It gives scholars the freedom to hold controversial opinions. It offers a level of job security unheard of in any other industry. And it places those who earn it at the very top of the academic food chain.
In 1915, the American Association of University Professors published a landmark statement describing three elements that comprise academic freedom: “Freedom of inquiry and research; freedom of teaching within the university or college; and freedom of extramural utterance and action.” The requirements for achieving this academic freedom (now known as tenure) have evolved at many academic health centers into two specific, and much narrower, mandates: publish prolifically and amass as much external funding as possible.
In the age of YouTube and globalization, Twitter and crowdsourcing, technology commercialization and online education, today’s academics aren’t just publishing research papers and winning NIH grants. They’re creating viral videos, inventing apps, building websites, improving quality, redesigning health systems, and promoting global health. They’re also mentoring and training the next generation of researchers, educators and clinicians, who will use modern tools to push science and medicine forward.
Many academics believe that the traditional construct of tenure, which remains squarely rooted in a “publish or perish” mentality, is long overdue for change. “Our current tenure system reflects a hundred-year-old idea of academic medicine that no longer exists,” says Harriet Hopf, M.D., professor of anesthesiology, associate dean for academic affairs and chair of the School of Medicine’s Retention, Promotion, and Tenure (RPT) Statements Revision Committee.
CAN’T LIVE WITH IT, CAN’T LIVE WITHOUT IT
Ask people what tenure means, and there’s usually a long pause. One thing they do know, however, is that they want it, especially basic scientists. “I wouldn’t have come here without it,” offered Trudy Oliver, Ph.D., assistant professor of oncological sciences, who joined Huntsman Cancer Institute from MIT two years ago. “Every other place I was considering was offering tenure, so to choose a place that didn’t have it would have felt scary.”
And therein lies the impossible problem: We can’t recruit without it. “Even though we may want to get rid of tenure, we can’t, because we couldn’t recruit the best physicians and scientists,” says John C. Carey, M.D., M.P.H., professor of pediatrics and vice chair for the department’s academic affairs and a member of the RPT Statements Revision Committee. Carey believes tenure is an outmoded concept, but understands its value in academia: “It’s still a badge of honor.”
Once we concede that tenure is here to stay, then we can begin working on defining what it means in the 21st century. “In its most elemental form, scholarship is the dissemination of good ideas outside the academic environment,” says Carrie L. Byington, M.D., professor of pediatrics and vice dean for academic affairs and faculty development. “Educational innovation, program development and public health advocacy can all be forms of scholarship when their impact reaches beyond the classroom or clinic,” says Carey. “Dissemination is about spreading the word, and there are more than a few narrow ways to do it.”
Hopf believes an evolved definition of tenure is critical to our survival. “If we don’t start recognizing and rewarding all kinds of scholarship, we’re leaving talent on the table and sabotaging our future.” The challenge is how to establish meaningful metrics that measure excellence and maintain high standards of scholarship for new areas of study and new venues of dissemination. “The key word really should be impact,” says Vivian S. Lee, M.D., Ph.D., M.B.A., senior vice president for University of Utah Health Sciences. “Has the work impacted the way in which clinical medicine is practiced or students are taught or basic biology is understood? Does the work impact the broader population of
patients, scholars, educators and scientists?”
HANGING THE CULTURE, NOT JUST THE CRITERIA
More than a decade since we last revised our guidelines, we are doing it again. This time around, we’re considering the input of more than 300 faculty members from all tracks and ranks who participated in 39 formal and informal focus groups this past year. One thing is clear. Transformation won’t come simply by revising promotion and tenure guidelines. It will also take significant culture change. “Many institutions have very inclusive guidelines,” says Hopf. “But in practice, committees often default to the tried-and-true metric of counting publications because it’s familiar and it’s easy."
Success will depend on figuring out a way to create a more inclusive system to value scholarship without diminishing the significant accomplishments of those who’ve worked hard to earn tenure the old-fashioned way.
Should these people get tenure?
AS WE EXPLORE MORE PROGRESSIVE DEFINITIONS OF SCHOLARSHIP AND DISSEMINATION, FACULTY WHO WERE NOT TENURE-BOUND AT THE OUTSET OF THEIR CAREERS NOW EMERGE AS STARS. IS IT TIME TO RETHINK TENURE? DO WE NEED NEW WAYS TO RECOGNIZE AND REWARD INDIVIDUALS MAKING SIGNIFICANT CONTRIBUTIONS?
1. The Digital Anatomist
Revolutionized anatomy education with the development of the first comprehensive, Web-based anatomy portal. Has earned national recognition in medical pedagogy for his research on the impact of cadaver dissection. Has authored multiple anatomy texts, including Gray’s Dissection Guide for Human Anatomy.
2. The Multimedia Educator
Directs the most widely used online genetics resource in the world, which received more than 47 million page views in 2012 and won the 2010 Prize for Online Resources in Education from the journal Science. Currently holds four NIH grants.
3. The Community Changemaker
Created a first-of-its-kind life skills training program that connects occupational therapy students with new Americans who arrived with refugee status. Publishes and presents both nationally and internationally on refugee resettlement and community-based practice.
4. The Global Teacher
Leads the only continuing medical education program for physician assistants in Ghana. Selected as the liaison for the Physician Assistant Education Association to the Consortium of Universities for Global Health. Collaborates with the World Health Organization to increase the physician assistant workforce worldwide.
5. The Implementation Scientist
Invented and implemented the e-Asthma Tracker, a tool for patients that shifts asthma care to a new model that is continuous and proactive. It focuses on preventing rather than managing exacerbations and dramatically reduces asthma readmission rates. The tool generated $1.2 million in a grant from Agency for Healthcare Research and Quality (AHRQ) and recently earned a $1.9 million grant from the Patient-Centered Outcomes Research Institute (PCORI).