Nicholas O. Davidson, MD,DSc Professor of Medicine Director, Division of Gastroenterology,

1. The Triple Threat: Time Management, Productivity Milestones and Promotion Nicholas O. Davidson, MD,DSc Professor of Medicine Director, Division of Gastroenterology, Washington University Medical School April 15, 2005

2. Time Management Productivity Milestones Promotion

3. Time Management • Critical skill in transition to independence • Responsibility for time and effort distribution • Consequences of these choices define trajectory How to manage, control and optimize your efficiency?

4. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

5. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

6. Understand what is expected from you • DILEMMA • Medical Schools, Departmental organization: • large,fragmented,highly complex • Viability linked to revenue steams: • competing priorities, funding constraints • define success and failure • Tripartite mission: Patient care, Research and Education often pursued independently • Lines of authority and responsibility for career • development no longer clearly defined

7. Understand what is expected from you RESOLUTION • Institutional and Departmental obligation to organizational framework that specifically incorporates junior faculty advocacy • Divisions assume increasingly important role in providing structure and substance to mentoring • Individuals acknowledge their role and responsibility to understand institutional culture and policies for academic advancement

8. Bottom line… In an increasingly competitive environment, medical schools and departments recognize that the most valuable commodity is its faculty. Faculty recruitment and retention is directly linked to success in nurturing and promoting the careers of junior colleagues.

9. Rules of the road Junior faculty must understand what is expected from them They must be provided opportunities and resources to succeed in today’s world Faculty responsibilities and expectations must be aligned with specific mission [Research, Patient Care, Education] Academic advancement should be predictable, based on a transparent accounting of how well faculty meet these defined expectations

10. Clinician 80% T/E Patient care, teaching admin. 20% other academic pursuits Investigator 80% T/E Research 20% Patient care, Teaching, admin Research Associate 100% T/E Research Clinical translational investigator 50% traditional patient care-teaching 50% research using clinical material Understand what is expected from you Faculty track assignment defines expectations

11. Understand what is expected from you-(i) Clinician [educator/scholar] • Patient care with teaching vs clinical research predominance • Build and manage a practice • Develop distinctive clinical expertise • Local/regional recognition • Successful teaching & communication skills

12. Understand what is expected from you-(ii) Investigator (MD, MD-PhD) • 80% time protection; balance clinical, teaching, administration • 80% salary recovery, time equals effort • Manage remaining 20% • Understand concept of tenure clock

13. Understand what is expected from you-(iii) Research Associate • 100% time and effort devoted to research • Requires dialog, effective communication with PI • No defined teaching or administrative responsibilities

14. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

15. Determine what you expect to accomplish for yourself Clinician BUILD REGIONAL REPUTATION AND DEFINED EXPERTISE • Define and refine your interests • Develop opportunistic approach to attending • Get involved in local chapters & organizations (CCFA,ALF) • Seek role in national professional societies (AGA, AASLD, ACG etc) Progressive, continuous process: time frame building over 5+ years

16. Determine what you expect to accomplish for yourself Investigator • ESTABLISH INDEPENDENT RESEARCH PROGRAM • Hold yourself accountable for finishing experiments • Develop discipline to write and submit papers • Accumulate preliminary data for grant submissions Discontinuous process- stepwise accumulation of published research builds credibility. Time frame 1-3 year blocks with frequent review.

17. Tracks and pathways to success • All academic institutions place high value on scholarship and excellence • Scholarship and excellence recognized in each of the tripartite missions • Expectations must be realistic and aligned with goals and resources • Understand in detail the expectations of your local institution • Use all available resources [web-based, handbooks] and solicit input and guidance from mentor, Division chief, Departmental leadership

18. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

19. Acknowledge and respect your personal commitments • Establish- and adhere to- expectation for personal and family time • Incorporate these expectations into long-range planning for future commitments [speaking engagements, grant submissions, attending] • Avoid the trap of having free time become a collapsible commodity Key to honoring personal commitments is responsible planning of professional goals

20. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

21. Know yourself, understand your work habits • Recognize the importance of effective written and oral communication skills. These are indispensable tools, and learned skills. • Develop your own presentation style. Understand your limitations. Seek feedback. • Recognize the importance of collaboration, team building. • Understand importance of distinct research identity. • Success in complex biomedical centers requires balanced portfolio of activities. • Key traits for both clinician and investigator track.

22. KEYS TO SUCCESSFUL TIME MANAGEMENT • Understand what is expected from you • Determine what you expect to accomplish for yourself • Acknowledge and respect your personal commitments • Know yourself, understand your work habits • Articulate, Communicate, Activate

23. Articulate, Communicate, Activate Articulate: Develop and outline 1,3yr objectives • Clinician track- can be general, but identify milestones (below) • Investigator- Vital to construct hierarchical plan,incorporating clinical commitments. Must include plans for manuscript, grant submissions. Communicate: Review plans with mentor, Div. Chief • Advantage- defines expectations; reality check Activate: Your ability to commit and follow through

24. Productivity Milestones-(i) Clinician • Certain parameters readily quantifiable [RVUs, Revenues, Expense control] • Teaching evaluations crucial • Referral base a surrogate for emerging local, regional reputation • CME invitations, local chapters, organizations • Industry or federally sponsored research • Role in national professional organizations

25. Productivity Milestones-(ii) Investigator • Productivity evaluated in context of local institution and promotion guidelines. Explicit goals with periodic review. • Time denominator-Instructor or equivalent; off-clock • First priority: High impact, peer reviewed, investigator initiated publications, first author • Transition to independence as senior author. [No mentor]. • Identifiable, progressive theme to research program • Sustained, extramural grant support (~80% t=e), federal> other • Collaborative programs with intersecting themes OK… • Teaching, clinical evaluations both important

26. Risk-Benefit analysis: Other Academic Pursuits ActivityDownsideUpside Visiting ProfessorTIME- Potential supporters Distraction- Long range collab. CME TalksTIMEClinician : Local/Regional reptn. : Referral base : $$ Investigator: $$ Inst. CmtesTIMENONE

27. Gauging Productivity Milestones Goal: Progressive, Predictable Path to Promotion • Progressive: Periodic review, adjustments as needed. Set and meet targets. • Predictable: Know what’s expected each year. Articulate plan, review and agree on goals. • Path to Promotion: Understand how high the local bar is set. Review progress regularly.

28. Steps to promotion • Expectations defined at the outset • Continuous documentation of accomplishments- THIS IS YOUR MOST IMPORTANT RESPONSIBILITY • Solicit (if not offered) periodic, written feedback • Keep yourself on task and accountable

29. What is the tenure/promotions committee looking for? Common themes regardless of track: • Excellence • Scholarly activity- continuous, well documented • External reputation- local, regional, national and international • Independence • Teaching and education • Institutional service • Service to the profession

30. Investigator track physician-scientist • ~10-20 high impact, peer-reviewed papers, majority as first or senior author • Identifiable trend or theme to research focus • Continuous high level (80%) extramural funding • National reputation [only external letters] • Defined clinical and teaching role [no weak evals] • Service to institution, profession [review cmtees, NIH reviews, editorial functions, professional organizations AGA, AASLD, ASGE, ACG].

31. Investigator track basic (PhD) scientist • ~30-40 high impact, peer-reviewed papers, majority as first or senior author • High impact theme to research focus • Continuous high level (>95%) extramural funding • Evidence of mentorship • National reputation [only external letters] • Defined teaching role, if possible [no weak evals] • Service to institution, profession [review,thesis cmtees] NIH reviews, editorial functions, professional organizations [AGA, AASLD, ASGE, ACG].

32. Research Associate track (PhD) scientist • ~20+ high impact, peer-reviewed papers, majority first author • Evidence of mentorship, leadership role in PI’s laboratory program • Independent, extramural funding definite plus • Regional and national reputation [external letters] • Service to institution, profession [review cmtees] NIH reviews, editorial functions, professional organizations [AGA, AASLD, ASGE, ACG].

33. Clinician track-(i) • Promotion criteria reflect balance of expectations • Publications emphasized for clinical scholar (those with clinical investigation as component of expectations), usually ~10-20 with mix of original articles, scholarly reviews. • Should be identifiable as driving force in multicenter/multiauthor studies. • Teaching and clinical evaluations key • Regional and national reputation [balance of internal and external letters] • Service to institution [clinical program dev] and profession very important

34. Clinician track-(ii) • Promotion criteria reflect balance of expectations • Publications for clinician educator (those with clinical care and teaching as component of expectations), usually ~10-20 with mix of case reports, scholarly reviews. • Teaching and clinical evaluations key • Ideally, should be viewed as “master clinician or teacher” • Regional and national reputation [balance of internal and external letters] • Service to institution [clinical program dev] and profession very important

35. Closing thoughts • Understand your local environment • Get, and stay on the right track • Make a plan and stick to it • If in doubt….ask • Document your accomplishments • Believe in yourself

36. GOOD LUCK!