UB Department of Medicine Promotions and Tenure Conference
April 1, 2013
Brahm H. Segal, MD: Tim Murphy’s talk today is going to be geared toward people applying for tenure while mine will be for those on the clinical track, which is also called qualified or non-tenured track.
I am delighted to introduce Dr. Tim Murphy. It’s very appropriate that I’m introducing him at a promotion and tenure conference since he recruited me. I don’t know if that’s one of his best decisions in the world, but he has served as a wonderful mentor and he will deliver his talk on what you need to do and know to get promoted.
Timothy F. Murphy, MD: Thanks Brahm and thank you for the kind words. If I could recruit more people like you, I would love to do that.
What I’m going to be talking about is promotion on the tenure track. Most of what I’m going to say is relevant to anybody who wants to be successful in an academic environment. I’ll talk about the nuts and bolts of what happens because sometimes it’s not obvious to people what to do to get promoted. Then I’m going to talk more about the subtleties, and at the end, which may be the most important thing that I say, I’m going to talk about what you need to do to actually be successful, not just for the promotion process.
In the Department of Medicine there’s a departmental review committee, which is comprised of the professors in the department. They will be the first to evaluate your CV and dossier, voting yes or no whether it goes on to the school of medicine committee (called the ad hoc committee) for unqualified or tenure promotions. When it goes to the ad hoc committee, outside letters and a letter from the department chair will be added with your dossier and CV for review. Then the ad hoc committee meets to evaluate your dossier. If it moves forward, the dean also writes a letter of recommendation at that point.
Once approved by the ad hoc committee, your package, along with a letter from the dean, will go before the presidential review board (PRB), which is the big one. The PRB will review the following:
In many ways, those first two committees, the professors’ committee and the ad hoc committee are trying to predict whether or not you’re going to be successful at the presidential review board level. It makes no sense for the committee to send things up to the presidential review board that they know aren’t going to be successful. So these first two committees, although they’re voting yea or nay, are acting as your advocate.
The presidential review board is actually an advisory board, it does not make a decision. It’s the provost and the president who actually decide, but they usually go by what the PRB says. Recently Lucinda Finley, who is the vice provost for faculty affairs, held a workshop on this issue, which I attended in preparation for talk. Some of the things I’m going to tell you are not the kinds of things you read in guidelines, but they are the kinds of things that the PRB looks for.
Keep in mind, as you write your three page statement, that the PRB is comprised of members from all university departments. You may have people from the department of music, from geography, from the engineering school, etc. reviewing your dossier. So the expertise and backgrounds of those who will be reviewing your dossier is very broad. When you’re writing your research statement, you need to write for an audience that is not well versed in your field. It’s interesting to note, for example, that musicians have a whole different set of criteria that they get measured by. They don’t write manuscripts and they don’t get grants, yet for us it’s the be all and end all. This means that a certain amount of learning has to happen in the PRB for its members to figure out what defines success in the different disciplines.
The criteria for promotion is simple: Scholarship, teaching and service. According to Lucinda Finley, if you have excellent scholarship and adequate teaching and adequate service, you will be promoted. If you have marginal scholarship and stellar teaching and stellar service you won’t get promoted. Whether we like it or not, that’s the way it is. This is the criteria in a research university. You need to have scholarship. You need to do your research and show that you’re moving your field forward. It’s important to keep that in mind.
Teaching is important, excellent teaching is important. Sometimes the teaching and service can push things over for you if the scholarship is on the edge, but the key thing for success and promotion is scholarship. I’ll tell you how scholarship is defined and what we as biomedical scientists need to do to be successful in scholarship. There are two classifications in the tenure track in the school of medicine: the research scholar and the clinical scholar.
The research scholar is the traditional laboratory based scientist. Brahm will talk about the non-tenured track. For both of these, there’s assistant professor, associate professor and professor. So, what’s the difference then between the two? Well first of all, let me tell you what scholarship overall is defined by: Scholarship is defined by original research. It’s defined by integration and synthesis of existing knowledge and application of research or knowledge to consequential, that is important, problems.
Integration and synthesis of existing knowledge would be something like systematic reviews and mining large databases. In clinical research now, that’s a real research direction. Some people might say that’s not generating new knowledge, but it generates new knowledge by integrating and synthesizing existing knowledge. It’s not developing a new drug, it’s not developing diagnostic test but it is moving the field forward. Application of research or knowledge to consequential problem — that’s running a clinical trial. Clinical research is a critical part of developing and testing new devices, drugs or vaccines and is accepted as scholarship.
For the research scholar track: Perform work in a research or clinical setting and maintain an independent and consistently productive research program. The way these are measured traditionally, the most important, the one that nobody will argue with, is publishing manuscripts and getting grants.
Clinical scholar tracks for the school of medicine would involve original contributions, so you need original research published in peer reviewed journals. Creatively and effectively applying scientific knowledge to important clinical problems, integration or synthesis of existing knowledge, application of research to important problems, and then participating and contributing to collaborative efforts, including sharing data in multidisciplinary and consortium type initiatives. These are what are defined as the clinical scholar track which is a newer type of track developed specifically in the school of medicine.
You need to think about that when you’re putting together your dossier, when you’re putting together your CV and also when you’re managing your time and making your decisions early in your career about what you’re going do. I’m talking now mainly from getting promoted from assistant professor to associate professor so, early career, although this is what all of us should be doing.
Evidence of scholarship and national recognition – that’s what committees want to see. Publications, but it’s not just the number of publications. More is better, but it’s also the impact of those publications. You can make your argument, or your chair can make your argument by going to Google Scholar and looking at the papers you’ve published and seeing how many times your work has been cited. You can see how many citations particular papers have had and if you have highest number of cited papers, you should state that.
The impact factors of journals are very controversial. They can be misleading, but it’s somewhat of an objective measure of the journals you’re publishing in. For example, the New England Journal of Medicine has a very high impact factor, but there are other journals, specialty journals that are read by very specialized small audiences, which will have a lower impact. Publishing in high impact journals is better.
Getting grants; it’s hard to get grants in this current economic climate. If you’re not a PI of a grant, then being a co-investigator on a grant, participating in a grant, getting grants from foundations, that sort of thing will also go in your favor. Things are getting more difficult, and we all have to be more creative and it counts more. As you know, about 94 percent of grants don’t get funded. Lucinda Finley said that they’re not looking to nail people; they’re looking to promote people. In order to be successful, you need to collaborate with other people, be a co-investigator, get foundation grants.
It hasn’t quite come up, but I think the PRB is going to be faced with very accomplished people that don’t have grants. It’s going to happen, and they’ll have decisions to make and they’re aware of it as well. It used to be that to get promoted from assistant to associate professor you had to have a grant. Now that rule or guideline may change. I think it has to or we’re going to lose talented people.
Being invited to give presentations at national meetings, service on study sessions, organizing national meetings – these are all great opportunities to beef up your CV and meet people in your field. As an assistant professor/young investigator, if you have an opportunity to organize a meeting, take it. You don’t want to spend all your time doing it, but it’s a very valuable thing to do. I did that for one of these local American College of Physician meetings early on, and you end up meeting people and when you do a good job, they think you know what you’re doing. It’s a great networking opportunity for you.
If you get an opportunity to be a consultant in some way or be a member on editorial boards of journals, visiting professorships or giving seminars are all very valuable because you meet other people at the institutions that you visit. Coordinating and participating in multicenter studies, those are nice too because you end up meeting a lot of people who are involved in the multicenter studies.
Reviewing manuscripts for journals is very, very valuable. Editors are desperate now looking for reviewers, and it’s a great opportunity. If you get an opportunity to review a manuscript, it’s worthwhile spending the time to do a good job and get it in on time. The editors are the leaders in your field generally and they want to be able to rely on a young person who does good, thorough reviews and gets them in on time. They decide who gets invited to give talks at meetings. Opportunities will arise for you. They may give you a grant on a study section. All these things contribute in a lot of ways. It’s amazing how these things come back over and over and over again as you continue in your field and in your discipline.
Patents and licenses didn’t used to be recognized as scholarship but now they are. Bob Genco has been influential in compelling the PRB in recognizing those kinds of things as scholarship. They used to be considered sort of separate, non-academic things.
What is the difference between meritorious achievement and excellent achievement? Meritorious is really good and excellent is really, really good. An example of excellent achievement is authorship in peer-reviewed journals. If you’re a senior or a first author that’s better. Integrative reviews put discoveries into perspective while the systematic reviews that are rigorous and statistically based are a step up from that. Other examples are: co-investigator on grants v. principle investigator on grants, contribution of original data to consortium and multicenter trials v. coordinator on multi-center trials. These are the things that the PRB are looking for. That doesn’t mean that the meritorious are not important; they’re very important. At the associate professor level you may have more meritorious things than excellent things. Those come later on.
Let me spend a couple of minutes then talking about clinical investigators. This is where it’s been more challenging for people who do clinical research than for people who do laboratory based biomedical research to get promoted. I’ve been involved also in these clinical translational science award consortiums and writing our CTSA for UB where it’s a large network of people who do and value clinical research. It is nationally recognized that there is actually a disincentive for people to collaborate and share their data. If you’re studying a rare disease, for example, juvenile rheumatoid arthritis, you could do a small trial of your own, be first author or be senior author and have a low impact publication.
How you’re really going to move the field is if you collaborate and get a large number of cases of this rare disease. If you collaborate you have the opportunity to do high impact research, but the problem is there’s only one first author and one senior author with some exceptions but sometimes middle authors in these collaborations make very important contributions. This is nationally recognized and there’s a lot of interest in the RFA from the NIH.
UB, as part of our planning for our 2010 DTSA application, actually changed the tenure guidelines, and this was presented to the faculty council for review and approval. It’s not a very impressive sentence but it’s an important sentence. This is what it says. “Where research publications reflect efforts of many individuals, the contribution of the candidate must be specifically identified and evaluated.” That’s directed at the review committee. There are three things you can do as a clinical investigator that will help your dossier:
1. Have a CV for promotion and a CV for the rest of the world.
2. Explain your contributions. What people are doing is: For each publication that you list on your CV for promotion, put a bullet point, like a sentence or something below each one what was your contribution toward that study. Let’s say it’s a multicenter trial, you could say site PI, you could say served on the publications committee, enrolled 42 subjects, third highest of 27 centers or something like that. It doesn’t have to be long but state what your contribution is, particularly if you wrote any part of it. This will help you and it helps make it transparent to the review committee what your contribution was. You can also say it in your personal statement. In fact, in the guidelines for the three page personal statement ask, “what are your contributions to collaborative projects?”
3. The third thing you can do is get a letter from a collaborator. This would not be these external review letters that I’m going to tell you about because that has to be a disinterested person. But if, for example, you’ve collaborated with somebody and many of your publications are with that person, then what you can do is ask that person to write you a letter detailing your contributions. It’s about transparency, and it’s communicating to the review committees what you’ve done and what you haven’t done. Don’t leave it up to them to try and figure out as to where you are in the line-up of authors.
I think we’re lucky in the department of medicine. Anne B. Curtis, MD, made her living as a clinical investigator and participated in multicentered trials, and Michael E. Cain, MD, dean of the medical school, understands in a big way the importance of this, so it’s up to us in the Department of Medicine to educate the PRB, and that’s what doctors Curtis and Cain are doing with the letters they’re writing for the dossiers for clinical investigators.
One of the most important things are the letters from external reviewers. These are not letters of recommendation. These are sometimes called external reviews but here they’re called letters of evaluation. I think I’ve written hundreds of these for other institutions.
Everybody’s got a little bit of a different angle about what they want from these. At UB, they want reviewers from AAU institutions. There are 60 AAU institutions in the United States. Check out their website. It’s basically the leading institutions in the US. If you have a letter that’s from a faculty member from a non-AAU institution, you’ll need to have a good reason. For example, UCSF is not an AAU institution but they have a great medical school, and they have leaders in the field and all that so you can explain that.
Again, remember, you might have a musician reviewing your dossier. You may have worked with a person at an institute, an international person, a person based in another country. The reason might be it’s he or she is a leader in the field. You might say, “this is a leader in my field and therefore this is a valuable letter.” If you have letters from non-AAU institution reviewers and you don’t explain why, it raises questions.
With regard to uninterested reviewers: They don’t want collaborators, they don’t want friends, former supervisors, faculty from institutions you’ve spent time. UB is a little different from some institutions. It makes it hard sometimes because it’s a natural instinct of people writing letters of recommendation to tout whatever relationship they may have with you, and the more they go on to say that, they think the more they’re helping you but in fact the more they’re hurting you. The best would be a letter stating, “I’ve never met this person, I know of him or her because of what they published,” and then, “this work has moved the field forward.” You don’t contact these external reviewers, it’s the department chair who contacts them, but you do have a lot of influence.
Usually you meet with your division head and discuss whom to get for external reviewers. That list goes to the chair, and the chair will make the request for a letter on your behalf. It’s a good strategy to ask for more than the four letters needed because some people won’t get around to doing it. If I get asked to write a letter for somebody for promotion and I feel like I can’t write a strong letter, I just decline outright. I say I’m too busy. It’s not always good to be persistent, to say come on I need your letter because sometimes these people may be doing you a favor. Some people write a weak letter which doesn’t help you.
You also have the option to identify people who you don’t want to have as reviewers. It should be a short list. There may be somebody who just doesn’t see things the same way, doesn’t like your science or whatever. You can say I don’t want that person as a reviewer and they will honor that.
There’s the guideline for the personal statement on the school of medicine’s website. Three pages, non-technical language and you want to provide an overall perspective on what’s presented in the CV and highlight significant trends, accomplishments, unique contributions and so forth. What I learned at this workshop is that you want to make sure that you talk about the future. They are not looking to promote people from assistant to associate and have them end up at associate professor. They want to see you got the future in mind, that your research program is going places. It’s good to talk about what you have planned for the future. This is where you can discuss your role in collaborations.
If you have gaps in publications, you went a couple years without a publication or you lost a grant or whatever, you need to be careful with your language. You don’t want to make it look like excuses, but on the other hand, people have life events. It happens. People have trouble with their research; just say it so it gives the reviewers an opportunity to evaluate that instead of them coming to a conclusion that you were goofing off for two years. Maybe there was a significant illness in the family or maybe your work or animal facility had a flood and you lost all your transgenics and it took a year to get them back. It happens, so take the opportunity to explain in careful language.
I think I should tell you what I know about getting promoted. This is what to do to get promoted: You must work with a sense of urgency. It’s easy to put stuff off, so you have to be able to make your own deadlines and move forward. The things that are the most successful, the things that are most important for your success are things that don’t have deadlines. Nobody’s telling you that you have to get a manuscript written by this date. You can always target the next deadline for a grant – that sort of thing. So make sure you use your time wisely.
Get in, get to the bench, get in the research trenches because when you start out, you don’t have a research coordinator if you’re a clinical investigator, or you don’t have a technician if you’re in the lab. You have to do it yourself. You can’t be hanging around waiting. You’ve got to just suck it up and do it. In the first couple years, most people, many people don’t have the kind of support that you hope you will have once you get grants, once you hire people so you’ll have to just do it.
Be opportunistic. I’ve mentioned this already. When you get invited to review papers and grants, do so. It’s a really good thing to do in terms of making connections and attaching your name to other people. When you get invited to write reviews or chapters, that’s also a good thing to do. If you get invited to write too many of them and it takes away from your own work, that’s not good, but usually as a young investigator, young faculty member, you’re not getting too many of those invitations.
Attend conferences regularly. Everybody knows that you’ve got to go to conferences. Here’s another nice strategy: A lot of times you’ll get emails from the division and they’ll say "Who would you like to invite to speak this year?” Think about suggesting names that might be potential evaluators of yours in the future. That’s a very nice strategy because once you meet people it helps a lot. That brings up another thing: Meet with visiting seminar speakers.
When I first came to Buffalo, I worked at the Erie County Medical Center and my mentor, the head of the ID division was Mike Epissella. He was a great mentor. He was a neisseria guy and I was an ammophilous guy, so he would invite these neisseria guys to speak and say, “Alright you’re going to meet with him for 45 minutes and tell him about your work.” I’d say, “I’d be better off just doing my own work, why should I meet with a neisseria person?” He told me: “Tell your story, tell them what you’re doing,” so I would meet with these people. It was about the most valuable thing I ever did. These were the people who ended up reviewing my manuscripts and reviewing my grants, and a couple of them literally were my evaluators when I went up for promotion.
Now when I get invited to other places to give talks, they’ll give me a packed in schedule. You’re meeting one person after another for 30 or 45 minutes. It’s frustrating to meet somebody that you know doesn’t have anything planned. You sit there trying to figure out what to talk about for 45 minutes as opposed to meeting a young investigator who’s got a little story to tell you. That’s impressive.
Remember to take advantage of those opportunities to visit with seminar speakers. You see them all the time, emails come out, “Do you want to meet with Dr. So and so? If so, let me know.” Seize those opportunities and remember, they don’t have to be right in your area. It’s a good opportunity. It also helps you hone your story. Present your stuff a few times, and you get better at it as you do that.
Look to spin off low risk studies from your big efforts. As a young investigator, you usually have one big thing you’re moving along but then look for those opportunities for little manuscripts like a methods manuscript or something like that. They say it’s not all numbers, it’s impact, but these reviewers count papers too, so you want to have a balance. You want to have your big stuff going, but you don’t want to have all your eggs in one basket. Take advantage of the smaller opportunities along the way.
One of the most important things I can tell the grant writers is: Finish your near final draft of your grant 4-6 weeks before the deadline. If you’re writing the first words hours or days before the deadline – you’re dead. It’s not going to work, it reflects the quality. Try it for yourself; write something and let it sit for two weeks and read it again.
When you ask somebody else to read it, make sure you give them enough time to read it. One of the most annoying things that happens to me now is I get a 12-page grant and one page of specific aims and it’s now Thursday and the grant’s due on Tuesday, and I get a request “Would you please read this for me?” One, you’d like to have a little bit of time to do it, but the other thing is I can’t do anything other than critique grammar now. I can’t tell them anything that will help them. It’s really critical that you do it in advance and that you ask people to critically review it and then listen to what they say. Sometimes we all get too tied in to our own ideas. You have to be open minded and listen. That’s one of the things that will help you a lot.
Avoid arguing with reviewers. You can’t say things like “I don’t like animal models in COPD because I think they’re lousy.” The bacteria that causes infection in COPD don’t infect animals, and animals don’t get COPD, and when you do it in mice, the COPD doesn’t look like it does in humans. Well lots of people who do this animal model are reviewing my grants. I don’t trash the animal model in my grant. I say my grant is going to build on animal models. There are ways you can nuance these things. Sometimes you may have to respectfully disagree but don’t get yourself into trouble with arguing.
Think about how you spend your time. There are urgent things and there are important things. And so urgent things are things you have to do right now. You have patient emergencies, you have a clinic every Thursday morning, you’re on service, you have to make rounds, you’ve committed to give a lecture like this one, you have important meetings that are scheduled – you have to do it. You can affect how much you do that, if you’re asked to give 50 lectures a year, you can decline some of them to keep yourself out of the urgent/important quadrant too much.
Then there’s the unimportant stuff. This is the killer stuff like reports. I’m in the Department of Medicine, Department of Microbiology, I was at the VA, I’m in the school of medicine. Everybody wants reports; they’re all a little bit different, they’re in different formats. You can spend half your life doing reports. Save those for your down time.
If your goal is to be successful as an academic investigator, you don’t want to spend your time on unimportant stuff. There are some committees I’m on that I know I’m only going to attend 50% of the meetings. If others ask you to do things that should be their job, sometimes you just have to say, “Sorry, I can’t. You’ll have to do it yourself. “
Then there are the time wasters, the not urgent, not important: For me it’s the CNN website. We all have our own time wasters. Make sure you limit those. You want to be doing important things that don’t have deadlines. You need to create that urgency yourself when it comes to writing manuscripts and grants. If you miss the February 15 deadline say, “All right I’ll do the June 5th deadline. It’ll be a better grant anyway.”
Planning research, analyzing data, reading the literature in your field, cultivating relationships with collaborators, that’s the sort of thing you need to figure out how to do. I get to work early, and I work on this stuff pretty much every day from 7:00 – 9:00 a.m. I try not to have phone calls or meetings. That’s 10 hours a week that I’m really trying hard to do that. This works for me.
It may be different for you. It would be the afternoon if you’ve got clinics in the morning, maybe you’re more of an evening/afternoon person. Figure out where it works and set those times. Even in your calendar just block it off so you don’t schedule other stuff as best you can because you have to use that time. It’s that non-deadline stuff that’s going to determine whether you’re going to be successful or not.
If you do all this stuff and you are writing and getting published and getting grants, then you’ll just sail through. The key to your future is how you do this stuff now.
Segal: Tim actually covered a substantial amount of what I intended to, so that’s good. It means I’m just going to really focus now on the clinical track. First we’ll talk about criteria for promotion in the clinical track, resources for faculty development in the Department of Medicine as well as at the medical school level, and then maximizing your chances for success, and what I’ll focus on again is the clinical track.
Tim had gone over the general scheme regarding the process for promotion review, and he did it shorter and more succinctly than I did, which is a good thing. The main thing that I want to highlight is to submit your dossiers on time. Why is that? I put a star over here where it says dossier goes out to internal/external reviewers. In practice, that’s your bottleneck as far as time. So you email people, and they don’t respond or they say, “Yes I’m happy to do it,” and yet they’re not sending it back, and then you’re using judgment to say well if they’re not all that enthusiastic, should I go with another reviewer?
What’s needed in the Department of Medicine is six months. Most of the stuff that we do is actually quite quick. There’s an initial vote by the tenured professors to move forward or not. Then the dossier goes out, but really actually getting back the review letters can literally take months. So if you submit six months before it needs to go to the dean’s office — you’ll see on the web site when the time lines are — then we have enough time to deal with even difficult delays.
For the clinical track, the dean is the final person who decides whether you promoted or not. Then as Tim pointed out, for the tenure track it’s at the president’s level where that decision is made. So who are the clinical educators? These are full time faculty whose major commitments are to patients, teaching trainees and administration of teaching programs. They participate in scholarly activity at a more modest level with less emphasis than required for tenure track. This is from the faculty and promotions brochure that is also available on the web.
As Tim pointed out, scholarship is the major criterion for promotion along the tenure track. For the non-tenured track think of it now as three approximately equal measures. Scholarship, education and we’ll get to service a little later. The focus is on teaching, your ability as clinicians and participation both in the university and community service.
Look at the terminology: “The quality of teaching and clinical activity of such an appointee should be unambiguous and unequivocal.” So you have to be a great clinician and you have to be a great educator, and you have to have evidence for it. That’s one of the things that people don’t think about because if you’re focusing on teaching and patient care, you may not give the attention needed to document that. Here are the specific benchmarks you want to look for:
“Associate professors in the clinical track should demonstrate at least meritorious” (meritorious is a step below excellence) performance in clinical work/service, teaching and scholarly activity.” So your scholarly teaching should be at a meritorious level. And you should demonstrate excellence in teaching or clinical activity. Professor is just one step higher but along that trajectory.
Meritorious scholarship – what does that mean? You should produce several meaningful scholarly contributions that develop and expand knowledge. Publications are the most common currency to demonstrate scholarship. It’s clear that if you’re spending most of your time in clinical care and in taking care of patients directly and in education, it means you don’t have 70 or 80 percent of your time protected for research. You don’t have the level of time for scholarly activity that’s seen in the tenured track. I would strongly suggest that you need to have a list of a number of publications on your CV. Not at the level of 20 or 30 that is expected at the tenure level, but you ought to have a number of publications. These are common things that are benchmarks for scholarship: Publications of reviews, textbook chapters, being an investigator or co-investigator during clinical studies. As Tim had pointed out, don’t lose an opportunity to be a journal reviewer. If they’re asking you to review, it means that the editor believes you have the necessary expertise. Service on symposia and recognition as a leader at least on the regional level in your field are also valuable.
If you’re spending at least 80 percent of your time seeing patients, educating students, what resources do we have that can accelerate your faculty development as far as scholarly work goes? I do want you to pay attention to this link going to the medical school’s web site that lists a number of instructions that you need with regard to preparing your CV, with regard to the process involved in soliciting internal and external reviews and going over in detail as far as the promotion policies in both the tenured and clinical tracks.
Take advantage of mentors and advisers. A mentor is a much closer relationship. A mentor is someone who has an intensive role in terms of guiding your career. An adviser, and I’d like for all of you to think of me as a potential adviser, to come, discuss with me what your work life is, discuss with me what are your aims as far as your career development, this includes both the tenured and non-tenured tracks. You have the chair of medicine, other senior faculty, former mentors, colleagues. For some of you, especially those on the tenure track, you might benefit from a formal mentorship committee similar conceptually to what’s used for PhD students, to set what benchmarks are reasonable and to give critique on your progress.
This is relevant to both clinical scholars on the tenure track but also to people who are interested in clinical research who spend most of their time as full-time clinicians. There is a newly created office of clinical research that Sanjay Sethi, MD, not only leads but has actually developed. This provides an infrastructure for clinical trials in the Department of Medicine. For those who want to do courses in clinical research, that opportunity is available to you through social and preventive medicine. This department, in addition to providing formal master’s degree programs, which may not be feasible for the majority of people, there are also courses in epidemiology and statistics that could be of value. There are also opportunities to engage in collaborative research with epidemiologists in which ideally you would provide the clinical expertise. They have more of a research expertise. Together you could synergize your talents to study questions that are clinically important in your own practice.
Tim Murphy is in charge of the CTRC and also the PI on a major grant application that, if funded, will provide career development award funding. If that does get funded, I definitely want the Department of Medicine junior faculty to be applying and to be competitive. My role is as a leader of faculty development.
For clinical research, I do want you to see that this is an opportunity for you even in the context of a busy clinical practice. As I said, you want to develop common areas of mentored clinical research. I think the social and preventive medicine department offers particular expertise that could be relevant to research, for example related to QI and outcomes research. With that expertise in hand, you can have more leadership roles in the hospital environments or in the clinic that could benefit patient care as well as increase your role as a leader in an administrative capacity.
As always, you always want to publish results. This is a major part of being an academic physician in my view. And this effort for training and research will be reflected in pay for performance. I know that there’s pressure in terms of meeting your RVUs and having patient revenue, etc. but time devoted to research and training, quality time that’s focused on your training and conducting research, will be recognized as part of your pay for performance.
Maximizing your chances for success — again, three criteria: scholarship, education and service. I see peer-reviewed publications as the center of demonstration of scholarship. It is the common currency to generate scholarship. I think as Tim had pointed out, it does have a ripple effect. You do good work, it gets published, you publish based on a common theme so not five different case reports on disparate observations, but a more consistent record of publication in your specific area of expertise. This establishes you as an expert. It’s the foundation for other metrics of scholarship such as being invited for talks, invited reviews, participation in journals, as that moves along maybe even having a leadership role on an editorial board. Leadership in clinical trials groups and, of course, publications are what you need for grants as well.
Quality and quantity count. Quality is generally more important. Again, there should be common themes for publication reflecting interest and expertise that’s persistent. Not one case here, one case there, but really a much more sustained effort in an area that’s of interest to you.
You want to show expertise in study design and analysis, so that will not be done with a series that only shows a few cases with a common presentation. It will be shown,for example, with a case control analysis. This could be all through chart review but a much more structured analysis that involves a design that involves statistics. This shows that you are analyzing data and the impact is substantially higher.
As Tim has pointed out, leadership in collaborative research also can also result from publications. I wanted to show you; I hope I’m not embarrassing my colleague Nikolaos G. Almyroudis, MD. He has been promoted, so he’s an associate professor in the clinical track. I think this was a really neat paper that he had had the major role in doing that I think is ideal for the type of scholarly work you ought to be thinking about. This involved molecular epidemiology and risk factors for vancomycin resistant enterococcus (VRE) colonization in patients and leukemia transplant patients. This was a new finding.
We thought that we had this terrible problem, still do, with VRE. We thought that it was being transmitted from one patient to the next. We put a lot of useless, unproductive effort into contact precautions that never seemed to work. But then we did a molecular analysis and found to our surprise that most of the isolates were unique. In fact, the vast majority were unique, arguing against patient to patient transmission, arguing for some unique host factors. The features of this study were published in a peer-reviewed society-type journal. It addressed several clinically important questions. We had access to patient data and samples, so it wasn’t remote; it was something that we saw all the time on the wards. There was a collaboration with clinicians and lab research. Alan Lesse’s (Alan J. Lesse, MD) lab together with a graduate student of ours had done the molecular analysis to show clustering vs. unique isolates and is a foundation for further research. Nick currently has a paper in an advance stage of preparation related to additional risk factors that predict VRE colonization in this patient population.
Education is very important. It’s one of the things we do and that I do. I’m embarrassed to say that on my CV, until recently, I didn’t list the courses I taught. I figured wrongly that these were internal, it was part of my role as an academic physician, so if I teach medical students and it’s the same course for 10 years, why bother putting it on my CV. Of course you should put it in your CV. Everything you do that’s a meaningful part of education goes in your CV. This is something that’s very important particularly for the clinical track. To the extent possible, you want to get ratings by your trainees. That counts a lot, so if there’s a scale from 1-5 where 5 is the best and you’re consistently between 4-5, that’s very good. You want to get feedback from expert educators. I know in my situation, when I was teaching the medical students when I first started, I was a little too detailed. I didn’t give enough background. I got feedback and I think I do a better job now.
The Royal College of Physicians’ workshop is a great opportunity. You want to explore it if this is your interest. Explore opportunities for more intensive contributions such as curriculum development. Don’t forget to keep in touch with your trainees. If you’ve mentored them, know when you mentored them. You have to write it down because over time you won’t remember. Put their names down. Be sure you don’t lose touch. You want to know where they wound up. The more of your trainees that wind up in academic medicine, the better it is as a reflection of you as an educator and a mentor.
It’s the same thing for university service. You need to show meaningful sustained effort. If you find your motivation to join committees six months before you go up for promotions, that will be evident to the promotions committee. I listed a faculty council link that lists a whole range of committees. There may be specific committees that are of interest to you – contact the chairs. Some are elected, some are appointed. If there’s one of particular interest that’s under the direct auspices of the dean, you can shoot him an email as well. Choose how you contribute based on your interests and skills. Don’t waste your time on CV building tasks that are of no interest to you. Your time is too valuable for that. Select the ones that are of interest to you and pursue those.
There are lots of ways to serve the profession. One way you do it every day is by patient care. So that is an important service that is unique to a clinician group. That counts as service. If we have clear metrics for how you do as a physician, evaluations, that sort of thing, that’s a positive thing. Contributions to hospital service, again the better training you have, let’s say in outcomes research or QI, the more you are able to serve in a leadership role as far as our partner hospitals go. In addition to direct communication with patients, are there other ways you can think about patient or community education, like local radio or web based opportunities?
Local and regional professional societies and symposia certainly count and are important. In fact, the local and regional efforts really focus on service. I would say that national level service is more intimately tied with peer recognition for your scholarship. So for example, if you’re on the editorial board for a major journal, yes that’s service, but that’s also a recognition of you as a scholar and expert in the field. Same thing if you are on an NIH study section; that is clearly recognition for your expertise in that field. So it’s both service and recognition for you as a scholar, and at the national level the two are intimately tied.
In my opinion, your CV is the most important part of your dossier. It’s what the committee will look at first. I always look at it first because I want the objective data before I look at other people’s opinions. It’s a foundation for letters of evaluation. Follow the instructions for how to prepare your CV. Here’s the link: http://medicine.buffalo.edu/faculty_and_staff/faculty_promotion.html. Feel free to email me your CV, I can give you some guidance as well.
Keep a detailed record of your accomplishments. Make sure they’re included in your CV, and make sure the significance of the accomplishments is clear. Let’s say I served on an IDSA panel for treatment and management of invasive aspergillosis, and you don’t know what IDSA stands for. It’s a good idea if I specify what IDSA stands for (by the way it the Infectious Diseases Society of America). As it goes up to the level of the president, they may not know what AHA stands for. Use your abbreviations selectively or not at all and make it very clear in your CV so that reviewers can recognize the importance of your accomplishments. If you are invited to give a talk at ASCO I would suggest writing out the full name (American Society of Clinical Oncology) and explain that it is the major professional society for oncology. It’s a major accomplishment if you are invited to give these talks. Make its importance very clear.
A personal statement is good. I think for the clinical track it’s optional, but don’t miss the opportunity to give your personal statement. This is where you give your accomplishments, training and career trajectory, and you have the ability to expand on the accomplishments listed in your CV, which is very important. Now for personal statement, you don’t need to make it overly personal. The committee really wants to know about scholarship, education and service, so focus on that when you are writing your personal statement. Again, I’m very happy to review at all stages your dossier.
Faculty recognition awards for research: For the clinical track we are going to give an award. All of these are newly created awards in the Department of Medicine. Number five (award to clinical faculty for scholarship) is most relevant to the clinical folks. There will be an award to clinical faculty for scholarship. Why is that important as far as promotion? It’s very important because there’s only one given per year. It immediately distinguishes you. This is a very important thing that you can say this is what you were awarded.
There are three faculty awards for clinical excellence in teaching. I won’t go through all three of them, but these are three per year, and I think they’re very important because again they single you out, and I’m speaking as someone who hasn’t won any of the three. If you do, it singles you out as an expert clinical teacher.
When should you start planning for promotion? As soon as you’re recruited. That doesn’t mean you should do activities solely to support your promotion. Your time is too valuable for that. Plan to succeed in key areas that are relevant for promotion, and plan to be a successful scholar and educator and to contribute in a meaningful way to your university and to your profession. That requires both planning and commitment.
Q: Is there anywhere to look for the criteria of the scholarship award? What are you looking for?
A: For the award to clinical faculty for scholarship, we are emphasizing that these are full time clinical faculty. If you are a clinical researcher spending 80 percent of your time enrolling patients and collecting data, you are not eligible for this award. This award is earmarked for people doing full time clinical work with the reasonable expectation. So a very good fit for that is invited talks at regional meetings concerning your research, a peer-reviewed publication that would be focused on your analysis, so case control or you implemented a different kind of approach to avoid readmissions, and you have analyzed the data and published the results. These are the kind of criteria that we would be looking for that recognition.
Q: I have a question about the type of research courses. When I talked to Dr. Freudenheim last time, she said that most of these courses are during the 9-5:00 hours, so it would be very difficult for a clinician to actually attend those courses.
A: So the question is: Is it difficult for the timing to attend some of the courses in social and preventive medicine? I can’t tell you exactly about the schedule, but when I spoke to Dr. Freudenheim, the goal is to make these available to clinicians, really in two different ways: One is someone with much more protected research time than the full time clinician has to pursue a formal master’s degree. The second is to accommodate the schedule of a full-time clinician, and so what that would require, we can’t go to the social and preventive medicine and ask them to rearrange their courses, but we can, for select members of our faculty, say it is important for you to attend this class, we are going to rearrange your clinic schedule.
A (Murphy): If there were enough people interested, for example junior faculty and senior fellows, I think they would consider running the courses specifically for us. The problem is, I don’t know if we have enough at this point to make it worthwhile. Jo Freudenheim is very interested in clinical investigators.
(Segal): She totally is. I’m going to have a separate talk with med-peds, so we’ll flesh that out more. We are committed on every level. Anne B. Curtis, MD, is committed to it, and we’ve had a number of discussions with Jo Freudenheim. She was actually one of the speakers at a “meet and greet” a few months ago.
We all benefit by increasing the ability of our faculty to be better clinical researchers, so this is a goal we’re going to be pursuing.