Faculty

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Changes in Promotion and Tenure Policies for Clinical Departments Duke University School of Medicine

Based on the Report of the Task Force to Review Faculty Hiring and Promotion Practices August 2006

Task Force Members: Ross McKinney, Jr, M.D. (convener), Michael Frank, M.D., Danny Jacobs, M.D., Salvatore Pizzo, MD. PhD, and Anthony Means, PhD

A task force was appointed in August, 2003, to evaluate certain elements of the hiring and promotions process. The initial charge was to assess the process by which faculty are hired, particularly the Dean’s office review. However, over time the charge expanded, and a variety of hiring and promotion practices were evaluated.

The Tenure Tracks Changes have been approved in the three tenure tracks, mainly to make them more consistent with current trends in faculty expectations. Changes have also been approved in the two historically non-tenure tracks.

Summary of Track Revisions Track I is designed for faculty who are academically-focused clinicians, teachers, and administrators (a “clinician” being defined as someone who spends 75% or more of their time in patient-related activities). As appropriate for the individual, expectations will include teaching, clinical research, and administration, and a tenure clock will be applied. For faculty who are hired primarily for administrative or teaching functions, analogous criteria to the standards for clinicians (e.g. excellence and a national reputation) will be applied. Educators on Track I are expected to be judged on how they improve the educational process, rather than simply on the quality of their teaching. New curricula, papers on education-related issues, and participation in national committees engaged in student or resident education will be considered.

Track II has been the track for faculty who perform a relatively balanced mixture of clinical and research work. While this role will continue, Track II will also be the home for team-based clinical and translational research. Biostatisticians who predominantly engage in support of clinical research will be considered on Track II as a special case.

Track III is for faculty whose primary mission is bench research. Faculty on this track are expected to be judged on the quality of their research. Most faculty on Track III will have secondary appointments in a basic science department, and it is encouraged that basic science department chairs review the candidates for a position prior to the issuance of an offer letter. However, a secondary appointment is not required.

In Track IV, the faculty will be clinicians who teach primarily in the context of providing clinical care. When faculty on Track IV are assessed for promotion, the criteria to be used will emphasize clinical care-related metrics. Teaching will be required and evaluated, and research and publication will be encouraged (particularly where it enhances the regional and national reputation of the faculty member as a master clinician), but the critical measure to be used for promotion will be clinical productivity and reputation.

Occasionally, faculty with less than 75% effort in patient care will be appropriate for Track I or IV. For example, faculty may be appointed for the primary purpose of caring for a limited pool of specialty patients insufficient to maintain a full time clinical load, or for specialized teaching and service responsibilities that are unlikely to result in grant funding or publications. For such individuals, promotion should be based on the level of excellence they achieve in their assigned tasks. Faculty in Track I are expected to have a larger proportion of time devoted to academic endeavors, with a consequently higher expectation of academic productivity, than faculty on Track IV (see pages 8 and 23 for further details).

Track V faculty will most frequently begin in a supportive role, and usually will not have personal responsibility for assigned research space. The typical career paths have included working as collaborators in the labs of tenure-track faculty in Track II and III, or performing research in association with a service oriented lab (for example, one of the hospital laboratories). However, some Track V faculty will grow to increasing independence and recognition, will be assigned research space, and those faculty can now be rewarded with promotions to the Professor level. Historically, a few exceptional faculty have been transferred to Track III with the potential for tenure.

Faculty who have reached the rank of Professor in the non-tenure tracks (IV and V) will be periodically evaluated for tenure. A very limited number of professors in those tracks with national or international reputations may be granted tenure using a formal process that establishes the equity of their stature with that of professors in Tracks I-III.

The historical Clinical Track (e.g. “Associate Clinical Professor”) title could be used for regular rank, non-tenure track clinical faculty, although it has essentially been replaced by – “Track IV”.

Tabular Summary of the Tracks All faculty are expected to teach and participate in academic activities, although educational metrics are a primary promotion criteria only on Track I.

Track Primary Mission Focus for Promotion Secondary Objectives I Clinician, Educator, Administrator Publications, Reputation Grants; clinical volumes; quality measures re: teaching, clinical care II Clinician-Investigator Publications, Grants, Reputation Quality measures re: Teaching, clinical care III Research Publications, Grants, Reputation Teaching measures (esp. graduate students and post-doctoral fellows) IV Patient Care Clinical Volumes, Reputation, Clinical Care Quality Measures Publications; teaching measures V Research Publications, Reputation Grants; teaching measures

INITIATION OF THE TENURE TRACK The “Medical Instructor” rank is intended to be “incubator” time for junior faculty. It enables faculty to be hired with a reduced resource commitment and time-limited expectations. For many faculty, it is an opportunity for protected time to continue research projects or to learn new clinical skills. When a faculty member is promoted from the “Medical Instructor” rank to assistant professor on any track, there should be a search process to assure that the candidate is the best available, and resource commitments should be commensurate with those offered to externally recruited candidates. The Dean’s Office must approve all new Assistant Professor appointments prior to the issuance of an offer letter.

SECONDARY APPOINTMENTS Promotion in secondary departments should be based on a consistent set of standards. The purpose of secondary appointments is to encourage and reward collaborative efforts. As a means of emphasizing this point, secondary departments should nominate a tenured faculty member to serve as an ad hoc, non-voting member on the primary department’s APT review committee for an individual faculty member. This secondary department faculty member will represent the secondary department’s perspective on the candidate for promotion.

The faculty rank for secondary appointment will move in parallel with the primary appointment if the following criteria are met:

1) The faculty member must be active in the academic life of the secondary department. This expectation can be met by teaching in relevant courses; attending, participating in, and presenting departmental seminars; administrative work; or performing research in collaboration with department members. 2) Faculty who may not be active within their secondary department, but who have accomplished significant research within the field covered by that secondary department, may be promoted on the basis of published research at a level comparable to that of other members of a similar rank within the secondary department. However, it should be noted that a non-collaborative approach should raise a question regarding maintenance of the secondary appointment. 3) Once the primary department has determined to support the promotion of a faculty member, the secondary department will decide whether they support the parallel promotion in the secondary appointment.

PhD Faculty in Clinical Departments

PhD faculty in clinical departments serve vital institutional functions, but require different consideration from faculty who are qualified to perform patient care activities. For the purposes of this discussion, PhD faculty who can see patients (e.g. clinical psychologists) are not included, since they share with clinical faculty a means to support themselves when grant funding is not adequate.

Tenure track positions in the Basic Science departments are centrally regulated, and new positions are opened for search only with the agreement of the Dean’s Office. The School of Medicine provides the assurance that backstops salary obligations to tenured faculty in the Basic Science departments. The criteria for tenure and promotion are stringent. In contrast to Basic Science PhDs, PhD faculty in the clinical departments have been appointed most frequently into non-tenure track positions (Track V). Within this track, PhD faculty are expected to support themselves fully from grant dollars or operating revenues (as clinical laboratory directors, for example). There is no fixed departmental obligation, as there would be for a tenured faculty member. There are, however, some PhD faculty members in clinical departments who have sufficient skill and reputation to justify tenure, and the retention of such individuals at Duke may put Duke in competition with other institutions offering tenure. There is at present no formal system for backstopping their salary if they are unable to fully fund themselves through grants. There is at present no formal plan to manage the institutional financial risk that results from this growing group of faculty. One proposal is that departments should set aside reserves to cover 2 years of each tenure track PhD faculty member’s salary on an actuarial basis (i.e. the rate of reserve set-asides can be adjusted for the fact that not all PhD faculty are likely to need full salary support from reserves at the same time). The process of setting aside these reserves should begin at the point at which the faculty member is appointed to a tenure track, or over a five year time span for faculty granted tenure from Track V. This issue will be considered at a later date.

Promotions of PhD faculty in clinical departments who are on the tenure track should be based on criteria that are as stringent as those applied to PhD faculty in the basic science departments. However, PhD faculty in clinical departments are more likely to be engaged in clinical investigation and translational research as part of large research teams, and comparable levels of excellence may be achieved by publication in different journals and presentations at different meetings than those that would be typical for basic science departments. Thus, while equally stringent, the accomplishments required for tenure of a PhD in a clinical department may not be identical to what would justify tenure in a basic science department. If the PhD faculty member has a secondary appointment, a tenured member of the secondary department should be appointed by the department chair to serve as a voting ad hoc member of the primary department’s APT committee. Criteria for co-promotion of the secondary appointment are discussed above.

Primary Caretaker Leave According to Duke policy, tenure clock extensions are available for a faculty member who is the primary caretaker of a new child (newborn or adopted). Extensions of this type also apply to faculty in Tracks IV and V in the event they subsequently transfer to Tracks I-III. The record of extensions should be kept in the Dean’s Office.

Revised Tracks I-V

Clinical Sciences - Medical Center Criteria and Procedures for Appointment, Promotion and Tenure

Five career tracks are possible for tenure track faculty in clinical departments of the Medical Center. This document presents the minimal criteria for appointments and promotions in each track. It is important to recognize that meeting or exceeding these minimal criteria does not guarantee appointment or promotion. The most important criterion in all faculty appointments and promotions is outstanding quality of performance as judged by peers, supervisors, and the reviewing agencies for appointment and promotion. The goal of an academic promotions policy is to guide the behavior of faculty toward certain defined expectations. The policy should begin with the objectives: to encourage academic excellence in research, clinical care, and education. The guidelines must be broad, since no one faculty member should be required to be as accomplished in all three domains, and there must be accommodation for faculty who are hired primarily as educators, researchers, and clinicians. Although all faculty are expected to have a commitment to teaching and a variable commitment to administration, Tracks I, II, and IV characterize faculty who spend a significant portion of their time providing clinical care, education and/or administration. Track III is the current model for laboratory-based faculty and clinical faculty who are to be judged primarily for their basic science research. Track V faculty will generally teach in the context of their research work. Historically, the promotion pathways have favored individual accomplishment over collaboration. Reflecting a general change toward cooperative research, this revision of the promotion pathways incorporates criteria that allow team-based researchers to succeed. For most faculty engaged in clinical research, particularly that which involves patient contact, Track II will be the major pathway. Specific considerations for Track II clinical researchers will be incorporated below. In addition, given the collaborative nature of clinical research, on Track II particular consideration will be given to the teamwork and cooperative spirit demonstrated by the faculty member, as attested by group leaders and peers.

Faculty engaged in basic science research can be on Track II or III, depending on the portion of their effort committed to research, as opposed to clinical, administrative, and teaching efforts (Track III typically implies >75% research, but more importantly means that the quality of the basic science research will be the primary criteria for promotion).

On all tracks, participation in certain institutional committees or resources will be explicitly noted and considered. For example, full-time participation on a Duke Investigational Review Board panel will be weighted to be approximately equivalent to one first authored publication, since the time and effort required are similar. Participation on the Institutional Animal Care and Use Committee, the Institutional Biosafety or Radiation Safety Committees, the Medical School Admissions Committee, and certain other oversight bodies will be considered in the promotion decision.

Regardless the track of initial appointment, the tenure clock starts at the first Track I-V appointment at the assistant professor level or higher.

Track I: Clinician-Practitioner/Educator/Administrator Track II: Researcher/Clinician-Practitioner Track III: Researcher (Tenure clock) Track IV: Clinician-Practitioner (Non-clocked) Track V: Researcher (Non-clocked) [All tracks also include a teaching component]

Track I – Clinician Practitioner – Educator - Administrator

The Clinician-Teacher track at Duke will include faculty who are primarily engaged in patient care, clinical service functions, teaching, or administration. Faculty in this track will be judged primarily on the quality of their principal objective (clinical work, teaching, or administration). Consideration will also be given to research and to the other two domains (clinical work, teaching, or administration) as secondary measures. It is anticipated that most faculty on this track will spend 75% or more of their time in clinically-related endeavors. For those with formal teaching or administrative duties that occupy >75% time (alone or in combination with clinical duties), Track I is also appropriate. For example, a significant teaching role might be as director of a major course or residency director. A significant administrative role would be one that entails clear leadership and responsibility. In the discussion that follows, where the term “clinician” is used, “teacher” or “administrator” could be substituted.

Track I will include faculty who are primarily clinicians (defined as someone who spends 75% or more of their time in patient-related activities). When they are assessed for promotion, the criteria to be used will incorporate clinical performance metrics. Teaching, research, and publication will be required and evaluated. Occasionally, faculty with less than 75% effort in patient care will be appropriate for Track I. For example, faculty may be appointed for the primary purpose of caring for a limited pool of specialty patients insufficient to maintain a full time clinical load, or for specialized teaching and service responsibilities that are unlikely to result in grant funding or publications. For such individuals, promotion should be based on the level of excellence they achieve in their assigned tasks.

Research within Track I can take many forms. Most Track I faculty will not participate directly in bench research, but working in collaboration with basic science investigators will be explicitly valued. Track I faculty may participate in clinical research at a site level, and some faculty will be part of multi-centered groups and working at .25 FTE or less on that research. Working closely with other Duke investigators as a team member will be particularly highly valued.

There may be some overlap between individuals in Track I and Track II. The latter is preferred for individuals with a larger commitment to funded, original research. There may also be overlap between Tracks I and IV. Track I faculty are judged for their academic productivity – publications, national presentations, new curricula – while Track IV faculty are judged primarily by their clinical reputation and productivity.

Individuals can transfer from Track I to Track II and be judged by the Track II criteria as long as they fit within the standard tenure clock guidelines. Transfers from Track I to Track IV are also possible. However, once a faculty member has transferred from Track I into Track IV, they are only eligible to transfer back to one of the clock-based Tracks (I-III) if they are still within the original tenure clock time frame (e.g. they cannot move back to Track I from Track IV if their first appointment to Assistant Professor (any track) was >10 years from the date they change tracks.

Assistant Professor – This title is for faculty who are committed to a career in academic clinical medicine. It is distinguished from the entry level, non-tenure track “Medical Instructor” rank by the demonstration of clinical skills and commitment to the Institution.

Clinical Work – The faculty member should have a local reputation for excellence. This should grow to a regional reputation during time spent within this faculty rank. Referrals should come locally and regionally. Further evidence of reputation can be demonstrated by inclusion in national guideline setting panels. Distinguished service on important local and national committees (e.g. IRB), contributions to practice guidelines, plenary lectures at national and international meetings, and referral patterns are appropriate milestones for achievement on Track I.

Teaching – Faculty in this rank are expected to participate in teaching exercises locally and in the regional community. Activities may include lectures, seminars, teaching rounds, and workshops. For faculty who are judged primarily for their educational efforts, at this level important departmental or divisional contributions are expected (e.g. leading regular seminars or conferences). Teaching awards will be considered.

Research - Participation in research is expected. This participation could be enrolling patients in clinical trials, participating in clinical trial leadership teams, or collaborative involvement in basic science projects. It would be unusual, given the high proportion of time committed to clinical work, for a member of the faculty in Track I to have assigned research space, especially laboratory space. Good performance in research, in the absence of unambiguous clinical excellence, will not be sufficient to merit promotion on Track I.

Publication – Co-authorship of a minimum of 3 peer-reviewed publications on original research and/or important clinical applications of basic or translational science, including case reports and reviews. As appropriate, the development and dissemination of intellectual properties may also be considered. Book chapters in major texts may also be considered.

Associate Professor – This rank is for faculty who have demonstrated academic and clinical excellence. Faculty at the associate professor level should have a regional or national reputation, with referrals from a wide region. Reputation may also be demonstrated by participation in national boards and leadership groups within the faculty member’s field.

Clinical Work – The faculty member should have a strong regional or national reputation for excellence. Referrals should come from an interstate region. Further evidence of reputation can be demonstrated by inclusion in national guideline setting or protocol writing panels. Other markers of clinical excellence (outcome measures, patient satisfaction indices, etc) will be considered.

Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities may include invited lectures at national meetings, seminars, teaching rounds, and workshops. For faculty who are being judged primarily for their educational contributions, teaching awards and/or leadership of division level programs are expected.

Research - Participation in clinical research is expected, and success in research will be an important criterion within this track. At this rank, the faculty member should be producing nationally notable research. Within multi-center national research groups or clinical trials the faculty person should be a member of steering committees, protocol teams, or active in a leadership role. A history of successfully funded grant applications is positive, but not mandatory on Track I.

Publication – Publications are an important measure within Track I. Invited state-of-the-art reviews in peer-reviewed journals are particularly valued within this track. Textbooks or chapters in widely used standard texts will be considered, as will case reports. At this rank co-authorship of 15 articles or chapters are expected, with at least five as first or senior author. Because of the balance which must be achieved, success in publication, in the absence of unambiguous clinical excellence, would not be sufficient to justify promotion on Track I.

Associate Professor (with tenure) – This rank is for faculty who have demonstrated clinical excellence. Faculty at the tenured associate professor level should have a regional or national reputation, with referrals from a wide region. Reputation may also be demonstrated by participation in national boards and leadership groups within the faculty member’s field. The granting of tenure is an acknowledgement of a history of excellence, and judgment on the part of the institution that the individual faculty member will continue to be an asset for Duke throughout the duration of their career.

Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities should include invited lectures at national meetings, seminars, teaching rounds, and workshops. For faculty who are being judged primarily for their teaching contributions, leadership of departmental level programs, teaching awards, and participation in national educational institutions (Specialty Boards, RRC, the ACGME, etc), are expected.

Research - Participation in research is expected, and success in research will be an important criterion within this track. At this rank, the faculty member should be participating in nationally notable research. Within multi-center research groups or clinical trials, they should be active as a member of steering committees, protocol teams, or within a leadership role. A history of leadership within externally funded clinical research projects should be present (e.g. principal investigator of an NIH funded clinical trial or an important, publishable corporately sponsored protocol).

Publication – Publications are an important measure within Track I. Invited state-of-the-art reviews in peer-reviewed journals are particularly valued within this track. Textbooks or chapters in widely used standard texts will be considered, as will case reports. At this rank co-authorship of 20 articles or chapters is expected, with at least 5 as first or senior author. Because of the balance which must be achieved, success in publication, in the absence of unambiguous clinical excellence, would not be sufficient to justify promotion on Track I.

Professor – This rank is for faculty who have demonstrated clinical excellence of national or international renown. Faculty at the professor level will be national leaders in their clinical realm. Since the rank of Professor typically includes the award of tenure, faculty at this rank should be expected to be able to remain as pivotal members of their departments and national clinical groups.

Clinical Work – The faculty member must have a national or international reputation for excellence. Referrals should come from across a multi-state region. Further evidence of reputation can be demonstrated by inclusion in national and international guideline setting panels, or by participation in national boards and leadership groups within the faculty member’s field. Other markers of clinical excellence (outcome measures, patient satisfaction indices, etc) will be considered. National awards will be considered.

Teaching – For faculty who are judged primarily for their teaching efforts, at this rank the individual should have a national reputation as an outstanding and exceptional educator. They should have received local, regional, or national awards for teaching, and participated in activities like leading departmental training programs or medical school courses, publishing regarding educational processes, and demonstrating national educational leadership within their field.

Research - Participation in research is expected, and success in research will be an important criterion within this track. At the rank of professor, an individual should have a national reputation for research excellence. If they are engaged in multi-center clinical trials, the faculty member should be active in national research groups or clinical trials as a leader of steering committees, protocol teams, or hold other organizational leadership roles. A history of leadership within externally funded clinical research projects should be present (e.g. principal investigator of an NIH funded clinical trial or multi-center corporately sponsored protocol).

Publication – Publications are an important measure within Track I. Invited state-of-the-art reviews in peer-reviewed journals are particularly valued within this track. Textbooks or chapters in widely used standard texts will be considered, as will case reports. At this rank co-authorship of 40 articles or chapters are expected, with at least 10 as first or senior author. Because of the balance which must be achieved, success in publication, in the absence of unambiguous clinical excellence, would not be sufficient to justify promotion on Track I.

Track II - Researcher/Clinician-Practitioner The Researcher/Clinician-Practitioner/Teacher track at DUMC will include individuals who hold MDs, MD/PhDs, PhDs (or highest equivalent degree in relevant field) who are either clinician-scientists or are scientists who perform basic or clinical research and are engaged in patient care or service functions. The criteria for appointment and promotion include excellence in patient care or service functions, teaching, and basic or clinical research. Faculty on Track I will be judged predominantly on clinical care, on Track III on research, and in Track II on success in both, although the Track II standards may be somewhat lower for one domain (clinical care or research) than those of the more specialized Tracks I and III. Track II is also the primary avenue for clinical investigators who work in multi-center clinical trials and Translational Research. Assistant Professor -- This title is for faculty who show promise for, and a commitment to, a career in academic medicine. Minimal criteria: Clinical Work – The faculty member should have a local reputation for excellence. This should grow to a regional reputation during time spent within this faculty rank.

Teaching – Strong commitment to teaching and the potential for outstanding teaching performance.

Research - Clinical researchers should be participating in clinical trials as a team member, and should have experience in the design of clinical trials and analysis of clinical trials data. Basic researchers should have demonstrated promise for national reputation, including presentations at national meetings. Applications for peer reviewed grants (NIH, NSF, national foundations) should have been submitted, although funding is not an expectation at the time of promotion to assistant professor. Collaborative research is explicitly encouraged, and the relative contribution of the faculty member should be judged using reports from collaborating investigators.

Publication – Usually a minimum of 3 peer-reviewed first author publications on original clinical or basic research and/or important clinical applications of basic science, excluding case reports and reviews. As appropriate, the development and dissemination of intellectual properties may also be considered. Publications that are not first authored can be counted toward the minimum of 3 if there is attestation and description of the individual’s intellectual contributions to the publication by the study team leader (typically the chairperson or PI), and the APT Committee judges the contribution to be significant.

Associate Professor -- Appointment to Associate Professor is reserved for faculty who have demonstrated outstanding scholarship and clinical excellence.

Minimal Criteria for Associate Professor Without Tenure:

Clinical Work – The faculty member should have a strong regional or national reputation for excellence. Referrals should come from an interstate region. Further evidence of reputation can be demonstrated by inclusion in national guideline setting or protocol writing panel, or by participation in national boards and leadership groups within the faculty member’s field. Other markers of clinical excellence (outcome measures, patient satisfaction indices, etc) will be considered.

Research - Clinical researchers should be participating in clinical trials as a team leader, and should have experience in leading a team in the design of clinical trials and analysis of clinical trials data. Publications related to clinical trials which are not first/senior authored can be counted toward the 5 first/senior author publications if there is attestation and description of the individual’s intellectual contributions to the publication by the study team leader (typically the chairperson or PI), and the APT Committee judges the contribution to be significant. In addition, it should be recognized that major studies which are long term in nature may not result in short term publications, and may be counted toward the minimum publication count if it is demonstrable that the study is making progress toward completion and a submitted manuscript.

Some Track II faculty will engage in bench research, but still maintain clinical volumes. For these faculty, at this rank the individual should have an early national reputation for the quality of their research work.

Evidence of collaboration with other investigators, particularly in other departments or centers (e.g. joint grant submissions, jointly authored papers) is highly valued, and is often evidence of a growing reputation.

Publication – Usually a minimum of 15 co-authored, peer-reviewed publications will be necessary to be considered for this rank, with at least five as first or senior author. Publications should be based on outstanding, original, and innovative research findings and/or important clinical applications of basic science. For appointment or promotion to this rank, the 5 most important papers will be reviewed for evidence of original and significant scholarship by the candidate. As appropriate, the development and dissemination of intellectual properties may also be considered. As noted above, collaborative work done by research teams may be counted as a first/senior authored publication if the faculty member has made a significant intellectual contribution. Full time service on an IRB panel or the Admissions Committee for one year, with attendance consistent with the committee’s standards, will be considered as the equivalent of one peer reviewed publication toward expected minimums, with a maximum of 3 publication equivalents.

Associate Professor With Tenure: Appointment to tenured Associate Professor is reserved for faculty who have met the criteria for Associate Professor without tenure and who exhibit excellence in all the spheres mentioned. Tenure implies that the institution has decided the individual will continue to be an important contributor, and that they will not become a liability for the department or institution. Clinical Work – The faculty member should have a strong regional or national reputation for excellence. Referrals should come from an interstate region. Further evidence of reputation can be demonstrated by inclusion in national guideline setting or protocol writing panels, or by participation in national boards and leadership groups within the faculty member’s field. Other markers of clinical excellence (outcome measures, patient satisfaction indices, positions on national societies, etc) will be considered.

Research - Establishment of a national reputation as a researcher, especially as demonstrated by significant scholarship, publications, participation in NIH study sections and equivalent review groups, and/or offices in professional societies. o Most faculty granted the rank of associate professor with tenure will have established a record of sustained funding through peer reviewed grants (e.g. NIH, NSF, certain foundations with competitive award programs). o Clinical researchers should be participating in clinical trials as a team leader, and must have experience in leading a team in the design of clinical trials and analysis of clinical trials data. Publications related to clinical trials which are not first or senior authored can be counted toward the minimum of 10 first/senior author publications if there is attestation and description of the individual’s intellectual contributions to the publication by the study team leader (typically the chairperson or PI), and the APT Committee judges the contribution to be significant. In addition, it should be recognized that major studies which are long term in nature may not result in short term publications, and may be counted toward the minimum publication count if it is demonstrable that the study is making progress toward completion and a submitted manuscript. In most cases, at this rank clinical investigators will have leadership positions in clinical trials groups or organizations (e.g. steering committees, executive committees, organization chairperson, etc). o Bench researchers should have established a national reputation, as demonstrated by significant scholarship, publications, participation in NIH study sections and equivalent review groups, and/or offices in professional societies.

• Publication – Usually a minimum of 25 co-authored, peer-reviewed publications will be necessary to be considered for this rank, with at least ten as first or senior author. Publications should be based on outstanding, original, and innovative research findings and/or important clinical applications of basic science. For appointment or promotion to this rank, the 5 most important will be reviewed for evidence of original and significant scholarship by the candidate. As appropriate, the development and dissemination of intellectual properties may also be considered. As noted above, collaborative work done by research teams may be counted as a first/senior authored publication if the faculty member has made a significant intellectual contribution. Full time service on an IRB panel or the Admissions Committee for one year, with attendance consistent with the committee’s standards, will be considered as the equivalent of one peer reviewed publication toward expected minimums, with a maximum of 3 publication equivalents. Prior service as an Associate Professor without tenure may be waived in circumstances where outstanding scholarship has been demonstrated. Professor with Tenure -- The title of Professor is reserved for faculty members who have attained extraordinary national and international eminence, especially as demonstrated by significant scholarship, publications, participation in NIH study sections and equivalent review groups, offices in professional societies, and/or prizes and awards. The qualifications are the same as those for appointment to Associate Professor, but evidence of much greater and seminal scholarly accomplishments in required. Minimal criteria: Clinical Work – The faculty member must have a national or international reputation for excellence. Referrals should come from across a multi-state region. Further evidence of reputation can be demonstrated by inclusion in national and international guideline setting panels, or by participation in national boards and leadership groups within the faculty member’s field. Other markers of clinical excellence (outcome measures, patient satisfaction indices, etc) will be considered. National awards will be considered.

Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities may include invited lectures at national and international meetings, seminars, teaching rounds, and workshops. Participation is expected in medical student, house staff, and/or graduate student curricula.

Research - Establishment of a national reputation as a researcher, especially as demonstrated by significant scholarship, publications, participation in NIH study sections and equivalent review groups, and/or offices in professional societies. o Faculty granted the rank of Professor with tenure will have established a record of sustained funding through peer reviewed grants. o Clinical researchers should be in leadership positions within the field. They should have participated in multiple major clinical trials as a team leader. Publications related to clinical trails which are not first or senior authored can be considered among the 20 first/senior author publications if there is attestation and description of the individual’s intellectual contributions to the publication by the study team leader (typically the chairperson or PI), and the APT Committee judges the contribution to be significant. In addition, it should be recognized that major studies which are long term in nature may not result in short term publications, and may be counted toward the minimum publication count if it is demonstrable that the study is making progress toward completion and a submitted manuscript. On at least 10 publications, the researcher should be: 1) first author; 2) senior author; 3) study chair; 4) study co-chair; or 5) lead study designer. In addition, at this rank clinical investigators must have leadership positions in clinical trials groups or organizations (e.g. steering committees, executive committees, organization chairperson, etc).

• Publication – Usually a minimum of 50 co-authored, peer-reviewed publications will be necessary to be considered for this rank, with at least 20 as first or senior author. Publications should be based on outstanding, original, and innovative research findings and/or important clinical applications of basic science. For appointment or promotion to this rank, the 10 most important will be reviewed for evidence of original and significant scholarship by the candidate. As appropriate, the development and dissemination of intellectual properties may also be considered. As noted above, collaborative work done by research teams may be counted as a first/senior authored publication if the faculty member has made a significant intellectual contribution. Full time service on an IRB panel or the Admissions Committee for one year, with attendance consistent with the committee’s standards, will be considered as the equivalent of one peer reviewed publication toward expected minimums, with a maximum of 3 publication equivalents.

Track III – Researcher/Teacher The Researcher/Teacher track at DUMC will include individuals who hold MDs, MD/PhDs, PhDs (or highest equivalent degree in relevant field) who typically spend 75% or more of their time in research. Primary criteria for appointment and promotion will be excellence in research, with important consideration given for excellence in teaching. Most faculty appointed on Track III will have secondary appointments in a basic science department, with an expectation that the secondary department will participate in the appointment and promotion review process. However, a secondary appointment is not required. Some faculty in Track III will have relatively larger teaching commitments, and excellence within this role will be considered. Assistant Professor -- This title is for faculty who show promise for, and a commitment to, a career in academic research and teaching. Minimal criteria: Teaching – Strong commitment to teaching and the potential for outstanding teaching performance.

Research - Basic researchers should have demonstrated promise for national reputation, including presentations at national meetings. Applications for peer reviewed grants (NIH, NSF, national foundations) should have been submitted, although funding is not an expectation at the time of promotion to assistant professor. Collaborative research is explicitly encouraged, and the relative contribution of the faculty member should be judged using reports from collaborating investigators.

Publication – Usually a minimum of 3 peer-reviewed first author publications on original research, excluding case reports and reviews. As appropriate, the development and dissemination of intellectual properties may also be considered. Publications that are not first authored can be counted toward the minimum of 3 if there is attestation and description of the individual’s intellectual contributions to the publication by the study team leader (typically the chairperson or PI), and the APT Committee judges the contribution to be significant.

Associate Professor -- Appointment to Associate Professor is reserved for faculty who have demonstrated outstanding scholarship and educational contributions. Minimal Criteria for Appointment Without Tenure: Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities may include invited lectures at national meetings, seminars, teaching rounds, and workshops. For faculty who are being judged primarily for their educational contributions, teaching awards and/or leadership of division level programs are expected.

Research – Investigators at this rank should be doing nationally recognized work. They should have submitted peer reviewed grants, and most cases have obtained some research funding. Evidence of collaboration with other investigators, particularly in other departments or centers (e.g. joint grant submissions, jointly authored papers) is highly valued, and is often evidence of a growing reputation.

Associate Professor with Tenure -- Appointment to tenured Associate Professor is reserved for faculty who have met the criteria for Associate Professor without tenure and who exhibit excellence in all the spheres mentioned. The award of tenure reflects an institutional decision the faculty member will continue to play an important role in the department and is unlikely to become a liability for the institution. Minimal Criteria for Appointment With Tenure: Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities should include invited lectures at national meetings, seminars, teaching rounds, and workshops. For faculty who are being judged primarily for their teaching contributions, leadership of departmental level programs, teaching awards, and participation in national educational institutions (Specialty Boards, RRC, the ACGME, etc), are expected.

• Publication – Usually a minimum of 25 co-authored, peer-reviewed publications will be necessary to be considered for this rank, with at least ten as first or senior author. Publications should be based on outstanding, original, and innovative research findings and/or important clinical applications of basic science. For appointment or promotion to this rank, the 5 most important will be reviewed for evidence of original and significant scholarship by the candidate. In the case of certain disciplines that provide collaborative support for a wide variety of other areas of research (for example, biostatistics), a portion of important publications may include non-first or senior author papers, parts of which can be attributed to the candidate and reflect creative academic achievement that significantly contributes to the publications in question. As appropriate, the development and dissemination of intellectual properties may also be considered. As noted above, collaborative work done by research teams may be counted as a first/senior authored publication if the faculty member has made a significant intellectual contribution. Full time service on an IRB panel or the Admissions Committee for one year, with attendance consistent with the committee’s standards, will be considered as the equivalent of one peer reviewed publication toward expected minimums, with a maximum of 3 publication equivalents. Prior service as an Associate Professor without tenure may be waived in circumstances where outstanding scholarship has been demonstrated. Professor with Tenure -- The title of Professor is reserved for faculty members who have attained extraordinary national and international eminence in their chosen fields. The qualifications are the same as those for appointment to Associate Professor, but evidence of much greater and seminal scholarly accomplishments if required. Leadership is an expectation. Minimal criteria: Teaching – Faculty in this rank are expected to participate in teaching exercises across a wide arena. Activities may include invited lectures at national and international meetings, seminars, teaching rounds, and workshops. Participation is expected in medical student, house staff, and/or graduate student curricula.

Publication – Usually a minimum of 50 co-authored, peer-reviewed publications will be necessary to be considered for this rank, with at least 20 as first or senior author. Publications should be based on outstanding, original, and innovative research findings. For appointment or promotion to this rank, the 10 most important will be reviewed for evidence of original and significant scholarship by the candidate. As appropriate, the development and dissemination of intellectual properties may also be considered. As noted above, collaborative work done by research teams may be counted as a first/senior authored publication if the faculty member has made a significant intellectual contribution. Full time service on an IRB panel or the Admissions Committee for one year, with attendance consistent with the committee’s standards, will be considered as the equivalent of one peer reviewed publication toward expected minimums, with a maximum of 3 publication equivalents.

Track IV – Clinician – Teacher

The Clinician-Teacher track at DUMC will include faculty who are primarily engaged in patient care. Faculty in this track will be judged primarily on the quality of their clinical work. Consideration will also be given to research, teaching, and administration as secondary measures. It is anticipated that most faculty on this track will spend 75% or more of their time in clinically-related endeavors. Participation in the academic community (e.g. seminars, the IRB, IACUC, admissions committees) is explicitly valued and should be considered in the promotion process.

Track IV will have several distinct characteristics: 1) There are three faculty ranks on Track IV: Assistant Professor – Track IV, Associate Professor – Track IV, and Professor – Track IV. 2) Track IV is presently a non-tenure track.

There may be some overlap in roles between faculty in Track I and Track IV. The former is for individuals with a larger commitment to original research, formal teaching, or administrative duties. Individuals can transfer from Track IV to one of the time-limited tenure tracks and be judged by the criteria for that track as long as they fit within the standard tenure-clock guidelines. Transfers from Track I-III to Track IV are also possible. However, once a faculty member has transferred into Track IV, they are only eligible to transfer back to Track I-III if they are still within the original tenure-clock time frame (e.g. they cannot move back to Track I from Track IV if they have spent more than 10 years at Duke since first entering the tenure track as an assistant professor or higher).

In essence, Track IV will be for faculty who are primarily clinicians (defined as someone who spends 75% or more of their time in patient-related activities). When a Track IV candidate is assessed for promotion, the criteria to be used will emphasize clinical performance metrics. Teaching will be required and evaluated, and research and publication will be encouraged (particularly where it enhances the regional and national reputation of the faculty member as a master clinician). Occasionally, faculty with less than 75% effort in patient care will be appropriate for Track IV. For example, faculty may be appointed for the primary purpose of caring for a limited pool of specialty patients insufficient to maintain a full time clinical load, or for specialized teaching and service responsibilities that are unlikely to result in grant funding or publications. For such individuals, promotion should be based on the level of excellence they achieve in their assigned tasks.

Assistant Professor - Track IV– This title is for faculty who are committed to a career in academic clinical medicine. It is distinguished from the entry level, “Medical Instructor” rank by the demonstration of clinical skills and commitment to the Institution.

Clinical Work – The faculty member should have a local reputation for excellence. This should grow to a regional reputation during time spent within this faculty rank. Referrals should come locally and regionally. Further evidence of reputation can be demonstrated by inclusion in national guideline setting panels, or by participation in national boards and leadership groups within the faculty member’s field. Teaching awards, distinguished service on important local and national committees (e.g. IRB), contributions to practice guidelines, plenary lectures at national and international meetings, and referral patterns are appropriate milestones for achievement on Track IV.

Teaching – Faculty in this rank are expected to participate in teaching.

Research - Participation in research is encouraged, although success in research will be a relatively less significant criterion within this track. This participation could be enrolling patients in clinical trials, participating in clinical trial leadership teams, or collaborative involvement in basic science projects. It would be usual, given the high proportion of time committed to clinical work, for a member of the faculty in Track IV to have assigned research space, especially laboratory space. Good performance in research, in the absence of unambiguous clinical excellence, will not be sufficient to merit promotion on Track IV.

Publication – At this rank, publication is not required. However, within Track IV publication is encouraged and will be considered as a secondary measure, particularly in fields where a full patient load is not possible. Invited reviews of the state of the art in peer reviewed journals are particularly valued within this track. Other publications including chapters and case reports will be considered.

Associate Professor - Track IV – This rank is for faculty who have demonstrated clinical excellence. Faculty at the associate professor level should have a regional or national reputation, with referrals from a wide region. Evidence of a national reputation can come from elected or appointed positions in national professional societies and professional boards.

Clinical Work – The faculty member should have a strong regional or national reputation for excellence. Referrals should come from an interstate region. Further evidence of reputation can be demonstrated by inclusion in national guideline setting panels. Other markers of clinical excellence (outcome measures, patient volumes, satisfaction indices, etc) will be considered.

Teaching – Faculty in this rank are expected to participate in teaching.

Research - Participation in research is encouraged, although success in research will be a less significant criterion within this track. At this rank, for research to be a factor, the faculty member should be participating in national research groups as a member of steering committees, protocol teams, or within a leadership role.

Publication –Publication is not required for promotion to this rank. However, within Track IV publication is encouraged and will be considered as a secondary measure, particularly in fields where a full patient load is not possible. Invited state-of-the-art reviews in peer-reviewed journals, authorship/editorship of textbooks, or chapters in widely used standard texts will be considered, as will original research or case reports.

Professor - Track IV – This rank is for faculty who have demonstrated clinical excellence of national or international renown. Faculty at the professor level should be national leaders in their clinical realm.

Clinical Work – The faculty member must have a national or international reputation for excellence. Referrals should come from across a multi-state region. Further evidence of reputation can be demonstrated by inclusion in national and international guideline setting panels. Other markers of clinical excellence (outcome measures, patient satisfaction indices, etc) will be considered. National awards will be considered.

Publication – Publication is not required for promotion to this rank. However, publication is encouraged and will be considered as a secondary measure, particularly in fields where a full patient load is not possible. Invited state-of-the-art reviews in peer-reviewed journals, authorship/editorship of textbooks, or authorship of chapters in widely used standard texts will be considered, as will original research and case reports. Success in publication, in the absence of unambiguous clinical excellence, would not be sufficient to justify promotion on Track IV.

Track V – Research Track V appointments to the Faculty are normally used for full-time faculty who are engaged largely in research endeavors (usually 80% or more) and instruction, and who have little involvement in patient care. The primary criterion for appointment and promotion will be excellence in collaborative or independent research. Faculty on this track must have an "obvious instructional component" included in their professional activities, and which is verified and evaluated in the annual review process for renewal of appointment [Nomenclature Committee Recommendations approved 12/15/1988]. However, it is expected that for most Track V faculty, the teaching will come in the context of their research or service mission. Research Track appointments are reviewed annually for reappointment, unless a contract for a longer period has been executed. It is expected that a Track V faculty member will be funded largely through externally peer-reviewed grants, through laboratory service functions, as part of collaborative research projects, or as independent principal investigators. In the case of disciplines like biostatistics that provide collaborative support for a wide variety of other areas of research, the suggested publication requirements may include non-first-author papers, portions of which can be attributed directly to the candidate and which reflect creative academic achievement that contributes significantly to those publications. Departments may also require evidence that proposed Track V faculty candidates have the capacity for obtaining independent external funding support as a Principal Investigator. Track V appointments are intended to extend the research capabilities of the Medical Center and to fully utilize available resources in a way that is responsive to the availability of external funding, creates research opportunities for additional faculty, and protects the long-term fiscal stability of the research enterprise. Should a Track V faculty member lose external funding, departments are required to provide short-term financial support in the University component of compensation for a limited time after giving notice of intent not-to-renew the faculty member’s appointment (6 months notice for individuals with 1 year on the Faculty, 9 months for 2 years, and 12 months for 3 or more years). Faculty are required to keep their departmental Chair or Center Director fully informed of known or reasonably anticipated changes in funding as soon as that information is available. The following outline includes general performance measures for appointment and promotion criteria for Track V faculty. It is recognized that individual faculty will have different areas of productivity and contribution, so that not all criteria in each performance area may be applicable. Individual Departments may adapt and refine these general performance measures. The criteria below serve as general guidelines for judging accomplishments in each area, and will apply in the absence of Department-specific criteria, which must be approved in advance by the Dean's Office. Assistant Professor - Track V - This title is for faculty who, as beginning investigators, have demonstrated creativity and promise in their early research. Research – Assistant professor, Track V, usually requires a minimum of 5 peer-reviewed publications on original research, important clinical applications of basic science, or related publications. This minimal requirement may be waived if it is uncharacteristic of the candidate's discipline. As appropriate, the development and dissemination of intellectual properties may also be considered. Associate Professor -Track V - Appointments and promotions to this rank are reserved for Faculty who have demonstrated outstanding research contributions, and have gained national recognition for their work. Research - Establishment of a national reputation as a researcher, especially as demonstrated by significant scholarship, publications, independent funding as a principal investigator, participation in NIH study sections and equivalent review groups, or election to offices of professional societies. Publication - Usually a minimum of 15 peer-reviewed publications on original research, important clinical applications of basic science, or related publications will be necessary to be considered for this rank. At least 3 of these publications should be first or senior author publications in the candidate's discipline, or should be publications where the role and creative contributions of the faculty member were demonstrably critical. The 5 most important publications (identified by the faculty member) will be reviewed for evidence of original and significant scholarship. As appropriate, the development and dissemination of intellectual properties may also be considered.

Educational activities – Most faculty on Track V will focus the research. When education is a major component of the faculty member’s job description, special consideration will be given for teaching that motivates and inspires students. Effective mentoring of graduate and medical students, postdoctoral fellows, housestaff, and clinical fellows will be viewed positively, as will invitations to present topic workshops at regional and national professional meetings. Local and national recognition for teaching through awards will also be considered in the evaluation of the faculty member’s educational work.

Leadership - Demonstrated leadership capabilities, both locally and nationally. Research Professor - Track V - The title of Research Professor is reserved for faculty members who have attained national and international recognition for research contributions, as demonstrated by significant scholarship, publications, independent funding as a principal investigator, participation in NIH study sections and equivalent review groups, offices in professional societies, or prizes and awards. Research - Establishment of a national reputation as a researcher, especially as demonstrated by significant scholarship, publications, independent funding as a principal investigator, participation in NIH study sections and equivalent review groups, or election to offices of professional societies. Publication - Usually a minimum of 40 peer-reviewed publications will be necessary to be considered for this rank. Publications should be based on outstanding, original, and innovative research findings, or important clinical applications of basic science. At least 6 of these publications should be first-author publications in the candidate's discipline, or should be publications where the role and creative contributions of the faculty member was demonstrably critical. The 10 most important publications (identified by the faculty member) will be reviewed for evidence of original and significant scholarship. As appropriate, the development and dissemination of intellectual properties may also be considered.

Leadership - Demonstrated leadership capabilities, both locally and nationally.

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