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    Faculty Work Policies and Processes

    Ronald I. Paul, MD
    Professor of Pediatrics
    Vice Dean, Office of Faculty Affairs and Advancement
    University of Louisville School of Medicine

    Jacqueline Hill, PhD, MPH
    Director, Office of Faculty Development, Children’s Mercy Kansas City
    Assistant Professor of Pediatrics, University of Missouri - Kansas City School of Medicine Assistant Professor of Population Health, University of Kansas School of Medicine

    Lori Maness, MBA
    Faculty Programs Manager
    Department of Internal Medicine
    University of Utah School of Medicine

    Tara Lauriat, PhD
    Program Director for Academic Affairs
    Harvard Medical School

    Evaluations and Performance Reviews

    Evaluations and performance reviews can take many different forms. They can be annual evaluations, midpromotion/tenure reviews, focused reviews after corrective or disciplinary action, promotion and tenure reviews, post-tenure reviews, and periodic leadership reviews for chairs, decanal appointments, and division chiefs. Consistent among these reviews is that they should address the specific work assignment, set goals or promotion and tenure expectations, be accurate, and give appropriate feedback on areas in need of improvement. Faculty affairs deans and senior office staff should be aware of institutional policies regarding evaluations and performance reviews and the need for consistent and accurate documentation.

    Evaluations

    Most universities require annual evaluations in some form. In addition, the Liaison Committee on Medical Education (LCME) requires institutions to provide regularly scheduled and timely feedback to faculty on their academic performance. Faculty should have clear expectations and goals at the beginning of an academic year as detailed in the work assignment. The subsequent evaluation at the end of the academic or calendar year should address whether faculty demonstrated adequate progress to meet work assignment expectations and complete goals. It should also address items that need increased attention. It is important to notify faculty when they are not meeting expectations. Giving a satisfactory or “meets expectations” evaluation to an underperforming individual makes it extremely difficult to end employment with that faculty member if the need to separate develops. In addition, faculty deserve to know the areas in which they need to improve and be given an appropriate amount of time in which to show improvement. Some annual review processes may use a rolling three-year average for productivity. This may be especially important for research faculty or other faculty that have research as part of their work assignment as productivity in research is not always linear. Hence, reviews of grants and publications may demonstrate very productive years and, subsequently, some lean years. Chairs may delegate annual evaluations to a division or section chief or even a committee of faculty peers. It is important for the department chair to provide their own review or at least acknowledge approval of the review to provide consistency across all divisions.

    Performance Reviews

    Performance reviews by departments chairs, department promotion committees, and unit promotion committees are part of a typical promotion and tenure review process. Many universities also have a midpromotion review process, tenure review process, or both that give faculty feedback on their progress toward promotion and tenure. LCME also requires regular feedback on progress toward promotion and, when applicable, tenure. Depending on the institution, criteria for promotion and tenure may be based on the university, the unit, or the department. Promotion and tenure reviews should consider annual departmental reviews but may focus on different criteria based on unit or university requirements. Faculty should be informed of the criteria used in promotion and tenure reviews in advance so that they can work toward a successful review. Most institutions also have some form of a periodic post-tenure review. Again, faculty should be aware of the specific expectations and timing of post-tenure reviews, and the potential actions that can occur if the post-tenure review finds their performance unsatisfactory.

    Occasionally, performance reviews may identify a specific issue and result in a performance improvement plan or disciplinary action. When this occurs, it is important to document a second assessment of progress made toward improvement or correction of the specific issue identified. This may be an assessment of classroom teaching skills, clinical teaching, research productivity including funding, scientific presentations, or publications, or even chart or billing form completion. Faculty should be given an appropriate amount of time in which to demonstrate correction followed by a focused review that includes documentation of improvement or lack thereof.

    Those holding leadership positions should also have annual or periodic reviews. This includes department chairs and decanal appointments such as associate and assistant deans. Just as in annual faculty reviews, these should be based on clear expectations and goals given at the beginning of the period of review. Reviewers should note the areas in which faculty have met or exceeded expectations but even more important is formally notifying faculty of areas in which they are not meeting expectations or in need of improvement. If reviewers find significant deficiencies in work performance, faculty should be given an appropriate time period in which to demonstrate improvement.

    All evaluations and performance reviews should be summarized in a document and reviewed with the faculty member. Faculty should always be given an opportunity to correct mistakes or provide further information to the individual or committee completing the review. It is also important for the faculty member to sign the document. This does not necessarily mean that they agree with the review, but at a minimum it acknowledges that they received it. The review should then be collected and placed in the appropriate personnel or office files.

    Social Media Presence

    Social media can be a complex world to navigate. It is both fleeting and permanent at the same time. Many faculty, students, and institutions are using social media to varying degrees inside and outside clinics, research labs, and classrooms. Although a growing number of academic and health care institutions are implementing social media guidelines or policies, these can vary widely. Before engaging in social media, faculty, staff, and students should be familiar with their institution’s policies.

    Social media can be broadly defined as any mechanism that allows user-generated content to be shared online, such as blogs, wikis, message boards, electronic newsletters, chat rooms, online forums, videos, and social networking sites. When users participate in thoughtful and meaningful ways, social media can positively enhance learning, research, collegial connections, and academic medicine. However, users must also be cognizant of the risks and challenges it can create in interpersonal relationships.

    Regardless of institutional policies, faculty, staff, and students should always maintain professional conduct when using social media. When in doubt, err on the side of caution as online content lives eternally and future use cannot be fully controlled. Because faculty and staff are deemed representatives of the institution, regardless of when or where their social media activities occur, consider these best practices:

    • Follow the policies of your institution and profession at all times and avoid engaging in any unlawful activities, including breaking any federal, local, or copyright laws. Do not marginalize, threaten, bully, or stalk any individual or group.
    • Ensure that patient privacy and confidentiality are respected. Do not share information or images about patients, families, or learners, even if it appears to be deidentified, as there is a possibility that someone could recognize the information.
    • Preserve the patient-provider or learner-teacher relationship by maintaining professional boundaries. Do not directly connect with, communicate with, or transmit information to patients, families, research subjects, or learners on social media.
    • Use institutional internet, computer systems, and devices appropriately and ensure that social media use does not interfere with productivity or job duties.
    • Set up social media accounts using personal email addresses as institutional email accounts do not ultimately belong to the user and should be used with discretion. Some faculty have created separate personal and professional social media accounts.
    • Be aware of risks to personal privacy and security. Ensure privacy settings are maximized and keep pictures, statuses, tags, and comments clean. Routinely monitor your online presence and know what information the public can find out about you.
    • Be honest and transparent about your credentials and any conflicts of interest, and be clear that your opinions do not represent your institution.
    • Pause before posting. Reflect on how best to display yourself. Social media use often requires a subjective judgement call.

    If your institution does not have formal guidelines or a policy about social media use, consider creating one. The policy should include a definition of what social media is, who it applies to, when and where it applies, and consequences for not following it. The policy should remind users that their words and images will remain indefinitely and that they will have little control over future use. It should also include tips and recommendations for using social media safely. Finally, the policy should include an obligation and mechanism for faculty, staff, and learners to bring any unprofessional content from colleagues to the institution’s attention.

    Special Faculty Categories

    It is vital that all those involved in faculty affairs be familiar with faculty appointment policies, including for part-time (both tenure and nontenure options) and adjunct (paid versus volunteer) positions.

    Faculty leaders and administrators are responsible for fully understanding the faculty tracks available in their medical school. Faculty positions change, and not all positions fit within the original faculty track framework established by an institution. There can be important reasons for building new faculty track categories for faculty who fulfill essential roles and responsibilities.

    Unique career tracks can help retain and promote faculty. For example, physicians who are generalists are less likely than specialists to be promoted.1 The severe shortages of primary care physicians combined with generalists’ lower reimbursement rates and greater administrative responsibilities lead to lower publication rates and less time for scholarly activities. Due to such clinical demands, some institutions have created an exclusive faculty track without academic expectations for physicians who commit their entire full-time equivalent position to clinical care.

    Part-Time Faculty

    Part-time faculty positions are often created to help support and retain faculty members who choose to work part-time for various health, family, career, and lifestyle reasons. The Alliance for Academic Internal Medicine has recognized of the importance of part-time options for faculty and the challenges associated with providing this option to internal medicine faculty.2 It published a consensus statement that provides recommendations to department leaders, which include increasing programs to support work-life balance, educating leaders about the potential benefits of having part-time faculty in administration, emphasizing flexible time along with part-time schedules, and addressing the negative perceptions of part-time faculty.

    Volunteer Faculty

    Medical schools must provide diverse educational and mentorship opportunities. Physicians working outside the institution may be able to expose learners to different patient populations. Volunteer faculty from the community provide students with vital mentorship and learning opportunities. These volunteer faculty must overcome barriers to volunteering, such as time and clinical space limitations, to provide students with learning opportunities. These volunteer faculty are often motivated by the connections they make with students and other physicians and by the opportunity to develop their teaching skills.3 Programs that recognize the impact of these community faculty members can help in retention efforts.

    Research Misconduct

    Research misconduct is strictly defined as intentionally falsifying or fabricating data or plagiarizing the work of others; it does not include honest mistakes or differences of opinion.4 Institutions that receive funding from the Public Health Service, which includes the National Institutes of Health (NIH), are required to have a policy for addressing misconduct. The institutional research integrity officer is the primary person responsible for responding to an allegation, but the faculty affairs office may be asked to provide information during the investigation.

    The Department of Health and Human Services Office of Research Integrity serves as a resource for handling allegations as few institutions have much experience due to the rarity of formal investigations. Its website offers insights, outlines policies and procedures, and shares perspectives about how stressful the process is for all who are involved.

    The 2017 National Academies of Sciences, Engineering, and Medicine report Fostering Integrity in Research addresses this issue and offers strategies for change. One section of the report is devoted to research misconduct and detrimental research practices.

    Academia’s “publish or perish” culture contributes to misconduct on multiple levels. Faculty members focused on publishing enough papers for promotion may pressure trainees and set unrealistic expectations. Moreover, their intense focus on productivity may lead to insufficient oversight of their mentees. The combination of stress and inadequate monitoring of trainees may foster a culture that leads to unethical behavior. Faculty members should also be aware that foreign members of their research group may not be aware that certain practices are considered inappropriate in the United States.

    Honorary authorship is another issue that faculty affairs deans must navigate. A faculty member who inflates their own qualifications for promotions or other awards may simultaneously hinder the progress of their colleagues. This situation may arise when former mentees are trying to demonstrate independence but are pressured into including their former mentors as co-authors. Another challenge involves determining the degree to which a faculty member should be held accountable for a co-author’s misconduct.

    Using a broader definition, other actions that may be considered “misconduct” include misrepresentation of qualifications, appropriating ideas from grant applications or manuscripts shared confidentially for peer review, or failure to protect human subjects or animals. Interference with the research of others through theft or damage to reagents, samples, data, or other resources is clearly unacceptable.

    Conflicts of interest and conflicts of commitment also present challenges. These issues may not come to the attention of faculty affairs until the faculty member is being considered for promotion, tenure, or reappointment. Although it is realistic to require all faculty members to submit annual disclosures, it is far more difficult to ensure that all reporting is accurate.

    Sexual Harassment

    Title IX of the Educational Amendments of 1972 prohibits discrimination based on sex in educational programs that receive federal financial assistance. Sexual harassment is covered under Title IX and enforced by the Department of Education Office of Civil Rights. Each institution is required to designate a Title IX coordinator and have a policy for handling complaints. Faculty affairs offices should have a pathway of communication with the Title IX officer as the actual procedures for dealing with an allegation may differ based on whether the complaint involves a faculty member, student, or staff member. All institutions have written policies and require staff training; however, these efforts protect them from liability but do little to address the root causes of the problem. Currently, the optimal approach to training (online, in person, bystander, etc.) remains unclear.

    A 2018 National Academies report notes that the hierarchy in medicine enables mistreatment by superiors, but those in lower positions can also be perpetrators. For instance, when promotion and tenure decisions are based in part on evaluations from a limited number of trainees, individuals at the bottom of the hierarchy hold power over their supervisors.

    The report identified features of academic science and medicine that contribute to higher risk of sexual harassment:

    1. Male-dominated environments with men in positions of leadership and authority.
    2. Organizational tolerance of harassment, demonstrated through lack of sanctions, ignoring complaints, or failing to protect complainants from retaliation.
    3. Hierarchical and dependent relationships between faculty members and trainees.
    4. Isolating environments where faculty members and trainees spend much of their time.

    The American Association of University Professors (AAUP) addresses the issue from the perspective of academic freedom, which is compromised in threatening or hostile environments. It states that complaints against faculty members should be reviewed by a faculty committee to evaluate the merits of the allegations. The AAUP has expressed concerns about the “preponderance of evidence” standard, given the potential of even false allegations to ruin a career and potential risks for faculty members who teach courses about sexuality.

    The scientific community is making efforts to address sexual harassment at a systemic level. The Societies Consortium on Sexual Harassment in STEMM is a group of over 100 professional societies that are collaborating to create resources to combat sexual harassment. The NIH has begun responding to complaints by replacing principal investigators (PIs) on grants or increasing oversight. The National Science Foundation announced that it may reduce or suspend funding in consultation with the grantee institution if a PI is determined to be involved in sexual harassment.

    Faculty affairs offices can include an assessment of professionalism in decisions related to faculty positions, including appointments, promotions, reappointments, and endowed chairs. It needs to be clear that impressive funding and publication records do not make unethical behavior tolerable. Efforts to increase the number of women in leadership roles, already a focus in many faculty affairs offices, should further help to change institutional cultures.

    Retention/Renewal

    The importance of faculty retention cannot be overstated. Faculty departures can hinder research, teaching, and clinical care, and recruitment can be costly. Each year, the contract renewal period presents an opportunity to find innovative ways to keep faculty committed for the upcoming fiscal year. Worries about compensation equity and job satisfaction ratings can keep an institution on its toes and seeking new and innovative ideas for retaining faculty.

    Fair compensation with regular incentives and increases is only part of the equation for retaining valuable faculty. Additional benefits that can improve faculty retention can include:

    • Faculty development training activities in teaching, assessment, and evaluation methods designed to improve student and patient feedback and satisfaction ratings.
    • Leadership opportunities.
    • Promotional policies to support career growth and enhance job security.
    • Research learning and funding opportunities.
    • Comfortable working environment, including office/lab/clinic space, supervisory and administrative support, and team cohesion.
    • Quality of life and work-life balance.

    Each institution provides policies and guidelines for faculty contract renewal. Finding bridge funding and salary support for faculty can sometimes be challenging. Having an explicit written agreement before entering times of instability illustrates a committed academic relationship between faculty and their institution. These clear expectations help address and avoid unfortunate surprises.

     

    References

    1. Bland CJ, Wersal L, VanLoy W, Jacott W. Evaluating faculty performance: a systemically designed and assessed approach. Acad Med. 2002;77(1):15-30.
    2. Rourke J, Bornstein S, Vardy C, Speed D, White T, Corbett P. Evaluation of and feedback for academic medicine leaders: developing and implementing the memorial method. Acad Med. 2017;92(11):1590-1594.
    3. Bunton SA, Walling A, Durham D. Post-tenure review at U.S. medical schools. Acad Med. 2016;91(12):1691-1695.
    4. Public Health Service Policies on Research Misconduct. 42 CFR §93.103 (2005).

    Resources

    Social Media Guidelines for Medical Students and Physicians (American Medical Student Association Guidelines)

    Professional Guidelines for Social Media Use: A Starting Point (American Medical Association Journal of Ethics)

    Sample Graduate Medical Education Social Media Policies (AAMC)

    Six Ways for Applicants to Find a Happy Medium with Social Media (AAMC)

    Blazey-Martin D, Carr PL, Terrin N, et al. Lower rates of promotion of generalists in academic medicine: a follow-up to the National Faculty Survey. J Gen Intern Med. 2017;32, 747-752. doi: 10.1007/s11606-016-3961-2.

    Linzer M, Warde C, Alexander R, et al. Part-time careers in academic internal medicine: a report from the Association of Specialty Professors Part-Time Careers Task Force on behalf of the Alliance for Academic Internal Medicine. Acad Med. 2009;84(10):1395-1400.

    Office of Research Integrity (Department of Health and Human Services)

    Title IX and Sexual Harassment (Department of Education)

    The Center for Changing Our Campus Culture

    Societies Consortium on Sexual Harassment in STEMM

    Sexual Harassment: Suggested Policy and Procedures for Handling Complaints (American Academy of University Professors)

    National Academies of Sciences, Engineering, and Medicine. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2018. doi: 10.17226/24994.

    National Academies of Sciences, Engineering, and Medicine. Fostering Integrity in Research. Washington, DC: The National Academies Press; 2017. doi: 10.17226/21896.

    Jefferson KL, Shultz M, Heiselt A. Serving community faculty through a dedicated liaison. Med Ref Serv Q. 2018;37(1):1-9. doi: 10.1080/02763869.2018.1404379.

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