Clinician Educators

The Clinician Educator (or "CE") role is defined by engagement in clinical care, teaching, administrative and/or scholarly activities that advance clinical medicine. With four ranks and opportunities for reappointment and promotion, the Clinician Educator line is structured as a career path for both junior and more senior clinicians, educators, administrators and scholars who add value to the School by providing essential activities that advance the missions of the Stanford School of Medicine, Stanford Health Care and/or Lucile Packard Children’s Hospital. The Clinician Educator is normally a highly qualified, licensed M.D. (or equivalent medical degree), Ph.D. or holds a terminal degree in their field.  All non-MD Clinician Educators who qualify under the criteria should be at least 3 years post their terminal degree before becoming Clinical Assistant Professor. They may instead be appointed as a Clinical Instructor prior to this if they meet the criteria.

A Clinician Educator (Affiliated) (or "CE(A)") is employed by another institution with whom the School of Medicine, Stanford Health Care, and/or Lucile Packard Children’s Hospital has a master affiliation agreement. This provides for teaching, patient care, administration, scholarship or other duties that advance the missions of School of Medicine, Stanford Health Care and Lucile Packard Children’s Hospital, as well as the Clinical Educator (Affiliated)’s own institution. They are sometimes referred to as “non-employee affiliates” or “persons of interest;” these terms refer to how they are managed and tracked in PeopleSoft.

Master affiliation sites:
- Kaiser, Santa Clara and Redwood City
- San Mateo County Health Services
- Santa Clara County Medical Examiner
- Santa Clara Valley Medical Center
- Veteran Affairs Palo Alto HealthCare System
- Valley Children's Health

NOTE: Individuals in private practice or employed by institutions having no master affiliation agreement with School of Medicine, Stanford Health Care, or Lucile Packard Children’s Hospital are appointed as Adjunct Clinical Faculty.

A text overview of requirements for all actions can be found here:Detailed Evidence Required for CE Appointments

Suggested timing for initiating certain actions can be found in section 3.1.H.1 of the Faculty Handbook here: Duration of Appointments

All Clinician Educator offer letters are submitted via Smartsheet (prior to the appointment review); and all appointment, reappointment, and promotion actions are submitted via FASA. The procedural steps are as follows:

1. OAA and Faculty Compensation jointly review the draft offer letter for any paid new appointments or addendum for applicable actions; OAA alone will review letters of invitation for CE (affiliated) actions (and please note: all offer letters, addenda, and letters of invitation need to be drafted with Track Changes engaged for all edits to the OAA templates).

• Any unresolved offer letter edits must be made before the letter can be finalized, signed by the division chief and department chair, and released to the candidate.
• Faculty Compensation will concurrently review the Personnel Action Form (PAF) at this time (please note: the PAF template is owned and maintained by Faculty Compensation and not the Office of Academic Affairs)

2. The Faculty Affairs Administrator (FAA) for the CE’s division/department assembles the review package, including the applicable OAA cover page.

3. Create FASA transaction and attach package (see: reference guides and supplement). Submit to OAA:

• Files submitted for OAA review for appointments, reappointments, and promotions need to be submitted 60 days in advance of the requested start date.
• Requests for changes to current appointment (i.e. extensions, FTE changes, add secondary or courtesy, primary department or division change) need to be submitted 45 days in advance of the requested start date.
• See generally: Deadlines for Clinician Educator, Instructor, and Clinical Scholar Actions

4. At the same time, required documents for Faculty Compensation should be uploaded in FASA transaction separately (see the cover pages for requirements). Faculty Compensation should be FYI’d on the FASA transaction for all paid actions.

5. OAA staff reviews the entire set of documents, looking for support for the action being proposed, fulfillment of the criteria, etc.

6. The next step of review depends on the rank of the candidate and the action in question (this applies to CE (Affiliated) ranks as well):

• Clinical Instructor: file is reviewed and decided upon by the Vice Dean’s designate, regardless of action type.
• Appointment and promotion at ranks above Clinical Instructor: OAA staff will put the complete file on the appropriate review committee’s next open agenda based on regular schedules.
• There are three appointment and promotion review committees: one that reviews all Clinical Assistant Professor and Clinical Assistant Professor (Affiliated) files and two that review for all CE ranks above clinical instructor.
• Reappointments are also reviewed via committee, though these are not separated by ranks.
• The committee will review the file and then approve, table for more information, or turn it down.
• Extensions, FTE changes, and organizational code changes are reviewed by OAA staff only, on authority of the vice dean.
  
  NOTE: CE appointments, reappointments, and promotions receive final approval by the Dean’s Office of the School of Medicine and do not require review by the University.

• OAA staff notify the department FAA of the outcome of the review or if more information is needed.
• The academic approval of the file comes from the FASA transaction via e-mail.
• If a practice policy exemption was requested, OAA staff will separately notify the department of vice dean and Risk Authority approval.
• A position number will be assigned by OAA staff if the action is:
• A new appointment
• An FTE change going from less than 50% FTE to more than 50% FTE. This is because the individual is changing from a position that doesn’t accrue benefits to one that does, and that change in status requires a new position number.
• After all approval steps, department HR must hire the candidate into PeopleSoft.
• Lastly, OAA staff will enter the candidate’s academic appointment into PeopleSoft via FASA after the hire is complete (this may not happen until closer to the effective date of appointment).
   

Offer Letters, Letters of Invitation, and Offer Letter Addenda

Every newly appointed CE receives an offer letter; this letter must be reviewed and approved by the Office of Academic Affairs and Office of Faculty Compensation before it is signed by the department chair and division chief and delivered to the candidate.

Clinician Educators (Affiliated) must receive a letter of invitation instead, as they are not Stanford employees. These must also be reviewed by the Office of Academic Affairs before being distributed with each of new appointments, promotions, and reappointments.

Offer letter addenda are required for changes to all paid appointments (for changes to FTE specifically, there is a separate template , as is there a separate template for administrative role additions and changes with associated admin supplements). These must be reviewed and approved by the Office of Academic Affairs and the Office Faculty Compensation before being signed by the department chair and division chief and delivered to the candidate or current CE. More specific guidance may be found at the end of this section below.

NOTE: These documents must be submitted with Track Changes engaged for all edits to the OAA template so that it is easily reviewable by OAA and Faculty Compensation.

• Part of every new appointment package is a draft offer letter or letter of invitation in Word document format (separate attachment from the appointment file).
• In most cases, CE’s receive a standard offer letter. Please note the following, additional requirements for the ‘Other information’ section of the offer letter:
  •  Annual Review: Clinical Assistant Professors and Clinical Associate Professors with an FTE of fifty percent or more are required to receive an annual review of their performance; this meeting should be scheduled with the CE’s Department Chair or designate. If the Department uses a designate, this individual must be at the level of Associate or Professor. 
  • Mentoring: Clinical Assistant Professors with an FTE of fifty percent or more are also required to be assigned a mentor. Department Chairs and / or Division Chiefs should not be mentors, nor should this mentor be the same individual performing the CE’s annual review. Additionally, a mentor should generally not be at the Assistant-level rank, which requires an exception request submitted to OAA.

• When a CE’s FTE (full time effort) or FTE distribution changes (that is, when the amount of time that they work or the way that time is distributed among clinical, teaching, and other duties changes), an FTE change addendum must be submitted (in addition to the relevant action materials via FASA). 
• When an administrative role with an administrative supplement is being added to a CE’s appointment (or an existing role is being changed), a request must be submitted via Smartsheet for Faculty Compensation to review. Once Faculty Compensation approves of the title, the addendum may be submitted to their office and OAA and Faculty Compensation will review currently.
• When other components of a CE’s appointment change (e.g., duties allocation or description, term dates, division assignment), the changes other than FTE addendum must be submitted accordingly.

Cover Page

(Cover pages for all CE actions can be found here: Checklists + Cover Pages; and a list of guidelines and reminders for assembling packets may be found here: CE File Review Reminders)

• The Faculty Affairs Administrator should make sure that all applicable fields and checkboxes are completed.
• The “Appointment Summary” should be written and signed off by the department chair, FAA, and, optionally and if applicable, the division chief. This summary should:
  • Evaluate the candidate against the criteria for the proposed action found in Chapter 3 of the School of Medicine Faculty Handbook.
    • For example: promotion to Clinical Professor requires national recognition in their field. This recognition could come from clinical care, teaching, scholarship, administrative activities, national service, or other activities. Explain how they achieve this.
  • For new appointments, describe how the candidate was identified (e.g., national search, current Stanford fellowship, faculty referral, etc.).
  • Address any concerns in the file (e.g., negative teaching or CES feedback, negative comments from referees, etc.) and include a plan to rectify these, as applicable.
  • Address discrepancies with supporting materials (e.g., why a letter of reference may be from a referee at a lower rank).
  • For the Clinical Excellence Surveys, if there are too few responses based on the required categories and numbers (or missing responses from a required category), explain:
    • How many people were solicited in those categories
    • How many reminders were sent and when
    • Whether the candidate does or doesn’t work with people in those categories (e.g., if the candidate does not work with any clinic managers, you are not required to solicit any)
  • For the “Duties & Responsibilities” section, provide the candidate’s total FTE, duty allocations, and full description of responsibilities for each category (clinical care, teaching, scholarship, administrative activities, etc., as applicable).

• For the ‘Overall Department Summary and Impression’ section, address and summarize the Department’s overall impression of the candidate.
• For appointments and reappointments, describe candidate’s trajectory towards promotion.
• For Clinical Instructors that will be reappointed after three years into a benefits eligible position, justify why the candidate is not being promoted to Clinical Assistant Professor instead.

Curriculum Vitae

• Must be current, dated, and complete (bio-sketches will not be accepted).
• We recommend that you follow the sample CV template found in the Faculty Affairs Resources section of the website, but it is not required.

Candidate’s Statements

The candidate’s statement is the only section of the package in which a CE can have their voice heard directly. It is not required for Clinical Instructors and Clinical Assistant Professors. For Clinical Associate Professor and Clinical Professor appointments, it is optional for appointments and reappointments (but highly encouraged). However, it is required for promotions to these ranks. 

Guidelines for writing the candidate’s statement can be found in the  Evidence Tables & Guidelines section of the Faculty Affairs Resources page. The candidate's statement should be a maximum of two pages in length and should be written in the first person. It should then include discussion of the candidate’s contributions and achievement in clinical care, teaching and mentorship, administration, scholarly activity, and other areas, as applicable.

Referee Letters: External and Internal

All appointments and promotions require letters of evaluation from experts inside and/or outside the School of Medicine. Request letters from referees using the solicitation letter template. Reappointment files do not require referee letters.

• Each referee must be able to provide a meaningful and substantive evaluation of the candidate against the relevant criteria from personal knowledge or from impartial evaluation of evidence of the candidate’s contributions.
• The author of the letter must be fully identified (name, rank, and institution).
  • If the letter does not include this information, either in the letterhead or in the body of the letter, include it as an annotation on the letter header or footer.

• Referees, in general, are expected to have clinical experience.
• If a referee holds an academic appointment, it should be at a rank at least equal to that proposed for the candidate (e.g., do not ask an Associate Professor for a letter for a promotion to Clinical Professor).
• For each candidate, “external” and “internal” refers to referees based on the candidate’s home institution, not whether the referee is external or internal to Stanford.
  • Example: if a Clinical Assistant Professor (Affiliated) at Kaiser Santa Clara is being promoted and needs an “internal” referee letter, someone at Stanford or any of its affiliated institutions who meets the above criteria should be the referee.
• Referees do not require approval by OAA (as they do for most Professoriate actions).

Evaluation of Teaching

Teaching is a core part of the responsibilities of a Clinician Educator, and excellence in teaching must be documented for CE actions. Documentation can include standardized teaching evaluations and/or a solicited survey from trainees.

Teaching Evaluations

• Stanford teaching evaluation tools include e*Value (core curriculum) and ASSU (electives) for medical student evaluations and MedHub for Residents.
• Please include all evaluations that can be obtained for the candidate’s current appointment term. There is no need to include evaluations from before the start of the current term.

Trainee Evaluations Surveys

• Stanford teaching evaluation tools include e*Value (core curriculum) and ASSU (electives) for medical student evaluations and MedHub for Residents.
• Please include all evaluations that can be obtained for the candidate’s current appointment term. There is no need to include evaluations from before the start of the current term.

Evaluation of Clinical Excellence

Excellence in clinical care is evaluated by the Clinical Excellence Survey (CES), which should be administered via Qualtrics. A detailed Instruction Manual for CES can be found in the Letters, Templates, and Forms section of the Faculty Affairs Resources page.

Clinical evaluations are required from a broad mix of professional colleagues with the training, experience, and exposure to the candidate’s clinical work that allows for informed commentary on clinical performance. Clinical evaluator types include health care providers who consult with the candidate, clinical administrative staff, and non-physician health care professionals.

NOTE: If internal referees or clinical trainees are solicited for evaluations via Qualtrics, they must be asked to fill out a CES as well. Include the form with those solicitation requests.

Of course, clinical evaluations are not required for candidates who are not clinically active. Instead, candidates that will not have clinical duties should be evaluated (when required) via the Professional Excellence Survey (PES), which is also administered via Qualtrics.

• All actions except for Clinical Instructor new appointments require CES results:
  • 4-7 surveys for all applicable actions if the candidate is at less than 50% FTE or Affiliated
  • 7 surveys for all applicable new appointments, reappointments for Clinical Associate Professors who are over ten years in rank, and all reappointments for Clinical Professors when the candidate is at 50-100% FTE
  • 9-14 surveys for all other reappointments & promotions when the candidate is at 50-100% FTE
• Who to survey:
  • Health care providers who consult with, or refer patients to, the candidate
    • 3 for candidates at 50-100% FTE (as applicable)
  • Fully qualified physician colleagues (including fully qualified physician colleagues from above categories)
    • 4 to 6 for candidates at 50-100% FTE
  • Physician extenders (e.g., physician assistants or nurse practitioners) who work directly with the candidate
    • 1 or 2 for candidates at 50-100% FTE
  • Nurse managers, clinic managers, or similar senior clinical administrators
    • 1 to 3 for candidates at 50-100% FTE

NOTE: For candidates at less than 50% FTE, at least half of the required number from each of the above categories should be solicited.

Practice Policy Exemptions

The Faculty Practice Policy for clinicians, psychologists, and dentists in the School of Medicine governs the provision of clinical care by these professionals at Stanford and elsewhere, and the receipt of income for such care. In short:

• Full time clinicians (those at 100% FTE) at Stanford may not provide clinical care outside Stanford and its approved practice sites.
• For those that are not full time (less than 100% FTE but 50% and above), a practice policy exemption is required, which must be approved by the division chief, department chair, Vice Dean, and the Risk Authority.
• For Clinician Educators who are appointed at below 50% FTE, a list of other employers must be provided to the Vice Dean as part of the appointment package (usually included in the CV) and must be updated when there are changes to the list, or when they are reappointed or promoted.
• The Stanford University Medical Indemnity and Trust Insurance Company (SUMIT) provides malpractice coverage to clinicians at the School of Medicine. If a CE wishes to request a practice policy exemption, they must provide proof of malpractice coverage that is acceptable to SUMIT, or request that SUMIT provide coverage for their outside activity (e.g., pro bono clinical care overseas). The Office of Academic Affairs will contact SUMIT and obtain a form that the clinician must fill out in either case.
• Practice Policy exemption requests are required with all appointments, reappointments, promotions, and FTE changes for any CE with outside practice and to be appointed at 50% FTE or above. This is required for confirmation or renewal even if an approved exemption has already been previously granted.

Clinical Instructors: Terms

Clinical Instructors that will be reappointed after three years into a benefits eligible position need justification as to why the candidate is not being promoted to Clinical Assistant Professor instead.

Clinical Instructors: Mentorship in Advanced Clinical Skills

While they are not trainees, it may also be appropriate for a Clinical Instructor to receive mentorship in advanced clinical skills, typically focused in a specialized area of practice. This appointment is not appropriate for individuals enrolled in either non-ACGME or ACGME-certified residency or fellowship training programs. More detail may be consulted in chapter 3.3.C.1 of the Faculty Handbook. 

• These individuals will be paid by the department.
• None of the documentation (including the offer letter) may use the terms “fellow” or “fellowship” to refer to the candidate. The candidate also may not refer to themselves as a fellow.
• These individuals are not entitled to training Certificates, which are issued only by the Office of Graduate Medical Education and/or the Office of Postdoctoral Affairs for residency or fellowship training programs.
• Describe the duties of the Clinical Instructor in the offer letter and on the FASA form as usual, but specific mention of “receiving mentorship in advanced clinical skills” or clearly similar language should be included for clarity.

Clinical Assistant Professors

•  A candidate’s statement is not required for any action at this level; however, the candidate may be encouraged to write one if it is thought to be advantageous to them.
  

Clinical Associate Professors

• Regional recognition as a superior clinician and clinical teacher is required for appointment, reappointment, or promotion to the rank of Clinical Associate Professor, and must be highlighted in the appointment summary and documented in referee letters.
• The definition of “regional” may vary based upon the candidate’s specialty.
• For special cases, other factors may be considered, such as extraordinary contributions in other areas such as clinical innovation or program building. If promotion is sought based on these other factors or other exceptional circumstances, referee letters must explicitly support the case for promotion based on those factors. (See also: CE Extraordinary Contributions Examples.)

Clinical Professors

• National recognition as a superior clinician and clinical teacher is required for appointment, reappointment, or promotion to the rank of Clinical Professor, and must be highlighted in the appointment summary and documented in referee letters.
• For special cases, other factors may be considered, such as extraordinary contributions in other areas such as clinical innovation or program building. If promotion is sought based on these other factors or other exceptional circumstances, referee letters must explicitly support the case for promotion based on those factors. (See also: CE Extraordinary Contributions Examples.)

Examples of line change appointments include: Instructor to Clinician Educator, Adjunct Clinical Faculty to Clinician Educator, Visiting Faculty to Clinician Educator, etc.

Generally, departments should first follow the normal documentation required for a new appointment to the rank being requested. See:

CE cover page templates

CE actions evidence table

CE letter templates (offer letters, letters of invitation, and addenda)

However, because the individual currently holds a current academic appointment at Stanford, additional documents may be needed, such as what might be required for a reappointment at the current rank. For instance, if role and responsibilities as an instructor included teaching and clinical duties, then a line change to a clinical instructor should include teaching evaluations and CES results (i.e., as would be required for an instructor reappointment), in addition to the materials required for a new appointment.