2.3.I. Application of the Criteria
1. Standards of Excellence, Acceptable or Unacceptable Performance
In determining excellence in the overall mix of contributions, the following definitions should be used as a general guide:
Excellence is defined as achieving a level of distinction that is consistent with the high standards of Stanford University and the mission of the School of Medicine, that is, to be a premier research-intensive medical school that improves health through leadership and collaborative discoveries and innovation in patient care, education and research.
School of Medicine expectations for acceptable performance will typically be understood to be less than excellence (as described above), but to exceed the basic professional competence standards of the general clinical and scholarly communities. Areas where performance is found to be acceptable, but with room for improvement, should receive appropriate attention during annual counseling meetings or through the counseling memorandum that is part of the reappointment or promotion review process.
Unacceptable performance denotes a quality of activity that is below the standard for acceptable performance expected of a Stanford faculty member. In rare instances, such a situation may be mitigated if, in the opinion of reviewing bodies (informed by compelling evidence) the unacceptable performance is predicted to improve significantly through the counseling process.
2. Factors in Applying the Criteria
Determination of satisfaction of applicable criteria is based on material accumulated during the appointment, reappointment or promotion review process; documentation that explicitly and tangibly supports both the quality of performance and the quantity of contributions is required.
The professional judgment of those assessing these data is the critical factor in determining whether the faculty member’s accomplishments meet or surpass the standard of excellence in the overall mix of contributions.
Evaluation should be of total performance. Taking into consideration the proportionality of contributions in each year of the current appointment, appropriate weight should be given to the quality and quantity of work in the following categories:
a. Clinical Care
Excellence in clinical practice or clinical care is a requirement for those faculty members whose duties include such practice. Factors considered in assessing clinical performance may include (but are not limited to) the following:
General Clinical Proficiency: maintains up-to-date knowledge base appropriate to scope of practice; maintains current technical/procedural proficiency; applies sound diagnostic reasoning and judgment; applies sound therapeutic reasoning and judgment; applies evidence from relevant scientific studies; seeks consultation from other care providers when appropriate; maintains appropriate clinical productivity; and demonstrates reliability in meeting clinical commitments.
Communication: communicates effectively with patients and their families, physician peers, trainees, and other members of the health care team (for example, nurses, nurse practitioners, respiratory therapists, pharmacists); and maintains appropriate medical documentation.
Professionalism: treats patients with compassion and respect; serves as patient advocate (puts the patient first); shows sensitivity to cultural issues; treats physician peers, trainees, and other members of the health care team (for example, nurses, nurse practitioners, respiratory therapists, pharmacists) with respect; is available to colleagues; responds in a timely manner; and respects patient confidentiality.
Systems-Based Practice: effectively coordinates patient care within the health care system; appropriately considers cost of care in medical decision-making; participates in quality improvement activities; and demonstrates leadership in clinical program development and administration.
The MCL may include faculty members who contribute indirectly to patient care in clinical environments that heavily emphasize technology and/or a multidisciplinary approach. For example, a radiation physicist may play an integral role in treatment planning for individual oncology patients or a biomedical engineer may work closely with a surgeon or interventional cardiologist to develop and implement new treatment strategies. In such cases, factors considered in assessing clinical performance may include (but are not limited to) applicable factors described above.
Depending on the proportion of time and effort, a standard of excellence or of acceptable performance in teaching is essential for appointment, reappointment and promotion in the MCL. If the highest proportion of a faculty member’s time and effort is dedicated to teaching, a standard of excellence should nearly always be met. Factors considered in assessing teaching performance may include (but are not limited to) the following: knowledge of the material; clarity of exposition; positive style of interaction with students; availability; professionalism; institutional compliance and ethics; effective communication skills; helpfulness in learning; ability to stimulate further education; and ability to work effectively as part of the teaching team.
It is recognized that most clinicians teach in small group sessions or with individual trainees. With the approval of their departments and if time allows, MCL faculty members may also develop or participate in formal didactic courses.
Teaching may, for example, be of undergraduates, medical students, residents, clinical and postdoctoral fellows, ancillary staff (e.g., nurses) and in postgraduate and continuing medical education.
Depending on the proportion of time and effort, faculty appointed, reappointed or promoted in the MCL should meet a standard of excellence or of acceptable performance in scholarly activity that advances clinical medicine. Written scholarship that advances the field will almost always be required.
The nature of the scholarly activities, the effort required and the time available to pursue them should be aligned with the strategic goals and programmatic needs of the department and School, as well as with the interests and strengths of the faculty member. Scholarship within the MCL is viewed as an important result of outstanding performance in clinical care and teaching duties as well as a valuable yardstick for documenting performance. In most cases, scholarly activities will flow naturally from the MCL faculty member’s clinical responsibilities, and these scholarly activities are expected to complement the clinical activities. In turn, a successful program of scholarly work may lead to innovative approaches in the care of patients and/or the education of students. In most cases, the record should show how the clinical care, teaching and scholarly activities are intertwined and explicitly what scholarship resulted from the work that can be objectively judged by faculty peers.
MCL faculty members may pursue research in any appropriate arena, such as basic science research, clinical trials, clinical or translational research, or health policy research. Factors considered in assessing scholarship may include (but are not limited to) the following: scholarly activity and productivity; impact, innovation and creativity; recognition in the field; ability to work effectively as part of a research team; effective communication with colleagues, staff and students; and professionalism, institutional compliance and ethics.
Scholarship conducted by MCL faculty members may result in achievement in a more narrowly defined field than expected of a faculty member in the University Tenure Line.
i. When the Proportionality of Contribution is Secondary
For those Assistant and Associate Professors whose time and effort in scholarship is secondary, written contributions may take a wide variety of forms, including peer reviewed articles, chapters, commentaries, case reports and reports of the results of clinical investigations. Any of these types (as long as the quality is excellent or acceptable and the quantity is appropriate) may be considered sufficient evidence of scholarly work.
With the increasing prevalence of collaborative “team science,” it is understood that there are many ways for a faculty member to be recognized for individual substantive contributions to multi-author works. These may include conception and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; obtaining funding; administrative, technical or material support; or supervision. Evidence accumulated during the appointment or review process should provide information regarding the nature of the faculty member’s substantive contributions to multi-author works, as well as the impact that the publications have had in advancing medicine.
Scholarly contributions may also include activities as represented by the following, as long as these can be objectively evaluated by persons qualified to perform such evaluations: teaching activities that may include such achievements as developing and implementing novel teaching methodologies or a new and innovative course, shaping a core curriculum, or creating educational software or video programs; creation of novel diagnostic, therapeutic or administrative practices that may influence health care delivery; creation of major new patient services or new systems of health care; creation of mechanisms or tools to improve the efficiency of health services and/or systems of care or creation of methods to evaluate outcomes of care; administrative efforts that lead to scholarly activity or unusual opportunities for advancement of clinical medicine.
While it can be a useful marker of substantial scholarly contribution, investigative independence is not an absolute requirement. Likewise, although it can be useful in assessing matters such as distinction, including regional or national recognition, external funding is not a requirement.
ii. When the Proportionality of Contribution is Primary
Under certain limited circumstances, the highest proportion of time and effort may be dedicated to scholarship in order to meet a specific departmental programmatic need. In such cases, a standard of excellence should nearly always be met. The main emphasis of written contributions will usually be on peer-reviewed investigative articles, regardless of the proportion of time and effort dedicated to scholarship. For candidates whose written contributions do not emphasize peer-reviewed investigative scholarship, other written work such as books, chapters, reviews and commentaries (or alternative evidence of scholarly impact, such as the development of policies and protocols) may be acceptable as long as the contributions are of a nature appropriate to the candidate’s field, and the impact of the work in advancing medicine or the public health can be established. With respect to multi-author works, it is expected that contributions will be made through first or senior authorship or through other substantive contributions. The intensity of personal contributions to the advancement of clinical medicine will be tempered by the administrative commitments of those with major ongoing leadership roles within the institution.
Investigative independence is usually expected since it can be a useful marker of substantive scholarly contributions.
In most cases, faculty members whose primary contribution is through scholarship will have a record of external funding, which is often viewed as an indicator of how the work is regarded in the field and may likewise be relevant to an assessment of the ability of a faculty member to carry out an excellent program of scholarly activity that advances clinical medicine.
d. Institutional Service
Institutional service (including what may be called institutional citizenship) may at times be a factor in appointment, reappointment and promotion decisions. For example, many administrative duties critical to all aspects of the operation of the School of Medicine require input from, or direction by, faculty. Thus, Associate Professors and Professors are encouraged to participate in administration of the School’s programs, and both the scope and the quality of administrative performance may be considered in the reappointment and promotion of senior faculty at the Associate Professor and Professor ranks. Those with significant ongoing administrative duties, such as department chairs, service line directors and others involved in the operation of Stanford Health Care and Lucile Salter Packard Children’s Hospital, are understood to have less time for clinical care, teaching and scholarship compared with colleagues without such duties (though administrative efforts per se may lead to scholarly activity or unusual opportunities for advancement of clinical medicine). In such cases, the quality of the performance may be considered in the reappointment and promotion process.
Since a major commitment to administrative activities detracts from the time available for the primary areas of clinical care, teaching and scholarship, Assistant Professors are discouraged from significant administrative commitment and departments are discouraged from requiring such.
e. Respectful Workplace
The School of Medicine is committed to providing a work environment that is conducive to teaching and learning, research, the practice of medicine and patient care. Stanford’s special purposes in this regard depend on a shared commitment among all members of the community to respect each person’s worth and dignity. Because of their roles within the School of Medicine, faculty members, in particular, are expected to treat all members of the Stanford Community with civility, respect and courtesy and with an awareness of the potential impact of their behavior on staff, students and other faculty members.
As detailed earlier in this section, application of criteria for evaluating the quality of clinical care, teaching and scholarship include specific expectations regarding a faculty member’s professional behavior in the workplace. They are reiterated here to emphasize their importance as factors in appointment, reappointment and promotion actions.
In clinical care activities, such factors relevant to evaluation of whether the standards for clinical performance have been met may include: professionalism, institutional compliance and ethics; humanism; ability to work effectively as part of the health care team; and effective communication with colleagues, staff, students and patients.
In teaching activities, such factors relevant to whether the standards for teaching have been met may include: a positive style of interaction with students; availability; professionalism; institutional compliance and ethics; effective communication skills; helpfulness in learning; and ability to work effectively as part of the teaching team.
In scholarly activities, such factors relevant to whether the standards for scholarship have been met may include: the ability to work effectively as part of a research team; effective communication with colleagues, staff and students; and professionalism, institutional compliance and ethics.
Results from the distribution of clinical excellence and teaching evaluation forms, as well as from referee letters, will aid reviewing bodies in assessing a faculty member’s performance in the workplace.