Obstetrics and Gynecology
Uniformed Services University of the Health Sciences
Department of Obstetrics and Gynecology
4301 Jones Bridge Road
Bethesda, Maryland 20814-4799
Christopher M. Zahn, MD
Col (Ret), USAF, MC
Professor and Chair
Department of Obstetrics and Gynecology
Phone: (301) 295-3430
FAX: (301) 295-0419
Phone: (301) 295-3430
Fax: (301) 295-0419
Faculty appointments at USUHS are governed by the University, following USU Instruction 1100. Appointments may be tenured or non-tenured; active duty faculty CANNOT hold a tenured position. The Instruction 1100 is fairly comprehensive, and contains all of the policies, criteria, and instructions for appointment and promotion. The following provides some "practical" information and interpretation of the Instruction applicable to appointments and promotions in the Department of Obstetrics and Gynecology.
Faculty appointments for non-tenure track positions are typically categorized into one of several available pathways:
As might be suspected, each of the pathways has different areas of focus and the criteria to be appointed and promoted may vary. For example, faculty in the investigator or research pathways will need to demonstrate accomplishments in scientific investigation and research, while the clinician-educator pathway emphasizes clinical and educational accomplishments. Most clinicians will be categorized in the Clinician-Educator Pathway, while most of the Ph.D. faculty will follow the Research Pathway.
Faculty ranks are listed as follows:
- Teaching Assistant
- Assistant Professor
- Associate Professor
For the Department, Teaching Assistant appointments are typically provided for residents in training. These individuals provide valuable education for students and are therefore appropriately appointed. An "Instructor" appointment is typically provided to a physician after completion of residency but before achieving Board-certification. Once Board-certification is achieved, a physician is eligible for an Assistant Professor position. For Ph.D. scientists, entry level positions may be at the Assistant Professor level, tenure-eligible, if he/she has sufficient training and experience or he/she could be appointed as a Research Assistant Professor so that the faculty member can develop an independent research agenda and proceed through the steps required to move to the tenure track. Alternatively, depending on the training and experience, entry-level appointments may be Research Associate or Senior Research Associate positions, with advancement to the professorial ranks as appropriate. The decision on the entry-level position is made between the Department Chair and the candidate based on the results of the Departmental search or internal review process.
The "Adjunct" prefix is typically provided to an individual performing important functions relative to the Department but is assigned to an institution or facility that is not a core clerkship site for USUHS students or a primary residency site for Obstetrics and Gynecology. An example may be a staff physician performing educational activities relative to the USUHS mission while assigned to Darnall Army Medical Center at Fort Hood. Fort Hood is not a core clerkship site for USUHS students, nor a primary residency site, but residents from the SAUSHEC (San Antonio) program rotate at Darnall and receive valuable education there. As a result these faculty provide important service to the University.
The "Clinical" prefix was recently implemented at USUHS. This term was initiated to recognize critically important educational and clinical activities of clinical faculty who may not be involved in research or other activities that serve as criteria for non-prefixed appointments, particularly at the Associate Professor or Professor ranks. The University certainly recognizes the incredible demands placed on faculty with respect to clinical activities, and that faculty may not have the capabilities to pursue scientific investigation or to accomplish activities to address criteria for promotion, but these faculty members provide phenomenal clinical service and education of students, residents, and fellows. Therefore these faculty now have the opportunity to become promoted as a clinical appointment. Criteria for promotion in the clinically-prefixed ranks are detailed in the USU Instruction (USU Instruction 1100 – Enclosure 3).
The "Clinical" prefix can be applied to the Associate Professor or Professor ranks. Although detailed in the USU Instruction, to be considered for a Clinical Associate Professor, the generally accepted minimum time in rank as an Assistant Professor is 6 years. For Clinical Professor, there should be wider recognition as a clinician and clinical teacher, and generally the minimum time in rank as an Assistant and/or Associate Professor is 10 years.
The requirements for the appointment/promotion package to be forwarded for consideration of a "Clinical" prefix are generally less involved than for consideration of an unprefixed appointment, particularly pertaining to the number of required letters of support. For a "Clinical" appointment/promotion, the candidate's Curriculum Vitae, letter from the USUHS Chair, letter of support from a faculty member of senior academic rank (at least the same level for which the candidate is being considered) in the candidate's specialty, and endorsement by the faculty member's Commanding Officer or designee, are required. The package is reviewed by the CAPT Chair or subcommittee, and then forwarded through the Dean according to the usual policies and procedures. Therefore, as described, the requirements in assembling the appointment/promotion package are less comprehensive compared to unprefixed appointments, and assembling the necessary documents should be a readily attainable task.
Other prefixes are also available (Distinguished, Visiting, and others) - details regarding these prefixes are contained in the Instruction.
The process for appointment and promotion are detailed in the Instruction, and are too extensive to comprehensively detail here. However, the following sections will hopefully prove beneficial in understanding the process and the "practical" aspects of the criteria evaluated.
The Department conducts an annual assessment and review of all faculty members. Participants conducting this review include USUHS faculty plus representatives from each Service, including the Consultants/Specialty Advisors. This process allows for review of faculty members, updates on locations, review of accomplishments, and consideration of invitations to submit a Curriculum Vita to review for possible promotion (see "mentoring" below). Individuals that do not have an appointment are welcome to submit a Curriculum Vitae for review. This situation may happen, for example, if a staff physician at a non-teaching facility moves to a teaching center. This individual may not have had a current appointment, and will therefore not be identified on the annual review, but once assigned to a teaching role is welcome to request appointment.
Rank-Appropriate General Processes:
Teaching Assistant, Instructor, Assistant Professor:
Appointments at the Teaching Assistant, Instructor, and Assistant Professor ranks are essentially provided at the Department level. Requirements include a current Curriculum Vita, a USUHS form completed by the Department, and for active duty faculty, a letter from the command endorsing the appointment. Once this information is complete, the packet is processed through the Office of the Dean by Civilian Human Resources (CHR), and the appointment granted.
Associate Professor, Professor:
Appointments and promotions at the Associate Professor and Professor ranks are more comprehensive. The general requirements include a current Curriculum Vita, a personal statement, an abbreviated Board of Regents Curriculum Vitae, copies of representative manuscripts, and letters of evaluation from individuals at or above the requested rank. The number of letters differs according to the rank requested; this information is further detailed in the Instruction. A departmental Committee on Academic Appointments, Promotions and Tenure reviews the packet once complete, and the packet is supplemented with a USUHS form and a letter of support from the Department Chair. This entire packet is then submitted through CHR to the University Committee on Academic Promotions and Tenure (CAPT); the composition of the University CAPT is detailed in the Instruction. The CAPT reviews the submission and makes a decision based on review of the criteria for the specific rank and pathway, as applicable, and review of the faculty member's packet. The CAPT meets four times per year. The CAPT may decide to reject the proposal, accept the proposal, or request additional information. Once a CAPT decision is made, it is routed through the Office of the Dean for approval, and then for Board of Regents approval. Once approved by the Board of Regents, the packet is routed back to CHR for official notification and documentation of the appointment/promotion.
Process - Timeline:
As can be surmised particularly for the process at the Associate Professor and Professor levels, requesting and obtaining the necessary information, assembling the packets, forwarding the packets fort CAPT review, routing packets through the Office of the Dean and Board of Regents, and ultimate documentation of the appointment/promotion with CHR is an extensive process that takes a fair amount of time. Contacting faculty and receiving the necessary information at distant sites adds to this timeline, and may lead to delays. It is probably a reasonable assumption that if a faculty member is pursuing appointment or promotion at the Associate Professor or Professor ranks, that AT LEAST six months should be allotted from the time of requesting materials to eventual appointment/promotion. This timeline obviously depends on the individual faculty member's adherence to the process. In the Department's experience, much of the delay in this process occurs during the procurement of the necessary materials stage. While obtaining a current Curriculum Vita is not often problematic, getting copies of manuscripts, a list of suggested references for writing the letters of evaluation, and personal statements is sometimes not accomplished in a timely fashion. Time needs to be allotted to request letters of evaluation from those listed by the faculty member or requested by the Department, and to receive those letters for assembly of the packet. Packets cannot be submitted for CAPT review until they are complete, so attention to timelines and required information is tantamount to achieving appointments and promotions is a timely fashion.
The Chair of the departmental Committee on Academic Appointments, Promotions, and Tenure is William H. J. Haffner, MD, CAPT (ret), USPHS. Dr. Haffner, a former Program Director and Chair, provides incomparable service in the support of faculty to develop their careers and to review faculty accomplishments relative to the requirements for the specific ranks. Dr. Haffner has been invaluable in the career advancement of numerous faculty. Furthermore, faculty members (currently Drs. Haffner and Zahn) have served on the University CAPT and therefore have insight as to how the CAPT evaluates faculty members, which can be translated into mentoring faculty members in their pursuit of appointment/promotion.
"Practical" Interpretation of Criteria:
As appointment/promotion at the Associate Professor and Professor levels are more complex, it is important to review the criteria used by the CAPT in review of faculty for appointment or promotion. Lack of understanding of the criteria, and lack of documentation or demonstration of achievement of the criteria, form the main reasons proposals for appointment or promotion are declined.
The USU Instruction details the criteria. They include:
- scholarship of discovery and/or integration
- scholarship of teaching
- scholarship of application
- institutional citizenship
The particular items reviewed for each of these criteria vary according to the pathway requested. For example, as described, for a research pathway, emphasis will be placed on the scholarship of discovery, where for the educator pathway, accomplishments in education are emphasized.
While it is not possible to address every potential situation relative to the criteria, several points will be addressed related to the "scholarship" criteria. Please refer to the Instruction for more information.
Scholarship of Discovery and/or Integration:
This criterion is actually fairly straightforward - it basically refers to scientific investigation. As indicated on the Instruction, achievement in this criterion is demonstrated by the faculty member's ability to "successfully conceive, execute, and report on research". This may involve acquisition of new knowledge, or integration of knowledge achieved through research. Demonstration of the ability to maintain financial support for research is also evaluated, although this aspect is typically reserved for tenure-eligible positions. The "bottom line" is this criterion mainly refers to research accomplishments. Furthermore, the minimum number of publications may or may not be specified depending on the pathway; faculty seeking appointment or promotion should refer to the specific pathway and the requirements. As might be surmised, for increasing ranks, greater accomplishments are required. For example, for the rank of Professor, it is expected that the contributions to scientific investigation are widely recognized and disseminated, and that this individual is recognized on a broad scale for scientific contributions.
An important aspect partially related to this criterion of scholarship is the concept of being "recognized" on a broader scale. This issue also applies to the scholarship of application, and will be subsequently detailed.
Scholarship of Teaching:
This criterion is also fairly straightforward - referring to the faculty member's contributions to the educational process. For this scholarship, there are three defined levels. The USU Instruction lists several examples of these three levels. For appointment or promotion to Associate Professor, particularly in the educator pathways, the individual should be developing Level Two criteria with the likelihood of achieving Level Two; for Professor, a minimum of Level Two is required. Examples of Level Two achievements include:
- invitations to present Grand Rounds outside of the primary department
- development of teaching materials (not just delivery of already-available teaching materials - that would be Level One)
- leadership in teaching - course director, program director
Example of Level Three achievements include:
- peer-reviewed research in education
- peer-recognition as an educator outside of USUHS
- visiting scholar invitations at other institutions
Again, far greater detail regarding this criterion of scholarship is included in the USUHS Instruction. Typically, for those in the Clinician-Educator Pathway, achieving scholarship in this category is not problematic.
Scholarship of Application:
This scholarship criterion is arguably the most difficult to achieve and/or document. This criterion primarily implies professional service in the institutional and broader academic and professional community. For clinician faculty, the scholarship of application also refers to an outstanding record of clinical care, and with increasing ranks, recognition for clinical excellence. For the Professor rank, the individual should serve as a role model for peers and students, and achieve wide recognition for their accomplishments.
The "easier" aspect to address is the clinical recognition. It is not often difficult to demonstrate or document clinical excellence; by the time an individual is eligible for consideration at the Associate Professor or Professor rank, they have held leadership roles in clinical departments (such as Division Director, Chief of Service, or similar positions), and may have been the recipient of awards for clinical service. Support for recognition of clinical activities can also be documented in the letters provided in support of a faculty member seeking appointment or promotion. Again, the clinical aspect is usually not problematic.
However, what often does become problematic is achieving and documenting recognition of professional service and accomplishments on a larger scale. In one sense, this is recognition "outside the box". Further complicating the achievement of scholarship in this category are the requirements for promotion in the military system. Some of the activities accomplished for military promotion, such as professional military education, do not contribute substantially to academic promotion. Likewise, some of the issues considered important for academic promotion such as research and possibly some aspects of teaching, may not contribute greatly to advancement in the military system. Thus, faculty who are attempting to advance in both systems often have to "go the extra mile" and demonstrate evidence of increasing accomplishments in both career paths. It is certainly acknowledged that this is not easy, but it can be done. To achieve successful advancement in both pathways, one needs to look ahead and identify the requirements needed for advancement, plot career goals to meet these requirements, and obtain help and mentoring along the way.
Returning to the scholarship of application, for advancement to the Associate Professor and Professor ranks, it is imperative that the faculty member is recognized on a progressively broader scale for the academic accomplishments. This translates into recognition outside of the home institution. To some degree, it also translates into recognition outside of the military system. Because the military system, particularly being a member of a particular Service, can sometimes be a relatively tight-knit system, recognition within a particular Service may not necessarily achieve the goal of recognition on a broader scale. Therefore, acknowledgement of a faculty member's contributions outside of the military system is more demonstrative of widespread recognition.
To put this in a more practical sense, a few examples may be beneficial. Most of these examples will probably be more applicable to those in the Clinician-Educator Pathway, but the concepts are relevant for the other pathways as well. Again, the criterion refer to demonstration of involvement at the institutional and broader academic and professional communities for the Associate Professor level, and professional service demonstrated by outstanding peer recognition at the Professor level. Some of the items listed to meet these criteria for the Professor rank include (these can be used as a reference; for the Associate Professor level, there are somewhat lower but nonetheless relative levels of accomplishments):
- selection for major academic administrative or leadership roles
- translation: Department/Division Chief, Chair
- leadership and service on study sections of federal granting, scientific, or health care review agencies
- translation: study section chair for NIH or another agency, committee or subcommittee chair of a GOG group
- holding office or selective committee membership in national/international scientific or health care organizations
- translation: leadership positions in major organizations, such as an elected positions in AFD, SMFM, ASRM, etc; committee or subcommittee membership that is a selected or elected position [NOTE: it is NOT sufficient to just be a "member" of a number of organizations/societies, leadership positions are required]
- service on editorial boards of scientific or scholarly journals
- translation: this is more than serving as a reviewer for a journal; reviewer roles may be adequate for Associate Professor, but may not be enough, in and of itself, for Professor
- serving as a consultant or advisor to the Surgeon General
- translation: self-explanatory, BUT not enough in and of itself
- special recognition awards
- translation: while A-Designator, Order of Merit, or the Air Force awards are important, they again are not sufficient by themselves
- invited presentations to national meetings
- translation: invited for Grand Rounds or other speaking events; demonstrates recognition of your expertise in an area to qualify you to speak on a particular topic
The common theme to all of the above-listed examples is demonstration of recognition. For example, being elected to a leadership position in the Armed Forces District requires recognition among your peers; this is more than just being a member of the District. The faculty member must demonstrate his/her selection to a position which acknowledges recognition. Other examples can be found in the USUHS Instruction.
As previously described, this scholarship is typically the most difficult for faculty to achieve. To some degree, the difficulty involves attaining leadership-types of positions, or other positions as indicated in the examples provided. The other challenge involves lack of documentation. The adage that applies to medical records also applies here - if it's not documented, it didn't happen…. Your Curriculum Vita is your life's story; if it doesn't adequately reflect the positions you've occupied or the accomplishments you've achieved, the CAPT cannot verify that you met the rank-specific criteria. The best mentoring that could be provided to any faculty desiring to pursue an academic career is to start early - get involved and work toward attaining leadership positions. Equally important is to document these achievements.
Institutional citizenship, like teaching, is typically straightforward and usually achieved by most faculty members. This scholarship is generally self-explanatory, translated into what you do for the institution/facility and the University. Some examples include:
- service on committees or task forces
- service awards
- Faculty Senate involvement
- administrative responsibilities at the Department, division, and institutional levels
- participation on search committees
Obviously, these criteria may be applied differently for a faculty member assigned to USUHS or the National Capital Area institutions compared to someone at a distant site, where much of the "service" may be at the local institutional level. However, the CAPT, and the University, realize that contributions made to the local facility that provides education to the students, residents, and fellows, so involvement at the local institutions is also important.
Letters of Evaluation/Support/Reference:
Letters are critical in assembly of the packet forwarded to the CAPT. The CAPT carefully considers the letters as further evidence of recognition on a broader scale. As might be surmised, the source of the letters is quite important. Since recognition on a broad scale is important, it is critical to suggest the "right people" from whom the Department will request letters of support. Translation: letters from local sources (within the institution or facility) are inadequate in and of themselves. If all the letters are from within the military system, it will likely be viewed as inadequate. Letters from those not in academic institutions and the letter-writers themselves not in positions of academic recognition or leadership will not be as strong as letters from academically accomplished faculty. The best letters are those from academic leaders at recognized institutions who document recognition of your accomplishments on a broader scale. This level of support is particularly critical for those seeking appointment or promotion at the Professor level. Indeed, one of the questions the Department asks of letter-writers is to reflect on your accomplishments as if you were to be considered for appointment or promotion at their institution. It is therefore critical for faculty members considering appointments and promotions to these levels to seriously contemplate the list of evaluators; the letters can be a significant proponent, or opponent, of a faculty member's consideration by the CAPT. Remember, however, that letters of evaluation must be requested by the Department and never by the candidate.
Civilian Human Resources (CHR) Process:
The CHR Office maintains records and handles administration of faculty appointments and promotions. This is not an easy task, particularly considering that USUHS faculty occupy positions on a worldwide scale. Further complicating this process is the fact that military faculty move quite often. In order to keep track of faculty, CHR maintains a policy of contacting faculty members via letter following Departmental review. This letter is sent in order to allow the faculty member to confirm or re-confirm his or her appointment. One of the main reasons faculty "lose" a faculty appointment is due to CHR not receiving the letter back from the faculty member. The Department attempts to keep CHR updated of any changes in faculty location and assignments; the annual review significantly aids in updating the faculty database. It is equally important for the faculty member to not ignore this letter from CHR - it is imperative to return this letter confirming the faculty appointment in order to keep the University's database current.
Final Point - "Defense of the Process"
The USUHS process of faculty appointment and promotion has "come under fire" at various times; some of the reasons supplied include lack of mentoring, lack of administrative support, lack of follow-up, lack of communication, the process taking too long, not recognizing certain accomplishments to equate to academic promotion, and lack of support of the faculty by not promoting the faculty. There are several aspects to address in answering these concerns. First, the Department of Obstetrics and Gynecology has developed a comprehensive annual faculty review, which has translated into a "reaching out" to faculty to review Curricula Vitae with the goal of trying to advance those pursuing an academic career. This process has led to mentoring and guidance in helping individuals achieve the goals of academic advancement. Departmental faculty have provided numerous sessions at regional and national-level meetings detailing the process, how to navigate through the challenges, and addressing the practical aspects of the criteria for appointment and promotion. Responsibilities of the administrative personnel in the Department have been re-arranged in order to make the faculty appointment and promotion process a priority, and Ms. Tracy Smith, with future involvement of Ms. Tanya Christian, have dedicated a portion of their responsibilities to the faculty appointment and promotions process. Indeed, we consider that the Department of Obstetrics and Gynecology as one of the more progressive Departments in the University in faculty appointments and advancement. It is important to note, however, as described previously, it takes time to complete the process. Review by the CAPT, routing through the Office of the Dean and the Board of Regents, and processing by CHR, is an involved process. Having an understanding of this process and the number of steps involved should provide a faculty member with a better understanding of the timeline and reduce potential frustration.
Related to potential frustration and the timeline is receipt of necessary materials. As alluded to previously, the Department can only do so much. In review of prolonged appointments and promotions, the singular most significant contribution to delays is lack of receipt of materials from the faculty member. The Department cannot "synthesize" lists of references, the abbreviated Board of Regents Curriculum Vitae, or a personal statement. These must come from the faculty member. Unfortunately, there are numerous cases in which despite several communications from our Department reminding a faculty member of the need to submit the necessary documents, the materials are not submitted. The Department will do as much as it can, but appointments and promotions particularly to advanced levels require submission of the necessary documents. It requires cooperation and interaction between the faculty member and the Department; it is not a "one-way" system. It is also important to note that some have expressed frustration at the number of documents required. This is essentially no different than any other University, however.
Additional frustrations expressed by some faculty members (and not just in Obstetrics and Gynecology) involve lack of recognition of certain accomplishments, thereby not "counting" toward academic advancement. As described previously, and reiterated here quite bluntly, academic and military advancement approaches a "dual silo" scenario. Significant academic accomplishments will not necessarily guarantee military promotion; in fact, it probably doesn't at all. Likewise, significant military accomplishments will not guarantee academic advancement. As described previously, accomplishments such as the Order of Merit, or A-Designator, are only a component of what is considered; it is not enough in and of itself. Some faculty members have questioned why USUHS seems so rigid. The answer is that USUHS is a military AND an academic institution, and the faculty and administration at the School of Medicine strongly believe that academic credibility must be maintained if an appointment at USUHS is to correlate with a similar rank at essentially every other medical academic institution. To be blunt, if USUHS awarded academic advancement based on accomplishments other than in the academic realm, then an appointment at USUHS would not be "worth as much". It would be a less-than-optimal situation if someone at an Associate Professor level was not able to attain a similar rank at another institution. In fact, USUHS has a great track record for faculty attaining similarly-ranked appointments at other universities, either concurrently with a USUHS appointment, or upon leaving military service. It is critical that USUHS maintains academic standards such that the academic rank at USUHS is recognized at other universities. If we did otherwise, we would be doing a disservice to our faculty. Again, it is not easy to advance along both a military and an academic path, but it can be done, as long as the faculty member is motivated and receives appropriate mentoring, particularly early in his or her career.
Please refer to the USUHS Instruction 1100 and its attachments for further information. You are welcome to contact personnel in the Department for further information or to address any questions you may have. The Department of Obstetrics and Gynecology hopes that this information is useful in the planning of your academic career.