Kanter, Steven L. MD
A recent survey of medical school faculty asked whether criteria for promotion are consistently applied to faculty across comparable positions. Only one third of survey respondents indicated agreement or strong agreement that this was so.1 A colleague asked me if this finding helps me think about what to do at my own institution. I said, “No, not at all!” But the question does.
Let me explain.
The question was part of an important survey aimed at developing an improved understanding of faculty vitality. The Association of American Medical Colleges (AAMC) in cooperation with the Collaborative on Academic Careers in Higher Education (COACHE) developed the Medical Faculty Job Satisfaction Survey to better characterize the issues that influence faculty well-being. The findings of this survey have the potential to provide valuable information to medical schools and teaching hospitals about faculty members’ satisfaction with their work environments, including factors such as quality of the institutional milieu, governance, opportunities for collaboration, usefulness of feedback from unit heads, compensation and benefits, and promotion policies.
However, does it make sense that criteria for promotion should be applied consistently to faculty across comparable positions? Certainly, an institution that values faculty vitality strives to ensure a rational and fair process for making decisions about promotion and tenure. So, it does make sense to include questions that ask faculty members to gauge their satisfaction with the promotion process. But does the consistent application of criteria for promotion lead to fair decisions?
Before we can answer this question, we must explore three of its subtexts.
First, does the term criteria refer to rules or goals? Is there a set of rules that should be applied in the same way to each candidate for promotion to measure his or her suitability for advancement (e.g., number of peer-reviewed papers, number of courses developed, number of invitations to speak at national conferences)? Or should a candidate’s accomplishments be evaluated in the context of an overarching set of goals (e.g., innovative accomplishments, intellectual leadership, creative approaches to difficult questions)? If you think about decision making for appointment, promotion, and tenure (APT) on a “decision continuum,” with rule-based decisions as one anchor and goal-based decisions as the opposite anchor, a quick review of institutional APT documents reveals that most institutions tend toward the latter.2 That is why documents describing institutional policy for APT generally are titled “guidelines” or “principles” or the like, and not “rules.”
Faculty who have served on APT committees have struggled with the dilemma of rule-based versus goal-based decision making. For example, Matusov and Hampel describe this phenomenon at the University of Delaware School of Education by contrasting a procedural model and a judgment model.3 And I can attest that each of the dozens of APT committee members with whom I have been acquainted over the years has attempted, usually about halfway through his or her term of service, to write a set of rules (as defined earlier) for promotion on the back of an envelope or on a napkin. These faculty members quickly realized that they were driven to try to devise a set of rules after experiencing the frustration of wrestling with difficult promotion decisions and the discomfort of grappling with the intricacies of the notion of fairness. But rules did not alleviate the frustration or relieve the discomfort. Ultimately, each came to the conclusion that APT decision making is a complex task that requires expert deliberation and professional judgment based on one or more sets of overarching goals (e.g., traditional goals of scholarship, institution-specific goals). A single set of rules cannot capture the full range of complexity involved in judging accomplishments in cutting-edge research, state-of-the-art clinical care, and current educational practice.
Second, to whom or to what does the term fair refer? Should promotion decisions be fair to the faculty member under consideration? To all faculty as a group? To the dean? To the medical school? To society as a whole? The easy response is to answer “yes” to all of these questions, but sometimes it is not possible to reach a decision that is perfectly fair to all parties. For example, if most faculty who are awarded tenure at a given medical school have demonstrated that they can renew their first grants, or compete successfully for second ones, but a faculty member comes up for consideration who has not yet done so but whose work holds great promise, is it fair to award tenure? Is it fair to the faculty member in question? Is it fair to his or her colleagues who had to clear a higher hurdle? Is it fair to the school, which has a financial investment in this individual and his or her lab, to decide not to award tenure and risk losing the individual? Is it fair to the institution as a whole to risk losing the ability to reap the rewards when the individual is successful in the near future? The expert and seasoned judgment of a wise and experienced committee, which can appropriately weigh this set of complex issues, offers the best chance to reach the best decision.
Third, does consistent mean to apply a set of predefined rules without exception? Or does it mean to make decisions within the context of a set of coherent, integrated goals? If an institution aims to cultivate a broad-based group of faculty who possess a diverse set of talents, the consistent application of predefined rules will not lead to the best decisions about career advancement. A promotion process must aim to reward originality, creativity, and intellectual leadership, recognizing that different criteria may be relevant for different individuals. A promotion committee should evaluate each faculty candidate for promotion by exploring all relevant information and working to understand a candidate’s professional trajectory.
A risk of using the phrase “criteria are consistently applied” in a survey question is that it easily can be interpreted to infer “making a fair decision.” But subjecting a promotion decision to a predetermined set of criteria, without latitude for judgment, is not fair to most faculty and likely will result in poor decisions both for individuals and schools.
If faculty promotion decisions could be captured in an algorithm, medical schools would no longer need promotion committees, faculty would save time and energy (service on promotions committees consumes significant time and effort), and universities would save administrative costs, because deans and provosts would not need to review dossiers in detail. However, good faculty promotion decisions require the deliberation of a seasoned and thoughtful group of physicians and scientists who can assimilate diverse goals, attend to nuances and subtleties, and reach rational, balanced, and fair decisions.
And so, let us return to the original question: Does the consistent application of criteria for promotion lead to fair decisions? The preceding careful consideration of the three subtexts in this question reveals that the answer is not necessarily, because the question does not capture adequately the complexities that are vital to making the best decisions about faculty advancement.
If that is the case, then what are the important questions to ask faculty to assess their level of satisfaction with promotion decisions? Important survey questions are ones that will provide to institutional leaders valuable information that can be translated easily into meaningful reform. These questions should elicit from faculty whether or not they have access to good information about promotion policies, mentoring on career advancement, and an environment that fosters creativity and intellectual risk-taking with appropriate safety nets. For example, questions might take this form: How satisfied are you that
* your school’s promotion process fosters creativity over conformity?
* your school’s promotion process rewards original thought, innovative ideas, and intellectual leadership?
* your school’s promotion committee is composed of experienced, dependable, and wise members of your faculty?
* your school makes available sufficient information about the promotion process, including a program for junior faculty to observe a promotion committee meeting?
* you have access to adequate mentoring within your department about promotion policies and procedures?
* your school’s promotion process helps cultivate the broad range of talent necessary to advance knowledge in medicine and biomedical science?
Questions such as these reflect critical issues that faculty should understand about their departments and schools, that chairs and deans should understand about their faculty, and that all of us must understand to cultivate faculty well-being. It is important for AAMC–COACHE to continue to develop and refine the Medical Faculty Job Satisfaction Survey. I recommend that this survey delve further into questions of faculty satisfaction with the promotion process to illuminate the most important values of career advancement. Survey questions must capture both the complexities and the subtleties that are vital to making the best decisions about faculty APT. And we must use this information in a timely manner to implement meaningful change at medical schools and teaching hospitals to foster faculty vitality.
Steven L. Kanter, MD