invitations to serve on panel discussions or join authorship teams for scholarly products. These efforts can lead to exponential growth in activities within an individual's areas of professional focus or discovering new areas of focus to shift to as one is reevaluating their pathway.

COLLECT DATA TO SUPPORT ACADEMIC ADVANCEMENT

The majority of one's work will be presented in a curriculum vitae (CV); however, some institutions may also expect a portfolio (e.g., teaching, clinical) highlighting evidence of accomplishments that is more extensive and descriptive than the CV itself. ²⁶ , ²⁷ , ²⁸ , ²⁹ Each institution will likely have preferred formatting or even software/electronic portal the CV and portfolio are entered into. Faculty should rearrange their existing CV into this format as early as possible. If the institutional CV formatting appears clunky, one can keep a separate version for use when applying for positions or awards. Faculty should frequently update their CV with any new activity, regardless of how small. Generally, the CV will need to include descriptions of activities including dates, hours of effort, and numbers of learners. ³⁰ A beneficial addition to simply listing activities is providing exemplary feedback received, particularly any narratives. When listing awards, administrative tasks, and committee work, descriptions should be written in a way in which individuals outside one's field of practice can easily understand, avoiding shorthand and explaining details that may seem obvious to those within the field. ²⁶ , ³⁰ Similarly, when listing digital scholarship, providing specific examples to P&T committees becomes important as these modern approaches have been more accepted within EM but may not be as avidly used in other fields. ³¹ , ³²

Aside from written work that contributes to the field of medicine, many forget to highlight their contributions toward the development of individuals. Faculty should list mentoring relationships along with the “results” of the mentoring (e.g., successful match, chief resident, career advancement) and the associated dates. Consider adding particularly good examples of clinical data such as patient letters or peer evaluations of clinical acumen.

Finally, a promotions package will require letters of evaluation and/or recommendation. The numbers of letters and specific criteria vary between institutions. Letters of evaluation are generally written by individuals holding the rank at or above that which the applicant is seeking and who have not worked personally with the individual. They evaluate the applicant's competitiveness by reviewing their promotions packet, comparing the applicant's accomplishments to others at that level of promotion. At times, they may be asked to assess whether the applicant would meet promotion criteria at their own institution so it becomes important to consider this prior to asking for a letter from that particular individual. ³³ National committees and networking at conferences may be places to identify potential evaluative letter writers. Letters of recommendation generally come from individuals who have worked with and can speak to qualities or achievements of the applicant that fulfill specific criteria for promotion. Letters from collaborators outside of one's institution can speak to an applicant's recognition and impact.

PACKAGE MATERIALS INTO A COMPELLING APPLICATION PORTFOLIO

A candidate's personal statement can be a powerful tool in the promotion application. When used strategically, this statement can guide reviewers to areas of highest impact from a faculty member's career and walk them through why the candidate meets all necessary criteria. Using the stated metrics and guidelines for promotion at their institution, faculty should craft a statement with sections addressing each of the areas of importance such as scholarly productivity, teaching/education, creating enduring educational products, dissemination of academic work, and how one has established and demonstrated a regional and/or national reputation.

Preparing an outstanding promotion application takes time, planning, and careful preparation to organize materials in a way that is easy for reviewers to understand. An applicant should ask for examples from recent successful candidates to inform them how to organize a compelling compilation of materials. One should ensure sufficient time in advance of any deadlines to thoughtfully assemble materials and be cognizant of both the time and the materials letter writers will need to provide their letters of evaluation/recommendation. Applicants should follow guidelines and use any available templates to ensure materials are presented in the best possible light. Consideration should be given to which activities are important enough to list, not exceeding word limits and avoiding poor signal‐to‐noise ratios. Finally, if professional accomplishments can fit into more than one category, strategically evaluating and relocating activities to “weaker” categories can allow an applicant to present the maximum amount of high‐impact accomplishments.

SPECIAL CONSIDERATIONS: DISPARITIES IN PROMOTIONS

This paper would not be complete without addressing the barriers women, those underrepresented in medicine (UiM) as well as sexual and gender minority (SGM) physicians ³⁴ may face in the promotions process. In EM, 31% of associate professors and 19% of full professors are women while 7% of associate professors and <6% of full professors are UiM. ³⁵ Importantly, the AAMC only reported data on gender as binary, so it is unclear what percentages SGM physicians fall into. Inequities affect every aspect of the promotion and career development process, but one in particular appears to be the “early” career checkpoint. One study examined diversity in the workplace of over 600 companies and found that early career and leadership advancement was one of the biggest obstacles to advancement. ³⁶ Another unique factor includes the “minority tax,” the burden of time and resources placed on UiM persons to represent and advocate for their communities. ³⁷ , ³⁸ , ³⁹ The American College of Emergency Physicians recently published recommendations to help mitigate these disparities on a systemic level and institutional leaders should be held accountable as well as consider assessing themselves based on metrics. ⁴⁰ However, it is critical to acknowledge and navigate these obstacles actively on a personal level to minimize their effects on promotion. ⁴¹ Identifying and participating in any leadership development programs specific to those impacted by these disparities can help address more focused concerns. Additionally, advocating for oneself through deliberate conversations with departmental leadership regarding mentoring, growth, and leadership opportunities in the early career is critical.

CONCLUSIONS

The promotions process may appear to be a major obstacle course filled with hoops and ladders; however, with some upfront reflective and preparatory practices, it can become a manageable endeavor. Identifying personal goals and philosophies and aligning them with the recommendations of the institution's promotions and tenure processes allows for creation of a roadmap for success. Next, understanding how best to keep track of and collect the relevant data can help in putting the pieces together in the end. Finally, packaging a portfolio, personal statement, and curriculum vitae to present oneself in the best light possible is best done with minigoals, personal deadlines, and mentorship.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Gore K, Dyne P, Fitch MT, Mattu A, Pillow MT, Gottlieb M. Educator's blueprint: A guide for clinician‐educators to achieve promotion in emergency medicine. AEM Educ Train. 2023;7:e10883. doi: 10.1002/aet2.10883