June 11, 2021

Shining a light on the 'black box' of the surgery promotions process

A team creates a roadmap to navigating the complicated promotions process, and shares lessons learned along the way.

Graphic of a light shining on a box

The promotion process seemed like a black box when Erin Perrone, M.D., a pediatric surgeon at Michigan Medicine, was embarking on it.

What did a packet look like for a surgeon who ran the gauntlet successfully? What nuances were important to understand when it came to packets for the clinical, instructional and research tracks?

As co-chair of the Junior Faculty Advisory Committee (JFAC) at the time, Perrone turned her struggle to figure that out into a service. She worked with others to develop a handbook to help other junior faculty members through the process. It serves as a template for crafting packets based on lessons learned from members of JFAC and other Department of Surgery faculty.

“I figured if I was doing the work already, I may as well pay it forward,” Perrone said.

If recent events are a measure, the handbook should be helpful; now chair of the JFAC committee, Perrone was recently promoted to clinical associate professor.

Special considerations for surgery promotions

The promotion committee evaluates packets and approves or rejects promotions based on whether they meet certain criteria related to the institution’s tripartite mission of clinical care, research and education. In the Department of Surgery, the Internal Promotions Advisory Committee reviews packets before they’re put forward to the Medical School. Andrew Chang, M.D., chairs that committee.

It’s clear what buckets need to be filled for a promotion to be considered, but the contents of those buckets can look a little different for surgeons. Hari Nathan, M.D., Ph.D., Division Chief of Hepato-Pancreato-Biliary Surgery, was the previous chair of the JFAC committee and contributed to the handbook development. He said the clinical demands of surgery can make the research category a challenge to satisfy.

“We’re not going to spend as much time doing research as non-clinical faculty or even clinical faculty in different disciplines. So while we still need to show academic productivity, it’s also important to demonstrate the value of the other things we do, such as clinical activity and leadership, and our impact on the institution and learners.”

His advice to junior faculty is to articulate how their clinical care contributes to the mission. Establishing new clinical programs and exposing students and residents to cases, for example, brings clear value.

“Remember, you’re talking to people from various backgrounds. You may have to convince non-clinicians that your non-research activities also contribute to the academic mission,” Nathan said.

The handbook includes examples of talking points for framing work, and an outline for the points to hit for each track.

Who’s your person? Different phenotypes to model packets after

There’s gold to be mined in packets from surgeons who’ve been promoted. The JFAC team identified people who went from assistant professor to associate professor and asked to see their packets for inspiration. Packets from a variety of phenotypes—including basic scientists, health services researchers, clinical track and research track surgeons— were sought out for inclusivity and evaluated for best practices.

Perrone’s own packet ended up informing the handbook; Chang was familiar with her packet and flagged some things for inclusion as the handbook was coming together.

“It seemed difficult and an uphill battle for me personally, but I wanted to put it all down and know that I would be helping other people,” Perrone said.

For Erika Sears, M.D., M.S., a plastic surgeon and JFAC member, having examples from different phenotypes to draw inspiration was invaluable when she went through the promotion process.

“I sought a bunch of examples from people I thought were similar in terms of emphasis on research and mentoring. I talked to people with similar phenotypes as me and asked people if I was ready,” Sears said.

No handbook can tell you if you’re ready, but your colleagues and mentors can.

Before Sears went up for promotion, her section head, Paul Cederna, M.D., reviewed her CV with Chang, who thought she’d benefit from things like more invited talks to raise her profile. They decided it was best to wait to apply for promotion and focus on that aspect of her CV. Luckily, there was structure in place to help her.

“That’s where the junior faculty exchange, which is part of the Michigan Promise, was helpful. I went to UAB in 2019. In February 2020, the last time I was on a plane, I went to Stanford. It’s an opportunity to present your work and put it on your resume,” Sears said.

The wait paid off. Sears was recently promoted to associate professor, with tenure.

It’s not enough to do things. You have to track them

One lesson that Nathan, Perrone and Sears all learned along the way is that carefully tracking activities is critical: If you can’t track them, you can’t tout them.

Nathan found that educational activities had a tendency to escape tracking, partly because such activities are often informal.

“It’s easy to keep track of a lecture you’re asked to give, but when you meet with the residents randomly on a Tuesday afternoon to do an informal teaching session for an hour, that counts.If you meet with medical students on a regular or ad hoc basis, that counts.

"If you're spending time mentoring residents in research, that counts and it needs to be played up in addition to the publications. We sometimes sell ourselves short a little bit,” he said.

Sears benefited from an early warning about tracking teaching activities. She leveraged her Type A tendencies and worked with her administrative assistant, Kate Weese, to implement a system.

“I have a color-coded calendar and Kate can estimate my time spent on teaching and mentoring activities. She organizes them into buckets that I developed as part of the educator portfolio,” Sears said.

Teaching and mentoring activities are coded purple, clinical activities yellow, research activities green, miscellaneous meetings blue and personal activities are pink.

The system helps Sears balance her time. When possible, she and Weese try not have more than four hours of blue or purple booked on her calendar a day. If that balance is disrupted, it cuts into research time.

A work in progress

The handbook wasn’t quite ready when faculty members were going through the latest round of promotions, and it will never quite be finished. As new lessons are learned the handbook will evolve to reflect them.

“The intention of this is to be a living document and be continually updated. The best feedback will be from people who went through the process,” Nathan said.

Some lessons learned along the way are already spurring more work. Perrone realized that it’s not just faculty struggling through the process. Administrative assistants, instrumental in helping get materials together, also find it daunting.

“Everyone has a similar experience, including our administrative staff, who help us with doing it. They may be doing it for the first time, or every three or four years,” Perrone said.

A guidebook for administrative assistants, based on best practices gathered, will be available to them soon.

(Download and view the handbook here.)


By Colleen Stone

Dr. Andrew Chang

Andrew C. Chang, MD

John Alexander Distinguished Professor in Thoracic Surgery
Professor, Thoracic Surgery
Associate Program Director, Integrated Thoracic Surgery Residency
Dr. Erin Perrone

Erin E. Perrone, MD

Vice Chair of Faculty Life
Clinical Associate Professor, Pediatric Surgery
Program Director, Pediatric Surgery Fetal Medicine Fellowship

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