Trains, tracks, and promotion in an academic medical center.

Academic medical centers (AMC) are defined as communities of students, physicians-intraining, clinicians, and scientists engaged in higher education, patient care, and research. AMCs typically reside within universities comprising other fields of study and ultiple colleges (eg, college of engineering, arts and sciences, usiness). However, an AMC may stand alone as a health ystem (eg, Mount Sinai, New York, and The Mayo Clinic innesota), or as a health science center comprising only olleges associated with health care plus a hospital (eg, Univerity of Texas Health Science Centers). Within these AMC comlexes reside the college of medicine and its associated hospital. he college of medicine, an important and an integral part of hese academic institutions, is charged with improving public ealth, a process that requires excellence in education, patient are, and research.1 The success of medical schools is based on he quality and achievements of the faculty and the environent provided by the institution to maximize the potential for uccess of its faculty.2 Indeed, the human capital of the medical school is its most precious resource and is to be developed, recruited, retained, and hopefully cherished. Because the goals of the medical school are multifaceted, yet intertwined within the larger institution, most medical schools offer multiple job descriptions to achieve research, educational, and clinical excellence. The job description is associated with expectations, responsibilities, and accountability, and is referred to as a “track.” The names and numbers of the institutional tracks vary among AMCs, but commonly include clinician–scholar, clinician–educator, and physician–scientist. Clinical scholars largely excel in clinical care. Clinician– educators are expected to provide clinical care and contribute heavily to medical education. Physician–scientists/PhD scientists conduct basic, translational, or clinical research and are expected to make substantive contributions in the areas of scholarly pursuit. Another commonly used model is the tenure and the nontenure track system, with the tenure being the “traditional” instructional track, which includes the physician–scientist, the PhD scientist, and the clinician–scholar, with scholarship/investigator initiated research being the predominant component of the job. The nontenure track predominantly includes the clinician– educator tract. To retain the best and brightest faculty members, medical schools in the context of the larger institution employ a series of review criteria to assess faculty performance. Success is defined as promotion through the academic ranks. It needs to be emphasized that criteria for advancement vary among different AMCs and it is essential for the faculty member to be well familiar with the local track expectations. Within each track, there is an academic rank; academic ranks in an escalating order includes assistant professor, associate professor, and full professor (Figure 1). Promotion from an assistant to an associate professor marks a key transition in the academic life cycle. This promotion signifies academic accomplishments and “value” to the college of medicine. Failure to obtain this promotion within a specified time frame (the academic clock) conveys the opposite message and may even result in dismissal from the institution. On the other hand, obtaining this promotion often provides a sense of long-term commitment to the individual by the AMC, a position referred to as tenure. Although the meaning of tenure is changing (it once indicated a position for life to preserve academic freedom), it is still considered by some AMCs as an important component of career advancement and recognition. Sometimes faculty members are appointed to the faculty as lecturers or instructors, positions that do not involve activation of the tenure clock. This position allows newly appointed faculty members to secure extramural sponsored research funding and to generate an appropriate number of peer-reviewed publications before the beginning of the tenure clock. The academic clock is usually 6 –10 years for an assistant professor to make the promotion to associate professor.3 In some but not all AMCs, the time period can be interrupted for maternity leave, and other family leave absences. To avoid a difficult request by the individual many visionary AMCs now automatically extend the “clock” for such leaves.