SAEM Academic Promotion Toolkit

The Quick Guide to Promotion For the Uninitiated

Academic Promotion Toolkit

Endorsed by the following SAEM Academies

Special Thanks

to Elizabeth Goldberg, MD, ScM, author, and to the following contributors of this toolkit:

Douglas Char, MD

Christopher Carpenter, MD, MsC

Jeff Druck, MD

Hans House, MD, MACM, Michelle Lall, MD, MHS

Luan Lawson, MD

This guide provides a brief, pragmatic approach to the promotion process� Note that while the guide is written to help you reach promotion by year seven, many faculty will reach the assistant to associate professor milestone later, while many others will not have a linear path to promotion at all� There is no “one size fits all,” but this guide provides a useful framework�

Year 1 Clinical Prowess

You just graduated and you’re at peak clinical prowess (yes, really)� You can start a central line with your eyes closed and admit almost anything to the hospitalist service� You’re like the sorting hat in Harry Potter — a disposition genius� But, young scholar, you have a lot to learn about academic medicine� This guide will give you tips on how to get to the finish line — i�e� associate professor — without losing your cool, your partner/dog/kid, and sleep�

TO DO IN YEAR 1:

1. Just say “no” to committee work and service. Your mission this year is to keep your head low, learn your new hospital’s electronic health record, and unwind after several not-sorelaxing residency or fellowship years� Find the cafeteria� Figure out where to park� Get your hospital ID� Start paying back those loans� Get unpacked� Pick up that hobby you haven’t pursued since medical school� No joke� Repeat after me: “This sounds like a wonderful opportunity� I’d love to get more involved when I’m more settled here!” If you do not have a niche and want to explore options, committee work could be desirable, just make sure you do it explicitly and carefully�

2. Meet the people. Your colleagues are going to be your closest confidantes and advisors They have been where you are now� They know the lay of the land — who the great mentors are, what conferences and presentation opportunities are worth pursuing, when to ask your chair for help� Take some time to get to know them and find your crowd� Trying to meet everyone is not productive� Identifying key persons is a big help� The best place to meet folks and create networks is by attending conferences such as the SAEM annual meeting� See what others are doing, learn about what is hot in emergency medicine, be inspired� New faculty should do this their first year so they learn about the specialty from an academic perspective

3. Go to your university’s promotion lecture. You have one, and only one, promotion assignment this year� Promotion is a long way away, but it’s essential to know what the requirements are, what it means to be in a track, who will evaluate whether you are ready to go up for promotion, and what counts and what doesn’t count (hint: book chapters)� To learn more about what might be presented at promotion lectures, click here� Many departments also have a vicechair of faculty development� Set up a time to meet him or her and get clarity on promotion requirements for your track�

4. Keep your CV current. Every time you give a talk at a resident conference, write a blog post, do a podcast, or become a journal reviewer, make sure to include it (along with the title, date, and location) in your CV� More on this later�

Year 2 Ready, Set, Go

Residency is starting to feel like a distant memory� You can now watch a movie and make it all the way through without falling asleep� You’re pretty settled into your new job, you can find your way around your new city, and you’ve found one or two people on the faculty that you can ask what they didn’t tell you when you were hired� Maybe (against my better advice) you’ve become involved with one or two committees, or projects� Here, your to-dos for year 2:

TO DO IN YEAR 2:

1. Write, write, write. Yes, you went into emergency medicine for the action You’re a doer, not a sitter and writer� We’re not asking you to write a PhD thesis, but academics write, and you are an academic whether you are a full time clinician or on a teaching or research track� Writing opens doors and is a mandatory part of promotion� There are a lot of ways to flex your writing muscles� Here some ideas:

a� Read How to Write A Lot by Paul Silva, PhD

b� Find one day each week that you’re not working clinically and make it your writing day� Schedule it in your calendar in advance, or it won’t happen� Repeat after me: “academics write�” Writing needs to become a regular practice� It needs nurturing� It will probably be the hardest thing you do and therefore should probably be the first thing you do on a day you’re semi-rested and well-caffeinated�

c It doesn’t matter what you take on as your first writing project Just sit down and spend a chunk of time putting words on a page� Two hours of focused writing is a good starting point�

d� What to write? Do you have a local journal that is likely to publish your work? Is there a colleague who is looking for a collaborator and will give you a section of a manuscript to help write? Perhaps you could write up the proceedings from a conference you’ve attended� Maybe your medical school has a magazine that has a faculty colum, or you could write an article for SAEM Pulse Maybe you worked on a curriculum in residency and you can write it up for MedEdPORTAL� For educators, understanding how to translate curriculum into publications is essential�

e� Form or join a writing group� This forces you to adhere to some agreed-upon deadlines, share your work effort, and actually do the work� Built-in peer feedback helps toughen your skin as well, for rejections�

On the promotion scale, the following types of articles/academic work are of value, in order from most to least impact:

WORK TYPE

Original research – peer-reviewed

PRODUCT’S PROMOTION VALUE

This is a novel research article that can be found on Pubmed/MEDLINE Think randomized controlled trials, retrospective chart reviews, cohort study designs�

Non-original research – peer-reviewed

This research can be found on Pubmed/MEDLINE but is a scoping review of others’ work or a commentary or a letter to the editor� You didn’t analyze your own data for this work�

Non-MEDLINE-referenced, peer-reviewed

Some journals do not submit to MEDLINE and you therefore can’t find this work unless you go to the journal website These journals are lower impact

Non-peer reviewed article

This is everything else that is published, but gets less credence during promotion review because your peers have not commented critically on this work nor had a chance to, sadly, reject it if it’s not up to snuff�

Blog posts, podcasts, social media writing, newspaper articles, book chapters

This work will increase your visibility to your peers and could help you develop a niche, but will have little impact during promotion evaluations�

2. Brand Yourself. Maybe you’ve done a fellowship already and you know exactly what your subspecialty is because you’re a toxicologist or a pediatric EM expert or a medical education specialist� Great! You’re already a step ahead� For most of us, “finding your niche” is a scary phrase� “How do I know what I’m good at? I’ve spent the last decade becoming a doctor! Isn’t that good enough?” No worries� Generalists are welcome here� Nevertheless, you probably have something that piques your interest and could see yourself doing off-hours and talking about at a cocktail party� Don’t stress over finding your one, perfect, life-long niche You do not need to marry your niche You can change your mind� Year two is a good year to explore� Maybe you’re an opportunist and you want to find the gap in your department that needs to be filled� Many have found their way this way� It’s nothing to sneeze at� Leverage your friends to help� Ask them what they think you’re good at and go from there� Read some EM journals or SAEM Pulse or ACEP NOW or Emergency Medicine News� What author-physicians are doing interesting work that you like to read? What resonates with you and gets you fired up? Consider attending a poster session or volunteer on an SAEM task force, academy, committee, interest group� This is the time to compile a basic CEP (Clinical Educator Portfolio)� By the end of year two, see if you can focus yourself on one subspecialty, interesting facet of EM, or concept�

3. Will you be my mentor? No promotion guide would be complete without the advice to “find a mentor�” Your best mentor is someone that has more experience than you, is willing to meet with you for an hour each month (minimum), and seems as excited to be your mentor as you are to be their mentee� Finding a mentor has many benefits� You’ll be more likely to stick to your endeavors� You’ll have someone to filter for you what’s worth pursuing and not worth pursuing (did I mention book chapters?) You will have someone who will assist you with making connections with others in your field who may involve you in projects that can advance your career� Here’s your quick-start guide for finding a mentor:

a� Set up a meeting to talk over coffee� Ask what the prospective mentor is working on and what advice he or she would for you At the end of the meeting, if you enjoyed the mentor’s company and would like to spend time together again, ask if you can meet again�

b� Send an e-mail to a much-admired person in the field: “I love what you’re doing� I’d like to learn more about your work and find a way to work together�”

c� Participate in mentorship programs� Many universities and organizations (SAEM, AAEM, ACEP) have a mentorship program� Join them� There are mentorship breakfasts at conferences and other formal networking events� Attend one!

d� Go into your mentoring meetings with an “ask�” Do you want advice? Involvement in meetings? A research project? A connection with someone in specific? A meeting just to “get to know them” is less likely to have the outcome you are looking for� Consider going in with a written agenda of the items you’d like to discuss�

Year 3 Dig Deeper

You know the lay of the land� You’re pretty confident you could figure out how to search PubMed and get journal articles from your university without any help� Maybe you’ve met the science librarian or you’ve had a one-on-one with the medical school dean� Perhaps you’ve taken on a minor role in your department and started to be the point person for some activity (e�g�, simulation, resident conference, stroke education, etc�)� Here are your to-dos:

TO DO IN YEAR 3:

1. The five-year plan. Yes, while you were busy working overnights, attending a resident conference, and traveling to the SAEM annual meeting , promotion inched toward the five-year horizon� Don’t fret� You’ve got time� But do yourself a favor and make a plan� Promotion isn’t a sprint� It’s a marathon and if you don’t buckle down and set some priorities you’re bound to be THAT assistant professor who’s been on the faculty for 17 years, but still hasn’t been promoted� Look at your promotion requirements and work backward What can you accomplish this year? Do you need to play a major teaching role at the university? (Click here for more about the education track�) Can you be a coinstructor with another colleague for an undergraduate class? Do you need a grant to fund some time to write? Ask your colleagues what grants they’ve gotten and if they can give you a copy of their grant� Is there a departmental grant you can apply for? An SAEM Foundation grant? Maybe now is the best time to take that job of assistant ED director or become the observation physician lead? Promotion is the reward you get for playing the game� Like politics, you have to play the game to win� You don’t get to make the rules� If you refuse to play the game (some colleagues feel that it is demeaning and will not, or will only do so half-heartedly) then don’t expect to get promoted�

2. National committees. One of the best ways to keep on track for promotion is to sign up (and really do the work) on a national committee� There’s a committee for everyone� Are you passionate about improving care for older adults? Join AGEM� Do you like exchanging ideas with women and learning the tricks of keeping afloat with major second jobs (yes, I’m talking about parenting, home responsibilities, elder care, etc�)? Join AWAEM� Perhaps you’re passionate about advocacy? Consider running for ACEP or AAEM representative� This isn’t just busywork Being on a national committee helps you get the scoop on how other departments do things, so you can bring good ideas home to your institution (and look like a rock star)� It also helps you be among the first to get the skinny on new job opportunities� As you rise through the ranks in the committee (and you WILL rise, if you volunteer to do work) you’ll learn valuable lessons about leadership, delegating, and communicating� Also, much less importantly, committee involvement is well regarded in your promotion package� If it’s the second or third time you show up at the same interest group or committee meeting your persistence will be recognized and rewarded�

3. Get your paperwork in order. Sometime this year you will get an email from someone in your administration saying you’re due for reappointment� “Please send your teaching dossier and updated CV�” What’s a teaching dossier? This is a list of all of your teaching accomplishments and commitments� See here for an example� Find out the CV format your institution prefers and start formatting your CV like this from day one� Reorganizing your CV is a major pain in the butt� Update your CV at least once every quarter� See if there’s an administrative assistant that works for a chair or vice-chair, or has several years of experience on staff, who can look over your CV and point out where your formatting/ organization is wrong� If you don’t update your CV regularly, you’re going to forget to do it and then not all of your accomplishments will be reflected in your promotion packet� Here, an example CV� CVs and CEPs do not get written/put together in 1-2 days� Expect your CEP to take a few weeks of work Here’s a resource that might be beneficial One final tip: Faculty should have a folder to keep “evidence” of work, including thank you notes, evaluations, conference programs, etc� to include in a PAD, if required�

If you started as an instructor, you should be ready to be promoted to assistant professor in your second or third year. If you were hired as an assistant professor (often fellowshiptrained folks who were already board certified when they started) then you need to keep moving forward.

Year 4 Halfway Point

Yes, that’s right� You’re half-way there and promotion is no longer a distant goal� By now, you’ve probably stopped stalking the charts of your patients for return visits, you’ve gotten more comfortable supervising residents, you have some tucked-away teaching pearls for the less busy days on shift, you know whom to go to when you have questions, and so on� One big tip on what not to do: If you’re talking more than your chair at your faculty meetings, that’s a problem� We know you have great ideas and you have the expertise and want to broadcast your knowledge� But to the faculty you’re still pretty fresh and, frankly, you may not know what you don’t know� Try vetting your ideas through a more senior confidante before you broadcast your great idea� Also, know that anytime you suggest a great new idea, you will be the one tasked to lead it� This could be good or it could be bad� If it’s in your niche, and it’s your real passion, your immediate response is “hell yes!” If you’re already putting in 50 hour work weeks and this will take up all the time you carved out for writing, or putting that new curriculum together, or taking that course on qualitative methods, then you may have spoken too soon�

TO DO IN YEAR 4:

1. Submit a didactic. You need talking/speaking engagements in your portfolio for promotion� These can be local, regional, national or international� The prestige increases the further the meeting is from your home� The burden and expense of travel also increase as you travel farther from home� If you’re traveling more than twice a year to a speaking engagement or a conference, you may be traveling too much� Yes, traveling is great for networking, it’s fun, and it will help you build your brand� It also makes it hard for you to find time to spend with family and friends, decompress after a run of shifts, and focus on your writing� Remember this guide is not about getting famous, it’s about making it to promotion by year seven Submitting a didactic to a conference or sitting on a panel is a great way to check off the “invited lectures” box� Trying to find your own speaking engagements can be difficult� Many departments have informal faculty exchanges� Both groups get the benefit of outside speakers� Including junior faculty in these exchange programs can be a great way to snag a regional didactic offer�

2. Write a peer-reviewed article. If you’re clinical faculty and work full-time clinically, this is not required, but it’s a nice plus� If you’re teaching or research faculty, and haven’t yet submitted a peer-reviewed article, don’t fret You’re still well within the average (Read Dr� Boudreaux’s article on writing productivity in EM� The average assistant professor publishes less than one paper in his or her first five years�) But strive for better than average, get started� Where to begin� Take a look at what is peer-reviewed� The best way to know this is to see if the journal you want to submit to can be found on PubMed� There’s also an abundance of resources on campus on how to write a manuscript� Take a course or look at Annals of Emergency Medicine’s excellent guide� You don’t need to run a $200,000 NIH clinical trial to write a peer-reviewed manuscript� You can use freely available data about ED utilization (NHAMCS), do a scoping review, or even write a case series� Caveat: Several faculty reviewing this guide felt year four is late to start submitting peer-reviewed publications� If you find yourself with the space and time to write earlier — do! Especially if you are on the research track or more academic tracks

3. Leadership training. You may think, “I have no ambition to be a leader,” or “I’m fine where I am right now,” or “I’m already a leader ” Take this advice to heart: do the training Leadership training will make your job(s) easier — your clinical job, your faculty job, your home job� Leadership training could be general, for any physician, or niche-specific (e�g�, Tideswell, AGS and ADGAP Emerging Leaders in Aging Program for the geriatric EMinclined, or the gender-specific AAMC Mid-Career Women Faculty Leadership Development Seminar, or the AAMC Minority Faculty Leadership Development Seminar)� You don’t need to travel for leadership training� Many medical schools have leadership training available� Also, put the AACEM/SAEM Chair Development Program on your list (as a future consideration)�

Year 5

Find the Essentialist In You

Chances are by now you are deeply entangled in the machine that is academia� You’re probably on a national committee, a university committee, and leading some efforts in your department� You may have written an article or two and you probably know what is worth your time investment� Now is a good time to start paring back� It’s easy to get overcommitted in academia, at tremendous risk to your well-being, your ability to focus, and your ability to achieve� If you’re burning the candle at both ends, you’re not going to make it to the finish line�

TO DO IN YEAR 5:

1. Become an essentialist. Read “Essentialism: The Disciplined Pursuit of Less” by Greg McKeown and learn what opportunities to focus on and what opportunities to pass over� Some things bring you joy in your job and others things you do out of a sense of obligation� Find ways to say “no” to the latter opportunities� Every time you consider saying “yes” to a new opportunity, figure out what you would have to sacrifice to take it on� If there’s nothing that you’re willing to let go, then you’ve already reached your max without tapping into your precious personal life� There are only so many hours in the day and week and you need unstructured, unscheduled time to decompress to keep the fire ablaze for years to come� This year, say “no” to things that don’t bring you joy, so you can say “yes” to things that will keep you an amazing ED doctor in the long run�

2. Ask for it. If you haven’t read the book yet, do� If you become a star negotiator you will make your life easier and better� This is especially important for the women or URiM (underrepresented in medicine) faculty who may be more likely to wait until they’re asked� No one knows your worth until you speak up and ask for it� Self-promotion is a necessity in academia� Everyone does it and you should do it too — shamelessly�

3. Connect with the C suite. Whether you’re in one of the largest hospital systems in the country or a small 10-faculty department in a three-specialty hospital, there are people who have great influence on how the hospital runs and what priorities rise to the top� It’s a good idea to figure out who these C-suite people are and make connections with them� Chances are you will have a project that will either live or die based on whether someone in the C-suite thinks it’s important� Find a way to connect with them by attending a town hall for physicians, going to an award ceremony, or just reaching out by e-mail�

Year 6 The FINAL Sprint

If you’ve followed this guide, you’re well on your way to being promoted� You’ve been writing, updating your CV, teaching classes, and finding your way in your department and among the hospital leadership� This year is about finishing off those last requirements and making it known to your chair, vice chair, or promotion committee that you’re ready to go up for promotion�

TO DO IN YEAR 6:

1. Set up a meeting with your promotion point person. Send them your CV ahead of time and say you’d like to discuss promotion readiness� Ideally, this will be the second or third time you’ll meet with this person� Show them you know what’s required for promotion and how you’ve met the requirements� Ask whether they have concerns about your ability to be promoted and what they would recommend rounding out�

2. Write your personal statement. This is a declaration of your achievements as an assistant professor and your (high) aims for the next several years� If you’re in the educator track, explain what courses you’ve taught, what teaching awards you’ve won, and what impact your work has had nationally� Write specific goals for how you intend to build a national reputation over the next several years Borrow the personal statement of a colleague in the same track to help you understand the tone and approach that should be taken� Putting together your personal statement is hard work� Forcing yourself to think about what it is you do and creating an elevator speech in your 3rd–5th year will make the job much easier�

3. Track down your mentees. Along the way you’ve had undergraduates, medical students, graduate students, EMTs, and many other people ask for advice and mentorship� What are they doing now? Keep up your relationships with them — not only because you helped them on their way and should be proud of what they’re doing, but because it looks good on your promotion paperwork if one of your mentees is now faculty at another institution or an astronaut for NASA� Closing advice: A quick word about disappointments and following your north star� Our profession has evolved into far more than being the doctors who are there when everyone else is sleeping, or in the OR, or with their family on the holidays� We are the first, and often the last, stop for people� And that comes at a heavy cost Asking anything more of you on top of this herculean task seems like a slight� Yet, there’s a reason you chose to go into academics� It’s fun to pursue projects� You grow with your learners� Your colleagues become your friends and “get” you like no one else ever will� Promotion is a necessary evil, but it’s also an opportunity to organize your career life and keep you on track to achieve greatness� It is about resilience, seeking advice, and moving an inch closer every day� If you build into your schedule the time to do things that are meaningful outside of work and keep close connections to the people you love, this can be a long and happy career� Fin�

Bonus Material

Don’t take my word for it� Here’s what other greats in our field had to say about promotion�

CHRISTOPHER CARPENTER, MD

[For your personal statement] weave a narrative describing: (a) what you’ve published, (b) why what you’ve published has contributed to “knowledge” in your field, and (c) how the pieces of your research/education/clinical duties tie together�

When I’m writing promotion letters (about 10x per month), I always include the individual’s h-Index in my letter� Academically-minded folks ought to monitor their h-Index (m-Index in the first 5-10 years post-residency) and include the h-Index (and their percentile “impact”) with their requests for letters of promotion�

I’ve maintained an annual academic portfolio that includes the distribution of my (a) hours by day (# hours) for research vs� teaching vs� admin vs� clinical care vs� editing vs� mentoring; (b) publications; (c) awards, letters of acknowledgement for excellence in peer review, etc�; (d) mentee’s academic output; (e) external lectures and the evaluations from those lectures; (f) CME and licenses; (g) social media output (podcasts, coverage on EM Abstracts/EM-RAP, etc�)�

The pot of gold at the end of the rainbow is an endowed professorship� I would encourage folks to be aware early on whether their university has ANY endowed professorships for EM and what the likelihood is that they would grow more during the career of the [SAEM] member� These endowed professorships require decades to cultivate, so they are worth being cognizant of

JEANETTE WOLFE, MD

Start your CV when you’re young update it religiously, at least every six–12 months; otherwise, you forget stuff Include committee work even if it is just a short-term committee Join national committees, academies, interest groups� Look for leadership opportunities outside of your department, within your hospital, and beyond your organization�

Intentionally network at meetings with people who share your academic interest and tell them you are interested in potential future collaborations�

Intentionally seek out skill-building activities that are outside your comfort zone, such as writing an article for a newsletter, doing grand rounds at a local hospital, etc�

Always have at least two to three projects going on, that way if you hit a roadblock on one you can pivot and focus on something else to offset any frustration or sense of failure� You can then go back to the first project after time has taken emotionality out of it� Find an accountability buddy to help motivate you to keep you on track for longer projects�

Resources for Academic Promotion

2019 SAEM Academic Career Guide. This is a short read about the early assistant professor years and the later assistant professor years, which nicely delineates what you should be working on (with a timeline) and what your department should provide� It also elaborates on the different aspects of our jobs (e�g�, administration, teaching, mentoring, etc�) with an emphasis on what is given weight in promotion decisions�

Getting Your Faculty Promoted. This is a brief PowerPoint by Dr� Hans House, who is a professor and vice-chair of education at the Department of Emergency Medicine, University of Iowa� It has great advice on the topic of academic promotion, tips about getting noticed through social media, and how to help promote your faculty if you are a leader�

Using Publication Metrics to Highlight Academic Productivity and Research Impact. This article by Dr� Christopher Carpenter et al� helps you understand the measures that exist for academic productivity� This could be useful to provide evidence that you’re ready to go up for promotion�

Simulation Specific Considerations

1� Think ahead! Solicit post-evaluations of simulation cases, workshops or curriculum you create and facilitate� You will need these for promotion packets, as well as publishing (e�g� MedEd Portal)� This is a general pearl that applies to education tracks outside of simulation, as well�

2� Curriculum development for the purposes of promotion should include the number and type of learners (learner contact hours), number and length of sessions, plus learner evaluations of the curriculum�

3� Simulation cases or workshops authored should include if the case was run locally, regionally, or nationally (e g SimWars) and if published in a case bank that is not formally peer reviewed (e�g� online resource emsimcases�com or thesimbook�com) or in a peerreviewed simulation case bank (e�g� ACEP case bank or MedED Portal)�

4� The inclusion of simulation-based contributions on your curriculum vitae or in your promotions packet can be tricky because simulation outputs may not yet be “standardized” to fit under a clear, standard CV heading� Do not let this deter you� Simulation-based workshops, case creation, and presentations are scholarly and should be included on your CV and “count” towards promotion�

Examples:

• Participation in national events, such as SimWars, that may include faculty writing a simulation case that they then help to facilitate during SimWars, should be included on your CV and highlighted as scholarly work for your promotions packet� While it may not “count” as much as an oral abstract or poster at a national conference, the case can be included as a “publication�” Participation on the SimWars committee or in the SimWars event may also be listed�

• For faculty who run a simulation-based event such as SimWars at their hospitals, state or local chapter meetings, or SAEM regional meetings, consider standardizing the title you list on your CV to reflect your role (e�g� “Event Chair” or “Event Director”) in order to help distinguish this from other titles such as program chair, steering committee chair�

• Invited simulation opportunities at external sites involving travel to another residency programs to facilitate and debrief simulation (e�g� Simulation Conference Day or Grand Rounds Simulation) should be included on you CV as an “invited presentation�”