The author discusses major issues of faculty promotion in medical schools by describing the decision-making processes of the Professorial Promotion Committee (PPC) at The Johns Hopkins School of Medicine, a committee he chaired for several years. Perhaps the major dilemma of medical school promotion committees is how to define standards that encompass the several different excellences and highly diverse talents of their faculty. This dilemma prompts a search for a natural set of "families" of rank, admission to which can be defined clearly and operationally. The author discusses methods of doing this (via various faculty track systems) and the pros and cons of each; analyzes the processes by which the PPC assesses evidence of nominees' achievements and attributes of scholarship; defines the three major career pathways at his school and explains the criteria used to evaluate nominees in each; outlines how the PPC evaluates individuals nominated for their excellence in teaching; and describes characteristics of nominees that may lead to their rejection. He makes clear that the decision-making processes of effective promotion committees are neither simple nor mechanistic and are sometimes difficult and problematic, and stresses the importance (in any promotional process, whether the setting be a medical school or a pencil factory) of institutional memory and of the committee's knowledge of leaders elsewhere whose generative contributions can be compared with those of nominees. The author concludes that the promotional process is not a simple "survival of the fittest" exercise but is a struggle to realize and foster an ideal of faculty quality to continue the high level of the institution's excellence and collegiality.
(C) 1994 Association of American Medical Colleges