9.2.C. Application of the Criteria

1. Standards of Excellence, Acceptable or Unacceptable Performance

In determining excellence 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, diversity and collaborative approach to discovery 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 through discussions with the candidate or through the counseling memorandum that is part of the reappointment review process.

Unacceptable performance denotes a quality of activity that is below the standard for acceptable performance expected of a Clinical Scholar.  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 or reappointment 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 Clinical Scholar’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, 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 Clinical Scholars.  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.

b. Teaching

A standard of excellence or of acceptable performance in teaching is essential for appointment and reappointment to be a Clinical Scholar.  Teaching is broadly defined to include such areas as clinical “bedside” teaching, didactic instruction, presentations, career mentoring and advising, program building, and development of written, audio, video and digital materials.  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 trainees; 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.

Teaching is broadly defined as activities that further medical knowledge and/or promote health. Teaching may target traditional trainees, medical personnel, special interest groups or lay populations. Teaching may, for example, be of undergraduates, medical students, residents, clinical and postdoctoral fellows, nurses and ancillary staff, other physicians, or non-medical individuals or groups.

c. 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, Clinical Scholars, 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 and teaching include specific expectations regarding a Clinical Scholar’s professional behavior in the workplace.  They are reiterated here to emphasize their importance as factors in appointment and reappointment 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.

Results from the distribution of clinical excellence and teaching evaluation forms, as well as from referee letters, will aid reviewing bodies in assessing a Clinical Scholars’ performance in the workplace.

3. Specific/Supplemental Criteria for Clinical Scholars

a. Appointment as Clinical Scholar

The Clinical Scholar should have demonstrated exceptional qualities and promise to become outstanding clinicians, teachers, institutional contributors and/or scholars. If the candidate has not had formal teaching experience, he or she should have demonstrated a commitment to develop the skills necessary for outstanding teaching. He or she must have demonstrated excellence or promise of excellence in a combination of clinical performance and clinical teaching appropriate to the programmatic need upon which the appointment will be based.

b. Reappointment as Clinical Scholar

Clinical Scholars are assessed for reappointment on the basis of their performance and achievements in the areas of clinical care and teaching. They may be reappointed based on evidence of progress, high-level performance and continuing programmatic need.  There should be evidence that the candidate will continue to successfully fill the programmatic need for which the reappointment is made and to make meritorious contributions to his or her discipline and to the School.