Defining and Assessing the Psychiatric Clinician-Educator through Holistic Productivity and Impact

To the Editor:

In a 2017 brief report published in Academic Psychiatry titled “Academic Productivity in Psychiatry: Benchmarks for the H-Index,” MacMaster et al. [1] describe how bibliometrics, or statistical analyses of publication data that evaluate an author’s productivity and impact, whether deservedly or not, play increasingly large roles in academic merit recognition and faculty promotion processes. MacMaster et al. write, “Hirsch’s h-index [2] is one of the most commonly used bibliometrics [3]. It is a measure of both productivity and impact for a given author where the h-index is the number of the papers published by an author which have been cited h times. For example, if an author has an h-index of 27, then the author has at least 27 papers (out of any number of papers ≥ 27) that have been cited at least 27 times” [1]. In their report, MacMaster et al. then calculate, using publicly available publication data, “benchmarks” for total citation mean, total citation standard deviation, total citation range, h-index mean, h-index standard deviation, and h-index range for a sample of assistant, associate, and full professor academic psychiatrists [1]. MacMaster et al. end by highlighting several limitations of the h-index, including that the statistic combines publication output and impact and therefore compares “apples to oranges,” and that the statistic fails to capture the myriad of ways beyond publication – including but not limited to teaching and patient care – in which a psychiatrist might productively and impactfully spend their working time [1].

In reading these notable limitations, we found ourselves wondering what it means to call someone a productive and impactful psychiatric clinician-educator. In our experience, this question is especially germane to the establishment and maintenance of clinician-researcher trainee pipelines. When writing grants to obtain funds for these pipelines, psychiatry departments are often scored primarily and narrowly based on measures such as the number of peer-reviewed manuscripts published and career development awards (ex. T32 grants, K awards, etc.) received by program trainees. Core features of many trainees’ professional identities, such as teaching and clinical work, receive little to no consideration. Beyond pipeline development, there is currently no definitive way to communicate, from one institution to another, a given psychiatry faculty member’s holistic (i.e., beyond publication) productivity and impact. Such communications are instead commonly made through the sharing of variable and exhaustive curriculum vitae.

Lessons for how to clarify and openly communicate holistic productivity might be drawn from medical academia’s hiring and promotion processes. These processes often consider factors such as clinical productivity through the use of measures like percent professional time allocation and relative value units. Faculty have attempted to quantify teaching contributions through lists of courses taught and number of trainees, as well as lists of mentees. However, the impact of these clinical and teaching efforts is far more difficult to assess. Is there a standardized metric that could capture the value of these contributions to the field? In medical academia, we often talk about the “triple threat” – the faculty member pursuing novel research, providing excellent clinical care, and teaching students. We believe that it is incumbent upon us as a field to identify and develop approaches to measure the value of clinical and teaching contributions as part of one’s academic identity. Without these efforts, measures of success are likely to remain heavily tied to peer-reviewed publications.

Data Availability

Data sharing not applicable to this article as no data-sets were generated or analyzed during the current study.