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Academic Medicine:
SPECIAL THEME: Expanding the View of Scholarship: CASE STUDIES

Revising Appointment, Promotion, and Tenure Procedures to Incorporate an Expanded Definition of Scholarship: The University of Kentucky College of Medicine Experience

Nora, Lois Margaret MD, JD; Pomeroy, Claire MD; Curry, Thomas E. Jr. PhD; Hill, Nancy S.; Tibbs, Phillip A. MD; Wilson, Emery A. MD

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Author Information

Dr. Nora is associate dean, academic affairs and administration, and professor, Department of Neurology; Dr. Pomeroy is professor, Department of Medicine, and division chief, Infectious Diseases; Dr. Curry is professor, Department of Obstetrics-Gynecology; Ms. Hill is special assistant to the dean; Dr. Tibbs is professor, Department of Surgery, Division of Neurosurgery; and Dr. Wilson is vice-chancellor for clinical services, Chandler Medical Center, and dean of the College of Medicine, all at the University of Kentucky College of Medicine, Lexington. At the time this paper was written, Dr. Nora was also a 1999-2000 American Council on Education Fellow at The Ohio State University.

Correspondence and requests for reprints should be addressed to Dr. Nora, Associate Dean, Academic Affairs, University of Kentucky College of Medicine, 800 Rose Street, MN 104, Lexington, KY 405360298; e-mail: 〈lmnoral@pop.uky.edu〉.

The authors are reporting on the work of an entire committee. We acknowledge the contributions of our colleagues: Drs. Shawn Caudill, Thomas Garrity, Jacqueline Gibson, Norman Goodman, Lon Hays, Darren Johnson, Raleigh Jones, Jamshed Kanga, Edward Kasarskis, Gerald Klim, Jacqueline Noonan, James Norton, William O'Connor, Anjana Pettigrew, Barbara Phillips, Frederick Schmitt, Julia Stevens, John Thompson, Lane Veltkamp, Kimberly Williams, and John Wilson, as well as the contributions of a previous committee chaired by Dr. Frederick C. de Beer. In addition, we acknowledge the contributions of Ms. Wanda Whitehouse and Ms. Charlotte Baker.

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Abstract

Scholarly activity and scholarly productivity are key features of the academic health center (AHC) and the work of college of medicine faculty. Recent changes in the academic environment of the University of Kentucky (UK) College of Medicine led to an examination of its appointment, promotion, and tenure procedures. This, in turn, led to a re-examination of the college's definition of scholarship. This article describes three of UK's scholarship-related challenges, particularly those related to clinical departments. The authors describe some of the new procedures being implemented to address these challenges; these include new faculty designations, clearer articulation of promotion procedures, explicit recognition of multiple forms of scholarship, expectations for investment in junior faculty, and mandatory discussion of faculty success in chairs' annual reviews. Faculty reactions, positive and negative, to these changes in procedures are also presented.

If academic health centers in the United States are to achieve their tripartite mission of clinical care, research, and education, scholarship must be a focal point of their activities.1 Changes in the environment at the University of Kentucky (UK) College of Medicine led to an examination of our appointment, promotion, and tenure (APT) procedures, including our definition of scholarship and the measures used to support the scholarly activity of our faculty. This paper describes how a broader definition of scholarship has been incorporated into the APT process in our college, and how procedures have been modified to support the scholarly activities of our faculty and enhance faculty development. After providing background on the college, we describe the process used to change our APT procedures. We then describe our new definition of scholarship and delineate the mechanisms being used to facilitate the incorporation of this new definition into the culture of our college. We conclude with a discussion of lessons learned in the process.

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BACKGROUND

The mission of the UK Chandler Medical Center, which includes the College of Medicine, is to help people of the Commonwealth of Kentucky and beyond to gain and maintain good health through creative leadership and quality initiatives in education, research, and service. Our vision is to be a top-20 academic health center recognized nationally and internationally for teaching, research, and patient care. Factors critical to the successful achievement of this vision have been identified; they include the need to attract, develop, and retain high-caliber faculty and staff.

The University of Kentucky College of Medicine employs approximately 600 faculty members, 75% of whom work in clinical departments. The number of faculty members has increased by 20% over the past five years; most of the increase has occurred in the clinical departments. The past five years have also seen substantial growth in the activities of all three components of our tripartite mission—research, education, and service. Total funding from research grants and contracts increased from approximately $31 million in 1994 to $51 million in 1999. Inpatient admissions number approximately 20,500 annually. Our faculty members staff more than 900 ambulatory clinics throughout the state annually, and more than 400,000 outpatients were served in 1999. The Kentucky Medical Curriculum, our program for undergraduate medical education, places significant demands on faculty members through its emphasis on smallgroup learning, problem-based education, and the heavy use of clinical faculty in the first two years for clinical correlative exercises in the basic science courses. In addition, our faculty members have time-intensive teaching responsibilities in the other health professions colleges of our medical center and in the UK's undergraduate and graduate programs.

The rapid growth in the number of faculty members and the increasing demands associated with our research, education, and clinical missions stimulated our interest in evaluating our methods for recruiting and developing faculty members. Our specific interest in APT procedures was further piqued by a 1997 internal review that concluded that our faculty recruitment, development, retention, and promotion processes were not working optimally, particularly in our clinical departments. Concerned about the situation, Emery A. Wilson, MD, dean of the College of Medicine, convened the Task Force on Faculty Affairs. The task force was charged with reviewing current College of Medicine procedures for APT and recommending appropriate modifications consistent with our mission and with university policies.

The task force met during the first eight months of 1998. The group included senior basic science and clinical department representatives with diverse interests and scholarly foci related to the clinical, research, and education missions of the college. The task force included tenured faculty members, contractual (non-tenure-eligible) faculty members, and voluntary faculty members. Task force members collected information, developed procedures, and communicated the work of the task force to the broader college community. In addition, they maintained communication with members of the university's central administration, the medical college faculty council, the university faculty senate, and the university's American Association of University Professors representative. The task force's report was presented to faculty members at a general faculty meeting, at department meetings, and at meetings of key college committees.

The task force's investigation yielded various findings that resulted in recommendations about the APT procedures in the College of Medicine. Many of the findings concerned the difficulties faced by clinical faculty members attempting both to care for patients in the manner demanded in the changing clinical environment and to meet traditional university promotion requirements. Most of the proposed changes were adopted by our faculty and have been incorporated into a college document available in hard copy or on the Web.2 This paper focuses on those changes in APT procedures that are specifically related to scholarship. However, it is important to note that many other APT procedures were impacted by this project. For example, the development of specific guidelines for the appointment and promotion of voluntary community-based faculty members has been welcomed by faculty members as well as by college administration.

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THREE SCHOLARSHIP-RELATED CHALLENGES

As the task force reviewed the college's APT procedures, questions related to scholarship emerged as a leading issue. What is the definition of scholarship used in the College of Medicine? Have changes in medicine, especially changes in health care financing, altered appropriate definitions of scholarship and/or the ability of faculty to meet scholarly requirements? What forms of scholarly activity occur in an academic health center (AHC) and how do we ensure that these are recognized within the broader university structure? How do we ensure institutional and faculty-member cross-accountability for producing scholarship? These were the questions faced by the task force; each is addressed below.

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What is the definition of scholarship used in the College of Medicine?

Our institutional mission and value statements articulate a commitment to scholarly activities across our mission areas. This breadth of commitment is consistent with recognition of the four forms of scholarship identified by Boyer: discovery, integration, application, and teaching.3–5 Although our faculty members engage in all forms of scholarship, we recognized that our explicit recognition of scholarship focused predominantly on the area of discovery. Formal discussions of scholarship emphasized discovery as the traditional form of scholarship conducted in Research I institutions. In orientation exercises, faculty documents, and other venues, our faculty and leadership often failed to engage in specific discussion of alternative forms of scholarship, and it seemed unlikely that the majority of our faculty members encountered such discussions elsewhere. Hence, there was a large gap in the faculty's understanding of the scholarship of integration, application, and teaching; the values that these types of scholarship bring to the college and the academic health center; and how these types of scholarship should be considered in the APT process.

This gap in understanding of the different forms of scholarship had several unfortunate consequences. First, some junior faculty members wrongly perceived that traditional research was their only opportunity for scholarly work in the college. Even if their previous research training, the nature of their work, and their personal interests were more consistent with other forms of scholarly activity, they felt pressure to produce scholarship of discovery. Second, a limited understanding of other forms of scholarship translated to a limited appreciation of the products of those scholarly activities. The scholarly products related to traditional research—NIH funding, peer-reviewed journal articles—are familiar, but scholarly products related to other forms of scholarship—clinical case reports, descriptions of new techniques, CD-ROMs, and monies from nontraditional funding sources—were less well appreciated. This lack of appreciation discouraged some faculty members from producing these alternative scholarly products and diminished the perceived value of these sorts of contributions among some faculty. Furthermore, these alternative forms of documentation of scholarship were too often discounted during the APT process. Because we did not have a thorough understanding of a broad definition of scholarship, less traditional scholarly products were sometimes perceived as being less important and less valuable. We concluded that we did not have an institutional understanding of scholarship that extended very far beyond the traditional view that “scholarship” means only the scholarship of discovery.

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How do we ensure that the work—including the scholarly work—of College of Medicine faculty is recognized within the university's APT structure?

In general, university APT policies are designed with traditional faculty members in mind. For the most part, the roles of basic science faculty members and recognition of their efforts can be easily incorporated into these policies. On the other hand, many physician faculty members pursue work that differs from traditional definitions. As a result, we found many difficulties present when attempting to incorporate these non-traditional roles into the general university APT structure.

The most relevant distinction between traditional faculty members and physician faculty members is the work expectations. Physician faculty spend significant amounts of time engaged in the clinical practice of the disciplines that they teach. The university has an interest in the conduct of these clinical activities. They form a major component of the university's outreach and engagement activities and have, over the years, provided a large source of subsidy for the other academic missions.

However, clinical practice consumes a great deal of faculty members' time and energy. Some of these activities contribute to faculty members' scholarly productivity, but many do not. Much of the time spent in clinical activities diminishes time available for research. Importantly, the scholarly work of integration and application that results from patient care is frequently of a type unfamiliar to non-clinicians.7 Thus, tension existed between APT policies, which stressed the traditional scholarship of discovery, and many clinical activities, which focused on integration and application. The task force concluded that scholarship-related difficulties between university practices and the College of Medicine fell into two broad areas: how faculty were organized and how clinical activities were understood in terms of their scholarly components.

Our university has five broad descriptors, called title series, used to organize faculty by roles. Two of the title series, the regular title series and the special title series, are tenure-eligible. The other three title series—research title series, clinical title series, and adjunct title series—are contractual and not tenure-eligible. In addition, the College of Medicine has a voluntary title series used by many of our community-based faculty. The expectations of faculty members in the various title series differ with regard to work done and promotion requirements, including scholarly productivity. The university categories did not adequately describe or distinguish the responsibilities of our faculty members, particularly physician faculty members. For example, most of our tenure-eligible physician faculty were in the regular title series. The regular title series covers a very traditional role, and promotion in this series demands excellence across the three mission areas of research, teaching, and service (the typical “triple threat”), and substantial scholarship (emphasizing the scholarship of discovery with independent funding) leading to national and international recognition. The special title series was developed to accommodate the university's need to recognize and value faculty members whose roles are different than those of the traditional university faculty member. Promotion requirements in this title series are articulated in the individual faculty member's job description that is developed at the time of hiring.

From the review of the two tenure-eligible university title series, the task force determined that the university's special title series designation was the more appropriate tenure-eligible faculty designation for many of our clinical faculty. However, the university's lack of standardized promotion guidelines for this series had created long-standing resistance to using it in the college. In particular, the lack of mandatory scholarly productivity in the special title series (according to university rules) was inconsistent with a strong underlying belief in the College of Medicine that all faculty members in tenure-eligible positions should participate in scholarly work. This is in part what led to many of our faculty members' being appointed into the regular title series even though it did not accommodate their roles and did not articulate promotion requirements consistent with their work expectations. An alternative existed for many of these faculty members (the special title series), but it was not widely used because it was poorly understood and did not appear to incorporate guidelines critical to the College of Medicine.

Related difficulties occurred when university committees, unfamiliar with the work of physician faculty and the demands of the clinical environment, evaluated College of Medicine faculty members. Just as we had difficulties placing physician faculty into the university-designated roles, other university colleagues had difficulties using the regular title series guidelines to evaluate the contributions and scholarship of physician faculty.

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How do we ensure institutional and faculty member cross-accountability for producing scholarship?

When a new faculty member is hired, both the institution and the faculty member make significant commitments to each other. A clear and common understanding of institutional and faculty expectations and roles, as well as ongoing faculty development, is important to ensure the long-term success of the commitments. Necessary time and resources must be provided to the faculty member to enable him or her to perform expected assignments, including the production of scholarly work. Mentoring and constructive feedback must occur on a regular basis. Except in the case of college-wide and medical-center wide orientations for new faculty, responsibility for faculty development activities has traditionally rested in the departments. This worked well in the past. However, the task force concluded that in our changing work environment this system of faculty development had weaknesses. This was particularly true in clinical departments, where increased demands for clinical activities competed with the demands of establishing and maintaining scholarly activities. Specific concerns of the task force included changing work assignments, lack of clarity about expectations, and inadequacy of time to conduct scholarly work.

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ACTIONS TAKEN

Based on task force recommendations for how to address the concerns described above, the College of Medicine made several modifications to its procedures. First, the college formally adopted an expanded definition of scholarship, and incorporated diverse examples of scholarship taken from activities traditionally performed by medical college faculty. Second, we developed a series of faculty designations that were consistent with university regulations but that better described each faculty member's role in the College with respect to the various forms of scholarship. Third, we strengthened college mechanisms for supporting ongoing faculty development and mentoring, including the centralization of certain activities and the standardization of certain practices across departments. Each of these changes is described below.

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New Definition of Scholarship

The task force emphasized the importance of recognizing all forms of scholarship, particularly in an institution whose values include innovation and leadership in clinical care and education. These other types of scholarship not only contribute to expanding the base of human knowledge but also are crucial for the intellectual climate in academic health centers.3 Recognizing all forms of scholarship is important if we are to legitimize the full scope of academic work. After long discussion and review of the work of many other institutions (we found the work of colleagues at Harvard Medical School and the University of Virginia School of Medicine particularly helpful), the task force endorsed definitions of scholarship adapted from Ernest L. Boyer's book Scholarship Reconsidered: Priorities of the Professorate.4,5,7,8 This expanded definition of scholarship, discussed in detail below and now adopted by our faculty members, is intended to stimulate an academic approach to each of the missions within the College of Medicine and to facilitate recognition of all of the contributions of the faculty. We found that the inclusion of medical-education—related examples of each form of scholarly activity fostered understanding of the various forms of scholarship among our faculty and others throughout the university community.

▪ The scholarship of discovery occurs when the faculty member pursues new knowledge. This form of scholarship comes closest to the traditional definition of “basic scientific research” and is closest to the traditional view of scholarship in our college. Those engaged in the scholarship of discovery ask, “What is to be known?” and “What is to be found?” In a medical college environment, the scholarship of discovery includes traditional bench research, as well as many translational research efforts and some clinical research efforts.

▪ The scholarship of integration occurs when the faculty member's work gives meaning to collected isolated facts and synthesizes them into a new perspective. Known facts are used to make connections across disciplines, to place knowledge derived in one specialty into a larger context, to explain another's data in a revealing way, or to carry out any combination of these activities. The scholarship of integration is closely related to the discovery of new information but seeks to interpret new insights, draw them together, and bring them to bear on original research. The faculty member engaged in the scholarship of integration asks, “What do these findings mean?” and “How can this known information be combined in a new or unique fashion?” In a medical college environment, many clinical research activities, including such activities as studies of health care delivery and health outcomes research, could be considered in this category.

▪ The scholarship of application occurs when previously discovered knowledge is applied to consequential problems and new understandings result. New intellectual understandings can arise out of the very act of application, whether in medical diagnosis, treatment, public policy, or other activities. Recognizing these new understandings and then evaluating and sharing them contribute to the scholarship of application. In clinical medicine, the scholarship of application relates to, and flows from, professional activity. Examples include the utilization of new procedures and techniques in inpatient care, the analysis of public health issues, and many clinical treatment trials.

▪ The scholarship of teaching is the process of communicating knowledge, including the results of the other forms of scholarship, to others in a way that both educates the student and entices the student to become a lifelong learner and a future scholar. Scholarly teaching stimulates active, not passive, learning and encourages students to be critical, creative thinkers with the capacity to go on learning after completing their formal education. The production of new materials, methods of teaching, and analyses of the best ways to accomplish the goals of teaching demonstrate the scholarship of teaching. In the medical school setting, examples include developing standardized patients as a training and assessment tool, implementing and testing a new women's health curriculum, and developing innovative combined-degree programs.

As a result of the task force's recommendations, a new faculty handbook on APT procedures has been developed that begins with an outline of the types of scholarship. Each form of scholarship is explicitly discussed during new-faculty orientations. Current faculty members have received information about the forms of scholarship via departmental meetings, a general faculty meeting, and discussions with college committees. It is hoped that a heightened awareness of these expanded definitions of scholarship will stimulate faculty to enthusiastically pursue diverse scholarly activities, all of which are needed to meet our tripartite mission.

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New Faculty Designations and Clarified Promotion Guidelines

As mentioned previously, we found that the university's title series were poorly tailored to the work of the medical college faculty (particularly clinical faculty) and the needs of the college. Given the many contributions of our faculty and the various forms of scholarship in which they participate, we determined that we needed to develop a mechanism for designating college faculty in a manner that better recognized their work and delineated their expectations for promotion. Many task force members were interested in petitioning for changes in university regulations, but this was beyond the scope of our charge and would have delayed other productive changes. Instead, we developed new College of Medicine-specific faculty designations consistent with the university title series designators. Each faculty member now has a designated university title series and also a college-specific designation. On its face, this complicates the situation, but we believe that using our college designation as the primary method for characterizing faculty roles within the college will accrue long-term benefits.

Assignment to the appropriate college designation and university title series is based on the mission and needs of the department and college; the strengths of the faculty member; and the expectations of the faculty member. Three designations are eligible for tenure: academic basic scientist, academic clinician-scientist, and academic medical educator. Excellence is required of all these faculty members, and all are required to participate in scholarly activity and to produce scholarship. Requiring scholarly productivity of all faculty members in all tenure-eligible faculty creates a different standard within the College of Medicine than exists in the larger university, but the requirements can be accommodated within university rules. The college now requires that scholarly productivity be included in all job descriptions for special title series faculty before job descriptions are approved.

Four of the new faculty designations are contractual positions and not eligible for tenure: research faculty, clinical faculty, medical educator faculty, and community-based faculty. These College of Medicine designations align fairly well with existing university title series. Excellence is also required of all these faculty members; however, scholarship is not a requirement for promotion unless it is specifically stated in a faculty member's job description. For example, scholarly productivity will typically be incorporated into promotion expectations for the research faculty member, but not for the clinical faculty member. But we explicitly recognize that all of these faculty members are extremely important to our mission and are valued members of our college community.

We also delineated promotion guidelines for faculty members based upon their college designations and university title series. These promotion guidelines are not new, but instead represent a formalization of pre-existing but poorly articulated guidelines. The guidelines now are more carefully aligned with the specific work and expectations of these various faculty roles and explicitly incorporate multiple forms of scholarship. Table 1, outlines the promotion guidelines for some common faculty designations. Table 1, panel 1, describes guidelines for academic basic scientists in the university's regular title series. These faculty members most commonly engage in the scholarship of discovery. Hence, their promotion guidelines emphasize original investigation and increasing responsibility for the research questions and ideas. Panels 3 and 4 reflect promotion guidelines for academic clinician-scientists (in the university regular title series and special title series) and academic medical educators (special title series). Because this article focuses on scholarship, the promotion guidelines for faculty in contractual tracks are not included, but they can be easily accessed via our Web site.2

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As panel 2 of Table 1 details, the academic clinician-scientist in the university regular title series will typically engage in the scholarship of discovery or the scholarship of integration. This faculty member is expected to achieve independent funding for original and innovative research findings. Table 1, panel 3 outlines the promotion guidelines for academic clinician-scientists in the university special title series. The research participation of these faculty members should be linked to their clinical responsibilities. It is anticipated that the research focus will be in an area related to their clinical responsibilities and that their clinical efforts will be synergistic with their research efforts. This research is not expected to result in the development of an independent laboratory. Rather, the laboratory will be the clinical setting in which the clinician practices. Collaboration with basic scientists to produce a team engaged in translational research is encouraged. Scholarship of discovery is not excluded for this faculty member, but work that integrates or applies other knowledge is more likely.

Table 1, panel 4 outlines the scholarly productivity expected of the academic medical educator in the university special title series. These guidelines make explicit that the scholarship of teaching is valued in our college. New curricula, textbooks, computer-based teaching materials, and other teaching materials are recognized as scholarly products. Note, however, that the mere development of such materials is not enough for successful promotion. As with the other types of scholarly work, scholarship in teaching involves developing materials in a way that allows them to be evaluated by others inside and outside the institution. Increasingly wide audiences must recognize the value of this scholarly work at succeeding levels of promotion.

We recognize that there is overlap in the activities among the four forms of scholarship. However, these guidelines allow faculty members and department chairs to consider the how the different designations match the work and promotion expectations of each faculty member. The guidelines also facilitate discussion of the resources necessary to support a faculty member, particularly early in his or her career.

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New Internal Procedures

The task force did not believe that either an expanded definition of scholarship or changes in the guidelines describing the forms of scholarship would be sufficient to bring about the types of changes envisioned for the college. Additional measures to support adoption of the expanded definitions of scholarship were necessary. The following are some of the measures that were proposed, and the rationale behind each. Some of these changes involved standardization of procedures across the college, with some centralized follow-up. Nonetheless, faculty recruitment, development, and promotion remain the primary responsibility of the department chairs.

Proposal one: reaffirm basic principles. The task force recommended a reaffirmation of certain principles to reinforce existing values of our college and make them explicit to all. For example, we reaffirmed that excellence in one's work is an expectation of all faculty members in our College of Medicine, regardless of faculty designation. We supported the principle that the college's mission and strategic plan should guide each department's mission and the hiring of all new faculty members. Hence, the strategic plan of each department, in alignment with the strategic plan of the college, will guide recruitment and appointment efforts. We affirmed that scholarly productivity is an expectation of all tenure-eligible faculty members and that scholarship is a career-long obligation. This last statement dovetailed with university-wide work on a senior faculty development and review policy.

Proposal two: implement new mechanisms for supporting faculty. Several practical new mechanisms were advocated. For example, the task force emphasized the need for adequate institutional investment in junior faculty members so that they have the opportunity to meet the demands for scholarly productivity. Hence, the task force suggested minimum allocations of time for junior faculty in the first years of their probationary periods. The most significant change occurred for junior faculty members who are recruited into traditional academic basic science and academic clinician-scientist positions with expectations that they will engage in the scholarship of discovery, produce outstanding and original research, and develop an independently funded program. These junior faculty members must have very significant resources and time to devote to their research efforts. Faculty members engaged in basic science research are now to be given a minimum of 75% of their time to devote to their research during the first three years of a probationary appointment. For faculty members engaged in clinical research, this requirement is modified somewhat: 75% of their time can be devoted to research, but up to one third of this time (i.e., 25% of the full-time effort) can be spent in clinical activities, if those clinical activities are directly related to the area of research. For example, a neurologist whose research focus is motor neuron disease may spend this time caring for patients with motor neuron diseases but should not spend this time in a headache clinic. This modification allows clinicians to remain very active in clinical practice, but ensures that there is adequate time for scholarship. The remaining 25% of the faculty member's time is allocated as deemed appropriate by the chair. These time allocations are coupled with an expectation that the faculty member will, in fact, be productive in his or her scholarly endeavors.

Proposal three: emphasize scholarship in word and deed. The task force reiterated that commitment to scholarship can only be achieved if scholarship is regularly emphasized by the words and actions of departmental and college leadership, and if there is ongoing discussion between faculty members and institutional leaders. To facilitate this, the college made several changes. First, at the time of hiring all faculty members will receive an appointment letter that outlines institutional commitment, faculty member responsibilities, and expectations. Second, an annual review of all faculty members below the rank of full professor should provide both formative and summative feedback and must include a yearly letter of reappointment that outlines any changes in job expectations. Third, a formal review of the faculty member's progress occurs at the two-year and four-year reviews. In addition, a specific review of the faculty member's college and university designations must occur at three years in a probationary period. The requirement of an annual review for tenured associate professors marked a change from university rules (which allowed tenured associate professors to be reviewed every two years) and was welcomed by many. Finally, the success of junior faculty is a mandatory element of each chair's annual review by the dean.

Proposal four: include scholarship in productivity models. At the time the APT task force was at work, another task force was developing college productivity models. The APT task force did not become involved in developing these models, but instead engaged in debate about their value. After extensive dialogue, the APT task force voiced support for the concept of productivity instruments as part of the mechanism for evaluating scholarship. The group concluded that a productivity model was going to be implemented in the college as part of its movement toward mission-based management. Thus, it was deemed better to have scholarship included in productivity measures than to have productivity measures that did not include scholarship. There was fear that if scholarship were not included, its value might be underappreciated and unrecognized.

The process and outcomes of our productivity model work will be dealt with more fully in an upcoming article. However, the process was markedly assisted by the concurrent focus on scholarship in the college. Measures of scholarship that have been incorporated into our productivity model include traditional measures: peer-reviewed publications, grants submitted, and grants funded. But less traditional measures have also been incorporated. These include teaching awards, software development, and development of new courses.

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ASSESSMENT TO DATE

The main strength of the APT task force's document on scholarship in the promotion process is that it incorporates an expanded definition of scholarship that more accurately reflects the contributions of faculty members in the College of Medicine and facilitates appropriate recognition of these contributions. The unique requirements of and demands on medical school faculty members, especially in the clinical departments, necessitated an expansion of the traditional definition of scholarship. Without this, it would be impossible to encourage innovative thinking and discovery in all aspects of the tripartite mission of academic health centers.

The work of the task force was not without controversy. Appropriate language was an important issue for many committee members. A remarkable amount of time was spent in identifying the correct wording for the seven faculty designations. The designation of all faculty members in the tenure-eligible series as “academic,” and thus requiring demonstration of scholarly accomplishments for promotion, addressed many of the concerns of faculty making important contributions other than basic or clinical research. However, academic clinicians expressed concern that their work might be viewed as less important than the traditional scholarship of discovery as practiced by the academic basic scientist. We believe, in fact, that the expanded definitions of scholarship attenuate these concerns rather than accentuate them. However, formalization of the more precise faculty designations continued to cause discussion among the faculty. Ongoing assessment of this issue will be necessary.

The new APT system brings with it the expectation that fewer faculty members in clinical departments will be assigned to tenure-eligible positions in the university regular title series and more faculty members will be appointed to the tenure-eligible special title series and to contractual clinical faculty roles. Within our culture, the special title series has been considered inferior to regular title series. We believe that several things will work to break down this negative attitude. First, scholarly productivity will now be an expectation for faculty in the special title series. Second, our focus in the college will shift from the university's to the college's faculty-role designations. Third, as the numbers of faculty members in various roles increase, so too will acceptance of these roles.

Concern has been expressed about the probable increase in contractual clinical faculty. These faculty members will have clinical and teaching responsibilities but will not be required or given time to engage in scholarly work. Will this result in a less productive environment? In fact, we believe that this will create a more productive environment by affording a mechanism to focus limited resources and use the skills of our faculty in the ways most satisfying to them and most useful to the institution. There are many benefits to academic life; scholarly activity is an important one, but not the only one. We hope that this system will incorporate more faculty members into roles with clear expectations and will facilitate the success of all faculty members by articulating expectations and allocating our limited resources wisely.

The work of the task force was both complicated and simplified by the requirement that any proposed changes in college procedures be consistent with the administrative regulations of the university. As noted, many rules that have been developed for traditional university faculty members are not easy to apply within a college of medicine, particularly for faculty involved in patient care. Conforming to, and working within, these rules created some difficulties and resulted in a more complicated process than we considered ideal. However, because the recommended changes were consistent with university policy, they were easily implemented. It is unlikely that the changes would have been implemented as quickly had we insisted on university-wide change. We also recognized that the existing university rules had greater flexibility that we had accorded them.

Some faculty, and even some task force members, questioned the importance of the entire document. Outlining specific expectations for faculty members was a “road to mediocrity” in the view of some. Many faculty members felt that “everybody knows what's expected in our system.” However, interviews by task force members found the latter not to be the case. Many junior faculty members expressed major concern about inconsistent messages they received from supervisors about what was expected of them. In addition, many junior faculty members felt that expectations articulated at the time of performance evaluations and promotion consideration were distinct from the day-to-day requirements of their jobs. The majority of junior faculty interviewed felt that formalizing the process of outlining reciprocal expectations would facilitate their ability to accomplish their job duties as required for promotion.

Some faculty feel that the entire document forces people into rigid designations; others feel that it too loosely allows a wide array of different approaches to accomplishing scholarship. Obviously, not all of these problems can be resolved, but the resulting document is thought to reflect majority opinion and to be an improvement over the previously existing procedures.

Another objection centered on the bureaucratic workload of requiring annual reviews of all faculty, detailed letters of appointment and reappointment, and job descriptions for each faculty member. However, the majority opinion was that the most successful departments have engaged in these processes, that this is what good mentoring should have involved all along, and that this process merely formalized these expectations.

A major concern focused on the challenges of measuring scholarly productivity with a productivity model. The task force influenced the development of the productivity model but avoided much of the debate about the details of various models considered. It is fair to say that support for including scholarship in the model was influenced more by concerns about what might happen if a model were finalized without including scholarship among the parameters than by strong support for the concept of productivity models. This remains a work in progress.

A final concern was raised about whether the revised procedures threatened the situation of current faculty or the tenure process in our institution. No substantive promotion rules or guidelines have been changed for existing faculty, although we believe that mentoring and professional development will be improved for everyone. Similarly, the tenure process is unchanged by this document, even though it makes explicit the college's expectation that ongoing scholarly productivity is an essential element of academic life.

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CONCLUSION

An expanded definition of scholarship has been introduced into the promotion process at the University of Kentucky College of Medicine. A review of the appointment, promotion, and tenure procedures of the college offered an opportunity to formally introduce this expanded definition of scholarship at our institution, which will facilitate our ability to appropriately recognize and reward excellence in scholarship related to all of the missions in the academic health center. We revised our faculty designation system to incorporate this expanded view of scholarship and introduced measures to ensure that faculty had adequate time and resources to be successful. Follow-up evaluation of the success of our junior faculty and our institution in relationship to our mission, and as compared with our previous performance and those of our benchmark institutions, will offer mechanisms for evaluating how successful this change has been.

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REFERENCES

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