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Criteria for academic promotion in medicine

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2253 (Published 25 June 2020) Cite this as: BMJ 2020;369:m2253

Linked Research

Academic criteria for promotion and tenure in biomedical sciences faculties

  1. Harold C Sox, director of peer review1 2*,
  2. Mark A Schuster, founding dean and CEO3*
  1. 1The Patient-Centered Outcomes Research Institute, Washington, DC, USA
  2. 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA
  3. 3Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
  4. *Both authors contributed equally
  1. Correspondence to H C Sox hsox{at}comcast.net

Can and should good citizenship in the research community be a criterion for promotion?

Job promotion in academia is meant to reflect the quality of previous work and an expectation of continued success. With promotion come prestige, institutional responsibilities, and, in some schools, the promise of continued employment. In academic medicine, the journey from instructor to full professor and beyond affords the opportunity to educate generations of physicians and biomedical scientists. Rewards tend to influence behaviors. Given that, Rice and colleagues describe in a linked study (doi:10.1136/bmj.l5214) the promotion criteria used by medical schools and recommend broadening the criteria to encourage behaviors they believe will enhance the quality of science.1

Although accomplishment in research has long been the principal standard for promotion, medical schools have recently developed promotion criteria to reward excellence in medical education,2 clinical innovation,3 and other areas.4 We will focus on the promotion of faculty whose primary activity is research, although most also have responsibilities for teaching, clinical care if a clinician, and other academic service.

Rice and colleagues investigated criteria for promotion in an international sample of 170 institutions; 146 had faculties of biomedical sciences, with 92 having accessible criteria. They created two categories of criteria: “traditional” (importance of research as measured by number of publications, journal impact factors, place in authorship order, grant funding, and any mention of research being recognized nationally or internationally) and “non-traditional” (number of citations of published work, sharing data, publication in open access journals, participation in research registries, adherence to research reporting guidelines, alternative ways of sharing research such as social media, accommodation for leaves of absence). Citation number is consistent with the listed traditional criteria, and accommodation of leaves of absence and other extenuating circumstances is a well established practice; notably, both were reported about as frequently as some of the traditional criteria (range 28-95%). By contrast, use of the remaining non-traditional criteria ranged from 0% to 3%.

Value and feasibility of non-traditional criteria for promotion

How might these non-traditional criteria add value to science and the public, and how feasible are they as promotion criteria?

Data sharing provides access to the source data for research. A review in 2014 by the US Institute of Medicine characterized potential benefits as generating deeper knowledge beyond initial publications and reducing needless, inefficient duplication of research with consequent burden on study participants (although the need for independent confirmatory studies would remain).5 However, authors may not control access to data (for example, in studies using health systems’ patient data), and some data require strict masking of participant identifiers. Because many journals ask authors to state in publications their willingness to share data, at least for clinical trials,6 documenting it as a promotion criterion could be feasible.

Publishing in open access journals—Many journals still charge a fee to non-subscribers who want to read an article. For open access journals, access for readers is free, but authors or research funders must generally pay a one-time publication fee. Although few people challenge the benefit of freely sharing scientific findings, the quality of fully open access journals varies, with some engaging in predatory practices with their fees and publishing seldom cited articles,78 whereas others maintain high standards (for example, BMJ Open, JAMA Network Open). Some long established, high impact journals are also open access for research papers (such as The BMJ), and some make selected articles available for free without an author fee. If medical schools chose to adopt this criterion, documenting open access participation to a promotions committee would be straightforward, although greater understanding of open access journals, their quality, and their impact on science is still needed.

Participation in a public research registry—Research registries seek to document the design and rationale for every study, regardless of results and ideally before the study starts, thereby revealing when a body of evidence is skewed because positive studies are more likely to be published than negative or inconclusive studies.9 US and EU laws mandate registration of clinical trials, so registration is easily documented, but its ubiquity renders it potentially non-differentiating for promotions committees. Registration for other forms of research, such as observational studies, systematic reviews, and biomedical science studies is not mandatory and could be differentiating.

Adherence to research reporting guidelines is meant to ensure that researchers disclose critical details needed to assess validity, giving clinical guideline developers and all users of research the necessary full information for quality assessment and patient care.1011 Use for promotion would be difficult to document because journals do not routinely require adherence to reporting guidelines, beyond using CONSORT diagrams for randomized trials.1213 This goal might be best achieved by journals requiring documentation of adherence to reporting guidelines rather than by promotion committees incentivizing adherence.

Alternative ways of sharing research, such as through social or public media, can expand a published article’s reach and indicate public interest in it. Public interest in a faculty member’s research is not, however, a measure of quality or importance, so this measure would need careful thought and exploration.

The study by Rice and colleagues serves two purposes: by documenting the range of criteria for academic promotion, it gives medical schools the opportunity to learn from each other and perhaps enhance their own criteria; and it prompts schools to consider ways (that would not necessarily include promotion criteria) to encourage faculty to make their research results more widely available and usable. Both are worthy goals. In light of the limited experience with the non-traditional criteria, as suggested by the observation that no more than 3% of studied schools use them, it will be important to examine their value, along with intended and unintended consequences, before moving forward with broad adoption.

Each medical school will make its own choice, but we believe that scientists and the public alike would benefit from a broadly inclusive discussion on criteria for academic promotion, the behaviors they encourage, and the signals they provide inside and outside of the profession.

Acknowledgments

We thank Maureen T Connelly for comments on a draft of the article and Caroline Miao for research assistance for the article. The views presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or its Methodology Committee.

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