Clinical Faculty Policy

School of Medicine Clinical Faculty Appointment, Renewal, & Promotion Policy

    ● Related Documents: Appointment of Clinical Academic Administrators Policy (ACAA Policy)
    ● Owner: Vice Provost, Faculty Affairs
    ● Approver: Board of Governors
    ● Approval Dates: September 2023

I. Introduction and Purpose

The University values its relationship with Clinical Faculty and recognizes the important contributions they make to the School’s academic mission through their teaching, clinical service, clinical research, administrative leadership, and service to the profession.

The purpose of this Policy is to provide a framework for the appointment and advancement of Clinical Faculty, the governance of Clinical Faculty relations within the University, and the mechanisms to provide for evaluation and discipline of Clinical Faculty.

II. Scope and Application

This Policy applies to the engagement and advancement of individuals within the School who, by virtue of their appointment in the School, are expected to participate in, contribute to, and support patient care, as well as teaching, training, research and administrative activities for a clinical department.

Any appointments or cross appointments of individuals who are members of the Toronto Metropolitan Faculty Association to the School are subject to the collective agreement entered into between the University and the Toronto Metropolitan Faculty Association, and as such are not subject to this Policy, provided such appointment or cross-appointment is not to a Clinical Faculty position.

III. Definitions and Terminology

In this Policy:

a. “Adjunct Appointment” means a status-only appointment in the School.

b. “Alternative Funding Plan” means a customized contractual arrangement between the Ministry of Health (MOH), and a group of physicians, and may involve other organizations, such as hospitals (and other affiliated healthcare organizations recognized by the MOH) and universities, where funding is provided by the MOH to the physician group for teaching and research as part of the group's responsibilities. From time to time, this may require the concurrent application of an Alternate Funding Arrangement.

c. “Attending Physician” means an individual holding the degree of Doctor of Medicine (MD) or equivalent, who is licensed to practice medicine in Ontario by the College of Physicians and Surgeons of Ontario and is actively engaged in the practice of medicine.

d. “Clinical Faculty” means an Attending Physician or Healthcare Practitioner who is eligible to hold an appointment to a clinical staff or substantive clinical administrative position of a hospital, health authority, clinic, clinical care facility, clinical research entity or healthcare/medical practice external to the University, and who is engaged by the School to participate in, contribute to, and support patient care, as well as teaching, training, research and administrative activities for a Clinical Department without expectation of compensation from the University.

e. “Clinical Scholar” means an entry level position in the School for an individual who is still completing academic training (e.g., a Masters or PhD) beyond the completion of their clinical training. This person should be eligible to be an Attending Physician or Healthcare Practitioner.

f. “Contributions” refer to academic contributions which may comprise a combination of: teaching hours, clinical/community service, clinical/community leadership, and SRC activities.

g. “Continuing Appointment" means an appointment in the School that is made at its commencement without a specified end date and which continues until the resignation, retirement, or termination of the incumbent.

h. “Cross Appointment” means an appointment of a Full-time Clinical Faculty Member or a TFA Faculty Member to a unit, other than the unit where the primary appointment is held, for a limited period.

i. "Department” means a clinical department (e.g., Medicine) in the School.

j. “Department Head” means the administrative leader and manager of a clinical department (e.g., Medicine) or a non-clinical unit (e.g., Centre of Excellence in Medical Education) in the School.

k. “Dean/VPMA” means the Dean of the School of Medicine and the Vice-President of Medical Affairs.

l. “Division Director” means the individual who leads a Division within a clinical Department responsible for a specialty or subspecialty recognized by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada, or the individual who leads a designated clinical teaching site.

m. ”DAPC” has the meaning set out in Section IV.B.

n. “Educational Service” means the educational activities that are required for the conduct of an educational program affiliated with the School of Medicine but not manifest as leading in or delivering curriculum as an instructor, facilitator, or participant in a key component of educational operations within learner-facing activities. Examples of this include being an interviewer for MD program admissions, or completing the administrative duties required of being a program director.

o. “Healthcare Practitioner” means a professional holding a professional or equivalent degree, including but not limited to DO (Doctor of Osteopathic Medicine), and MBBS (Medical Bachelors of Medicine and Surgery), or other profession who is fully licensed to practice medicine in Ontario by the College of Physicians and Surgeons of Ontario (or professional equivalent) and is actively engaged in the practice of medicine.

p. "Limited Term Appointment” means a full-time appointment for a specified period of time.

q. “Ministry” is the Ontario Ministry of Health.

r. “Practice Plan” means the document developed by a department (or designates) in compliance with University policies, that reflects the decisions of a department regarding distribution of clinical earnings or professional/academic revenue that accrue from the activities of members of the department, which may or may not include a mandatory contribution to a department or program academic enrichment fund.

s. “Promotion” means a change in academic rank from an initial or lower ranked position to a higher ranked position.

t. "Reappointment" means the renewal of a Limited Term Appointment or an Adjunct Appointment, in accordance with conditions set out by the University.

u. “School” means the School of Medicine of the University.

v. "Senate" means the Senate of the University.

w. ”SAPC” has the meaning set out in Section IV.C.

x. “SRC” means scholarly, research and creative activity.

y. "Toronto Metropolitan Faculty Association" means the certified bargaining unit for tenure-stream faculty, limited term faculty, librarians, and professional counsellors at the University.

z. “TFA Faculty Member” means a faculty member of the Toronto Metropolitan Faculty Association.

aa. “UCAP" has the meaning set out in Section IV.C.

bb. "University" means Toronto Metropolitan University.

IV. Organization and Governance

The following are the primary councils and committees of the School whose establishment and operations are governed by this Policy:

A. Department Appointments and Promotions Committees

Each Department shall establish a Department Appointments and Promotions Committee (“DAPC”) in accordance with the Procedures. DAPCs will have the mandate for the recruitment and recommendation for hire of all Clinical Faculty within the Department. Each DAPC shall determine its own decision-making process (e.g., by consensus rather than a vote) and for ensuring equitable processes which are mindful of managing/mitigating conflicts of interest and adhere to the Procedures.

B. Procedures Appointments and Promotions Committee

The School shall establish the Appointments and Promotions Committee (“SAPC”) in accordance with the Procedures. The SAPC will have the mandate to ensure that individuals put forth for appointments and promotions within the School are accurate and robust, yet sensitive to structural inequity or other issues (personal or systemic) that may alter the career trajectories of individual clinical faculty members. The SAPC shall determine its own decision-making process (e.g., by consensus rather than a vote) and for ensuring equitable processes which are mindful of managing/mitigating conflicts of interest and adhere to the Procedures.

C. University Committee on Appeals for Physicians

In the event an appeal from a Clinical Faculty Member is received arising from a negative decision with respect to a promotion, granting of a Continuing Appointment, or review of an appointment, the Dean/VPMA shall strike an ad hoc committee called the University Committee on Appeals for Physicians (“UCAP”) in accordance with the Procedures to hear the appeal. Where possible, members of the UCAP should strive to reach consensus in respect of its decision or recommendation. Where consensus cannot be reached, such decisions and recommendations will be arrived at by majority vote. The UCAP cannot overrule the decisions of the Provost.

V. Rank and Categories of Appointment

A. Academic Ranks

The academic ranks of Clinical Faculty are:

i. Clinical Scholar

ii. Clinical Instructor

iii. Assistant Clinical Professor

iv. Associate Clinical Professor

v. Clinical Professor

vi. Clinical Professor Emeritus/Emerita

as further described in Appendix A. The expected contributions for each rank are set out in the Procedures.

B. Categories of Appointment

Appointments to a Clinical Faculty position can be full-time, part-time or adjunct where:

i. A full-time appointment requires the incumbent to spend at least 60% of their time on educational or scholarly work that advances health, well-being, or communities affiliated with the Procedures. Such full-time appointments may have a contract type that is either a Limited Term Appointment or a Continuing Appointment.

ii. A part-time appointment may be made for an individual who has other commitments that would preclude them from meeting the full-time time commitment. Such part-time appointments may have a contract type that is either a Limited Term Appointment or a Continuing Appointment.

iii. An adjunct appointment is a status-only affiliation with the University and has limited responsibilities. Adjunct appointments are a Limited Term Appointment. Adjunct appointments via the School may from time-to-time supervise, educate, and conduct SRC and Innovation activities.

The expected contributions for each category of appointment are set out in the Procedures.

Full-time and part-time status reflect separate and distinct contractual relationships between a Clinical Faculty and the University. There is no entitlement to convert between full-time and part-time status. This does not restrict an individual’s ability to resign from a full-time or part-time Appointment and apply for another appointment of different status.

Both full-time and part-time Clinical Faculty may be required to participate in a Practice Plan or Alternative Funding Plan, as outlined in their letter of appointment. Adjunct Clinical Faculty will be exempt from participation in Practice Plans.

The granting of a Continuing Appointment is conditional upon a determination that the position is needed and that the resources are sufficient to support the position. If there are insufficient resources, a Continuing Appointment will not be granted by the University. If the University determines that the resources are sufficient to support a Continuing Appointment, a decision to grant a Continuing Appointment will be based on the record of performance achieved by the candidate in relation to the criteria established.

Failure to renew a Limited Term Appointment does not constitute a dismissal by the University, nor is reappointment guaranteed.

Should an individual’s academic hours fall below the minimums set out in the Procedures then the appointment may change to an Adjunct Appointment.

C. Appointments

The following principles apply to the initial appointments process for faculty members joining the ranks of the School:

i. Clinical Faculty appointments are made through delegated authority to the Provost (or designate) by the President on the recommendation of the DAPC to the SAPC and then the Dean/VPMA. All Clinical Faculty appointments are established and governed by the University through the Office of the Vice-Provost of Faculty Affairs.

ii. All Clinical Faculty appointed under this Policy are required to comply with the policies, rules and regulations of the University, Board of Governors and Senate.

iii. The appointment process for Clinical Faculty is set out in the Procedures.

iv. Except as set out below, the initial rank and category for Clinical Faculty appointments will be either a part-time Clinical Instructor, or a full- or part-time Assistant Clinical Professor.

v. A recent residency or clinical fellowship graduate would typically be appointed as a Clinical Scholar.

vi. Individuals who move from another academic institution to the University may be considered for initial appointment at the equivalent level of their previous institution’s rank on the basis of a recommendation of the Department Head to the Dean/VPMA.

vii. Individuals who move from another academic institution to the University will be eligible to seek an equivalent (or higher) rank at the University in accordance with the School’s promotion criteria.

viii. Any recommendations for appointment at a certain rank shall be supported by a rationale detailed in the Department Head’s covering letter to the Dean/VPMA. The Dean/VPMA will concur with or dissent from the recommendation of the Department Head and/or the DAPC but must suggest an alternative rank to the Department Head that must be explained in the Dean/VPMA’s response letter.

D. Criteria for Appointment

As a condition of appointment as Clinical Faculty an individual must:

i. maintain a valid certificate of registration and licensure for independent medical practice from the College of Physicians and Surgeons of Ontario or other health professional regulatory body provided that an individual holding a restricted license or restricted registration may be appointed to the rank of Clinical Instructor or Clinical Scholar status.

ii. accept and maintain an appointment to the active medical staff of an affiliated hospital or other healthcare organization. Exemptions to this requirement may be granted by the Dean/VPMA where the Dean/VPMA determines that the individual’s ability to undertake their academic responsibilities is not impaired in the absence of such an appointment; and

iii. ensure that they have sufficient malpractice insurance for all areas in which they currently clinically practice (e.g., either in the Canadian Medical Protective Association membership or equivalent level of liability in another entity).

Where a Clinical Faculty Member fails to meet any of these conditions, the University retains the right to terminate the appointment granted. This shall not constitute dismissal.

Clinical Faculty (with the exception of Clinical Professor Emeritus/Emerita) are required to immediately report to their Department Head and the Dean/VPMA any change in:

i. the maintenance of their certification with their professional regulatory body;

ii. the maintenance of their certification with their relevant professional organization, if applicable;

iii. status in respect of their appointment with a hospital/institution or other analogous clinical unit or entity;

iv. their malpractice insurance; and

v. any circumstance that would impede their teaching or scholarly performance.

E. Criteria for Cross Appointments

Clinical Faculty who wish to have an affiliation with a second Department may seek a cross-appointment to engage in scholarly and teaching activities within a Department that is not the Department of their initial appointment.

Where a Clinical Faculty member undertakes a significant amount of clinical duties and teaching activities within a Department that is not the Department of their initial appointment the individual may seek reassignment to the secondary Department.

Upon approval of such reappointments by the new primary Department Head upon the recommendation of the relevant DAPC, the individual would be appointed in the new Department at the same rank as per their previous appointment. Applications for consideration of promotion should always go through the primary Department to which the individual is appointed.

VI. Evaluation, Renewal, and Promotion

Each Clinical Faculty member who is a candidate for renewal or promotion, or the granting of a Continuing Appointment is expected to establish a record of performance demonstrating that the candidate is creating and disseminating knowledge through teaching and SRC, and
providing leadership in accordance with the process set out in the Procedures and the relevant standards detailed in Appendix A.

A Department Head may, on a case-by-case basis, recommend to the Dean/VPMA an individual for consideration for promotion earlier than the minimum required time when the individual has exceeded the criteria sooner.

Clinical Faculty in good standing who hold one or more appointments at other institutions may, upon promotion at another institution, seek similar promotion within the University within the next cycle and may submit the same materials to their DAPC for evaluation.

A. Criteria for Promotion

The performance of an individual with a Clinical Faculty appointment will be considered with reference to the national and international standards within the individual's discipline. A candidate for promotion from one rank to the next rank is expected to have increased quality and impact of academic contributions with each progressive rank.

The four pillars of academic productivity within the School are:

i. Teaching and Educational Service,

ii. Clinical service,

iii. SRC, and

iv. Service and leadership (community service/engagement, educational leadership, clinical leadership).

Each of these pillars are recognized as the primary activities in the assessment and ranking process for Clinical Faculty. Excellence is required in at least two of the four pillars. A Clinical Faculty member’s primary contribution to the University is usually in the form of Teaching and Educational Service.

Aligned with the University’s values around equity, diversity, inclusion and accessibility (EDIA) and the School’s central focus on primary care and generalism, the University will prioritize advocacy, clinical innovation, service, and other community-based work that focus upon these areas.

i. Teaching and Educational Activities
Teaching refers to being engaged in the teaching of School learners (medical students, residents and fellows) or other allied health professionals (e.g., PharmD, nurse/nurse practitioner, genetic counsellors) in a community, simulation, laboratory, or classroom setting as related to their affiliation. When teaching occurs within clinical spaces, it is generally considered clinical teaching. In general, it is expected that those at the Clinical Instructor rank should be engaged in clinical teaching of at least one School learner a year. The criteria for contributions and competent performance in teaching are applied with increasing stringency as experience and rank increases.

In assessing competence in teaching, evidence where applicable will be collected from
evaluations completed by students and residents. Where applicable, peer-to-peer assessments may also be incorporated in assessment of teaching competence. Other competency indicators should include the use or creation and implementation of innovative and constructive teaching methods, the incorporation of EDIA principles and inclusive practice in teaching/learning and student assessment, and the ability to communicate effectively with students and colleagues.

ii. Clinical Service Activities
Clinical competence is expected of all Clinical Faculty (e.g., Attending Physicians and/or other healthcare professionals) affiliated with the School. Clinical activities are expected to progress toward excellence as rank increases. Where available, performance reviews from peers, personal quality improvement projects or reflective activities, and peer evaluations will be incorporated in the assessment of clinical service by the candidate’s Department Head.

The development of special interests, programs of quality improvement, innovation and expertise, recognized by peers and professional associations are important factors in the consideration of promotion. The development and implementation of new techniques, clinical innovations, and novel or new approaches to clinical care delivery will receive significant consideration.

iii. SRC
Aligned with the principles set forth by the inclusive atmosphere at the University around SRC activities, the University will seek to reward and acknowledge innovative, creative, and
impactful SRC activities that celebrate medicine and health in its full capacity. The quality of scholarly activity (inclusive of research) will be based, in the case of abstracts, on the stature of the meetings at which presented (local, provincial, national, international). For publications, quality will adhere to the Declaration on Research Assessment (DORA) criteria and will not be based solely on the impact factor of journals in which papers are published. Instead, those seeking promotion will be asked to select a portfolio of their best works for the direct appraisal of external referees during the promotion process to allow for the opinion of peer experts in the field.

Participation and contributions to the advancement of clinical care (e.g., clinical service development, patient education, quality improvement, or clinical leadership which exceeds minimum job expectations) will be considered significant and important.

Contributions to clinical or educational scholarship in all forms - collaboration in grant contributions, peer review and editing within journals, participation in recruitment of study participants, research/scholarly leadership (e.g., being a local primary investigator for a multi-site trial), presenting/teaching at a beyond-local level, and writing/publishing - will be seen as valuable contributions that shall be acknowledged within the promotions process.

Clinical research activity such as recruitment of patients in clinical trials or acting as local primary investigator or in collaborative studies, will contribute to an individual's eligibility for promotion. To the extent that it may be helpful, adjudication around quality may also includewhich publications are cited in the literature (citation impact), and/or by governments, policy-makers and communities at large (social impact) and through professional recognition as indicated by invitations to speak at professional, community, and/or policy and government symposia, and other educational, professional or community-based meetings. Supportive submissions (e.g., letters of support) from members of the community, government, or a clinical organization composed of peers would also be viewed as evidence of impact.

Creative professional activities (e.g., narrative medicine, graphic medicine, music/dramatic arts related to medicine or healthcare, etc.), journalistic works (e.g., non-fiction, news reporting), free open access medical education (e.g., blogging, vlogging, podcasting, scholarly social media engagement, etc.), innovation work, and other alternative forms of scholarship, including community-based scholarly projects, dissemination and outreach will also be highly valued. For this material to be considered towards eligibility for a continuing appointment and/or promotion this material must adhere to the CPSO guidelines and be adjudicated by the individual’s peers. For example, material regarding health information must be verifiable and supported by available evidence and science and must not be misleading or deceptive.

Indigenous SRC activity is defined as research in any field or discipline that is conducted by, grounded in or engaged with First Nations, Inuit, Métis or other Indigenous nations, communities, societies or individuals, and their wisdom, cultures, experiences or knowledge systems, as expressed in their dynamic forms, past and present. Indigenous research can embrace the intellectual, physical, emotional and/or spiritual dimensions of knowledge in
creative and interconnected relationships with people, places and the natural environment. Indigenous SRC is welcomed and will be rewarded within the School’s policies and procedures.

IV. Service and Leadership

Aligned with our principles around citizenship and community, we are committed to fostering service and leadership in all parts of our School. Service and leadership activities that are within the community, educational/academic ecosystem, or clinical environments will be equally valued. Service and leadership may take the form of:

        ● community service or engagement,
        ● leadership,
        ● administrative service

where:
a) Community Service/Engagement includes service or leadership in the communities affiliated with the School, University and beyond. Special acknowledgement and consideration will be given to those seeking to engage in service work that seeks to close health disparities in structurally marginalized populations. Service or advocacy work that is related to equity-deserving groups is especially important to the Procedures and University. Work related to equity-deserving groups will be considered significant contributions for the purposes of faculty career evaluations and promotions.

b) Leadership and Administrative Service may include the organization, delivery and improvement of educational programming (e.g., curricula and/or courses) or clinical service lines/care pathways or parts thereof; service on regional, provincial, national, or
international, University, or professional organization committees, responsibility for special programs and formal administrative posts. Leadership positions within organizations (the School, University, regional, provincial, Indigenous communities, local communities within surrounding areas near/affiliated to the medical school, or national professional or community-based organizations) will also be considered significant contributions.

B. Performance Standards

The following performance standards apply to the evaluation of Clinical Faculty for promotion:

i. Excellent: Performance that is: a) functioning beyond commendable for their rank and/ or position description, or b) distinguishing and expanding skills and learning opportunities and stewarding people, work and service.

ii. Commendable: Performance that is above Acceptable and considered important towards promotion.

iii. Acceptable: This standard may be recommended when the individual’s performance demonstrates a deficiency in one pillar of evaluation, but performs well in other pillars, or when the individual overall performs below than the average expected for rank but within the acceptable range.

iv. Unacceptable: Performance that is unsatisfactory and unacceptable in two or more pillars.

The evaluation criteria outlined below are not comprehensive, and are intended to provide examples to form a framework that DAPCs can apply during evaluation of a candidate who is seeking promotion. In each of these four categories, leadership will be an independent consideration, as will mentorship, which can occur within any of these four pillars (e.g., learners, mentoring junior clinicians, teachers, scholars, or advocates).

All of the criteria for renewal and promotion should be interpreted with an emphasis on primary care and generalism.

Assessment of all four categories will take into consideration any Ontario Human Rights Code protected leaves or other leaves provided for compassionate reasons.

VII. Discipline and Appeals

A. Suspension and Termination of Academic Appointments

A Department Head may recommend to the Dean/VPMA the suspension or termination of a Clinical Faculty appointment on the basis of the following:

i. The criteria for appointment no longer being met (e.g., no longer teaching);

ii. The suspension or loss of professional licensure and/or clinical privileges resulting in the inability to carry out the duties required;

iii. A failure on the part of the appointee to comply with applicable policies, procedures, protocols or other requirements of the School or the University, and following conclusion of any investigations required by the policy or procedure;

and

iv. A failure to comply with the School's procedures to address a professionalism concern, as outlined in the Schools's Standards of Professional Conduct.

Consistently exhibiting professional conduct is essential for an individual seeking to renew their Clinical Faculty appointments or advance in rank. The Procedures has a strict stance against unprofessional actions and enforces a zero-tolerance approach to any instances of professionalism violations.

For professionalism concerns, the process will follow that outlined in the aforementioned guideline. The Dean/VPMA may suspend a Clinical Faculty appointment or restrict involvement with learners if there is impending and/or during ongoing investigation by professional organizations that may impact the Clinical Faculty appointment in terms of outcomes (e.g., College of Physicians and Surgeons of Ontario).

The University shall not terminate the appointment of an individual holding a Clinical Faculty appointment early, unless there is just cause including but not limited to, gross misconduct, criminal activities, failure to maintain necessary qualifications and privileges, and failure to maintain reasonable competence.

Clinical Faculty who wish to resign their appointment shall provide the Procedures with as much notice as possible (preferably three months) but no less than two weeks’ notice to ensure alternative arrangements for their responsibilities can be made.

B. Removal from Learners without Suspension or Termination
Where there are allegations of mistreatment, misconduct or breaches of professionalism, or breaches of University policies filed against a Clinical Faculty Member, the Department Head with the approval of the Dean/VPMA on recommendation of the Associate Dean/VPMA UGME or Associate Dean/VPMA PGME may temporarily remove the individual from contact with learners while the allegations are undergoing investigation. This would include investigations by the College of Physicians and Surgeons of Ontario, a hospital or health authority, as well as a Procedures and/or University investigation. The Dean/VPMA shall promptly advise the Vice-Provost, Faculty Affairs of any such removal.

The investigation process for mistreatment related to discrimination, racism (including but not limited to anti-Indigenous, anti-Black, anti-Asian), harassment, or sexual violence will follow the process as set out in the University's relevant policies. The investigation process for all other forms of mistreatment will follow the process as set out in the School's Protocol for Defining and Reporting Learner Mistreatment in Medical Education. This must be communicated in writing to the Clinical Faculty Member, outlining the rationale, with a copy of the letter to the Dean/VPMA and Department Head.

Upon resolution of the investigations and where necessary, remedial action completed by the member, contact with learners may be reinstated with written notification to the member in addition to copying the Office of the Vice-Provost, Faculty Affairs.

Disciplinary action shall be consistent with the principles of progressive discipline and procedural fairness, commensurate with the seriousness of the offense. Termination of appointments should not be the first course of action taken to address professionalism concerns, except for egregious cases.

C. Appeal Mechanism
Upon non-renewal, suspension or termination, an individual is privy to a process for appeals which is outlined in the Procedures.

VIII. Conflict of Interest, Competing Interest, Disclosure

A. Conflict of Interest
All Clinical Faculty shall comply with the University’s Conflict of Interest Policy, its related policies, as well as the School’s procedures for Disclosing and Addressing Conflicts of Interest with Learners and procedure for Identifying and Disclosing Conflicts of Interest in Relationships with Industry.

B. Conflict of Commitment
A Full-time Clinical Faculty may engage in external professional activities, paid or unpaid, provided that such activities do not constitute a conflict of commitment or interfere with the member’s responsibilities to the University, subject also to the following conditions:

i. when a Clinical Faculty member’s outside activity involve the use of University facilities, supplies and services, their use shall be subject to the prior approval of the Dean/VPMA or Dean/VPMA’s designate, via the Department Head. Costs for such facilities, supplies or services shall be borne by the Clinical Faculty Member at prevailing rates.

ii. the approval of the use of University facilities may not signify that such activities count as part of the Clinical Faculty Member’s fulfillment of duties to the University; and

iii. that the work conducted does not pose an inherent conflict of interest to the vision, mission, and/or strategy of the University.

If a Clinical Faculty Member plans to undertake a major external activity which has the potential to interfere with their academic duties, the Clinical Faculty Member must disclose the plans and seek approval via the Department Head from the Dean/VPMA or Dean/VPMA’s designate to undertake the activity. The disclosure shall be in writing to the Dean/VPMA and shall include:

i. a description of the nature of the work;

ii. an estimate of the time required to perform the work;

iii. an estimate of the extent, if any, of the use of University facilities, supplies, support staff or students;

iv. a list of any other external activities that have already been approved in that year or which are continuing from an earlier year;

v. an estimate of the impact the activity will have on academic responsibilities;

vi. an outline of actions that have been undertaken to deal with any potential conflict of interest with respect to relations with pharmaceutical and medical device and software industries and companies; and

vii. such other information as may be reasonably required by the Dean/VPMA to make an informed determination on the matter.

The Dean/VPMA or Dean/VPMA’s designate shall evaluate the request, in consultation with the Department Head, to determine the extent to which the activity will enhance or detract from the fulfillment of the academic duties of the Clinical Faculty Member and shall render a decision in writing within ten days. If approval is denied, or offered only on conditions, the Clinical Faculty Member shall be provided with reasons in writing for the decision.

IX. Confidentiality
All members of any committee mandated under this Policy will respect the confidentiality of the committee’s deliberations, consultations and any other relevant committee activities or proceedings. This constraint will also apply to all other individuals who may from time to time be required to appear before or otherwise be involved in the in-camera proceedings of any such committee in the capacity of consultant, counsel or academic colleague, witness or party. Limited exceptions exist to the requirement for confidentiality; for example, where a committee member is required by law or policy to report facts including, but not limited to, situations of harassment or discrimination or racism or where a person is at risk of doing harm to themselves or someone else in the University community.

Appendix A

Description of Academic Roles

The descriptions in this section are provided as examples, and are not meant to be comprehensively exhaustive. The Departmental leadership will evaluate each individual’s contributions based on the applicant’s annual reporting, using this document as a guideline.

1. Clinical Scholar

The rank of Clinical Scholar is an entry-level role given to early career Clinical Faculty Members who are in their first Clinical Faculty appointment. Individuals of this status are considered equivalent to Clinical Instructor in function, however, are expected to be engaging in concurrent training to advance their personal academic goals (e.g., Fellowship/Diploma, MSc, PhD, JD, LLM, etc.). As such, they will be eligible to engage in teaching and supervision of medical students, residents, and fellows or other allied health professionals (e.g., PharmD, nurse/nurse practitioner, genetic counsellors) in a clinical or classroom setting as related to their affiliation, while effectively embedding EDIA-ID in their teaching. This role welcomes those who are from underrepresented groups (e.g., Indigenous or Black scholars) to apply and be supported whilst completing advanced training and may be granted an extension to complete training of up to five (5) years for these individuals.

The following criteria are the expectations of the Clinical Scholar rank:

a. Teaching and Educational Activities

The minimum annual contribution per year for Clinical Scholars is 50 hours. If a Clinical Scholar is able to achieve 300 hours within 3 years (with a minimum of 1 year), they may be promoted directly to Assistant Clinical Professor without being appointed Clinical Instructor provided their academic work is deemed of appropriate quality.

b. Clinical Service Activities

It is an expectation that those at the rank of Clinical Scholar should exhibit clinical contributions for ALL the following items:

i. Maintain clinical competence as professionally mandated;

ii. Maintain a valid license with the College of Physicians and Surgeons of Ontario or other professional regulatory body; and

iii. Maintain privileges granted by a hospital/clinic if providing clinical services within that hospital/clinic.

c. SRC

Not an expectation at this rank, though considered if deemed appropriate by the candidate. Indigenous SRC is welcomed and acknowledged for those who seek to pursue these activities during their time as Clinical Scholars.

d. Service and Leadership

Clinical committee participation or leadership is not an expectation at this rank, though
considered if deemed appropriate by the candidate.

2. Clinical Instructor
The rank of Clinical Instructor is given to those who have decided to focus exclusively on teaching and clinical care as their only areas of focus. Normally, it is expected that Clinical Instructors will seek promotion within 5-6 years to the rank of Clinical Assistant Professor. However, in rare cases Clinical Instructors may choose not to access the promotion process, but may undergo the Continuing Appointment nomination process to maintain their status within the University after three (3) previous re-appointment processes (for a total of 9 years).

The following criteria are the expectations of the Clinical Instructor rank:

a. Teaching and Educational Activities

It is an expectation that those at the rank of Clinical Instructor should be engaged in teaching of medical students, residents and fellows or other allied health professionals (e.g., PharmD, nurse/nurse practitioner, genetic counsellors) in a clinical or classroom setting as related to their affiliation, while effectively embedding EDIA in their teaching. This may include teaching and educational service related to mentoring junior or new colleagues.

b. Clinical Activities

It is an expectation that those at the rank of Clinical Instructor should exhibit clinical contributions for all the following items:

i. Maintain clinical competence as professionally mandated;

ii. Maintain a valid license with the College of Physicians and Surgeons of Ontario or other professional regulatory body; and

iii. Maintain privileges granted by a hospital/clinic if providing clinical services within that hospital/clinic.

c. SRC

d. Service and Leadership

Clinical committee participation or leadership is not an expectation at this rank, though considered if deemed appropriate by the candidate.

3. Assistant Clinical Professor
Most experienced incoming Clinical Faculty are likely to be initially appointed at the Assistant Clinical Professor level with expectations of teaching, SRC, service or leadership activities at a minimum number of 100 hours per year for part-time faculty and 150 hours per year for full-time faculty. Individuals must engage in clinical activities and at least one (1) other pillar, although achievements in all four of the following pillars would be acceptable.

The following criteria are the expectations of the Assistant Clinical Professor rank:

a. Teaching and Educational Activities

It is an expectation that those at the rank of Assistant Clinical Professor should exhibit Teaching/Educational Activities contributions for at least two (2) of the following items:

i. Demonstrated commitment as a teacher, demonstrating satisfactory teaching quality as evidenced by teaching evaluations, peer evaluations; showing sustained effort to facilitate innovative and engaging teaching and education that embodies EDIA-ID;

ii. Demonstrated ability to be a preceptor, involved in developing formal bedside clinical skills, practice oral exams or medical Procedures interviews, or other formal scheduled teaching activities;

iii. May be involved in undergraduate and graduate teaching at the University level;
or

iv. Demonstrated ability to regularly teach within their specialty, helping to mentor, coach, supervise, and teach health care professionals or physicians for a training program.

b. Clinical Activities

It is an expectation that those at the rank of Assistant Clinical Professor should exhibit clinical contributions for most of the following items (items with an asterisk [*] are required):

i. Has developed an area of clinical focus (e.g., an area of enhanced skill or specialization) or expertise (such a new or innovative care approach that improves clinical outcomes) that they can share with learners, peers, or the public;

ii. Is recognized by local or regional peers as a leader or clinician others look to;

iii. Contributes to clinical quality improvement or practice peer review*;

iv. Maintains clinical competence as professionally mandated*;

v. Maintains a valid license with the College of Physicians and Surgeons of Ontario or other professional regulatory body*; and

vi. Maintains privileges granted by a hospital/clinic, if providing clinical services within that hospital/clinic. *

c. SRC

It is an expectation that those at the rank of Assistant Clinical Professor should exhibit SRC contributions for at least one (1) of the following:

i. Has contributed to clinical scholarship (e.g., collaborator on scholarly publications like case reports; recruitment of patients for research, engagement in quality improvement initiatives, clinical policy development, sharing expertise in their area of special focus with learners, peers, or the public);

ii. Engages or collaborates in in-person or virtual presentations, workshops, or abstracts for local, provincial, national, and international meetings, speakerships, rounds, and/or lecture series as a way of representing the University;

iii. Contributes innovations in teaching and/or is engaged in educational scholarship/research and/or critical appraisal activities (e.g., Journal Club);

iv. Collaborates in research studies led by a TFA Faculty Member or a faculty member at another institution;

v. Engages in independent research projects;

vi. Participates in community-based scholarship to decrease health disparities in structurally marginalized populations or service within a community, the Procedures or University;

vii. Engages in Indigenous SRC that enriches the School or another group of importance to the faculty member; and/or

viii. Contributes via creative or innovative routes to advancing clinical medicine and/or the intersection of humanity and medicine (e.g., engages in journalistic activities, Indigenous artistic activities, narrative medicine, graphic medicine or other medical humanities).

d. Service and Leadership

It is an expectation that those at the rank of Assistant Clinical Professor should exhibit service and leadership contributions for one (1) of the following items:

i. Serves on local (hospital, School, University), regional, provincial or national committees (e.g., medical staff association, residency training, site clinical service delivery, etc.);

ii. Engages in teaching administration, coordination (e.g., site clinical preceptor coordinator);

iii. Involvement within regional or remote community-based organizations (including Indigenous communities that are geographically distanced from the University) to advance the health of others; or

iv. Scholarly, innovation, and/or research-related leadership (e.g., leading quality improvement measures, advising or contributing to a new health technology entrepreneurial venture, leading multi-centre trials, serving as the head of a research centre).

An Assistant Clinical Professor who has demonstrated and maintained excellence in the areas of teaching, SRC and clinical and community service with contributions meeting or exceeding the requirements for promotion outlined in the Procedures may be recommended by their Department Head as well as the DAPC, to the Dean/VPMA, to be promoted to the rank of Associate Clinical Professor.

4. Associate Clinical Professor

The rank of Associate Clinical Professor is a career rank and is usually tied to a Continuing Appointment. To continue as a Full-time Clinical Faculty Member achievement of the rank of Associate Clinical Professor is necessary (and achievement of the rank of Clinical Professor is strongly encouraged). On rare occasions, those who are unable to achieve this rank may seek to reapply as Part-time Clinical Faculty Members to allow for better alignment with their
professional goals. Individuals who are being hired from another institution at the rank of Associate Clinical Professor or higher may seek a Continuing Appointment without a probationary period. There is a minimum expectation of 200 hours and/or scholarly contribution equivalent for full-time faculty at this rank, and 100 hours and/or scholarly equivalent for part-time faculty at this rank.

Individuals must engage in clinical activities and at least two (2) other pillars, although achievements in all four of the following pillars would be acceptable. The following criteria are the expectations of the Associate Clinical Professor rank:

a. Teaching and Educational Activities:

It is an expectation that those at the rank of Associate Clinical Professor should exhibit Teaching/Educational Activities contributions via at least two (2) of the following:

i. Recognized as an innovative and/or excellent teacher in the department (e.g., one who embodies EDIA in their educational practice); may have received teaching awards or commendations; has developed courses, curriculum or assessment models;

ii. Regular preceptor in formal scheduled lectures/seminars, practice oral exams, small group learning, seminar learning, simulation learning and clinical experiential learning for students, residents, and/or other healthcare professionals (e.g., interprofessional or interdisciplinary education);

iii. Invited speaker at medical society meetings, interprofessional/interdisciplinary conferences, grand rounds, accredited continuing professional activities locally, regionally or provincially;

iv. Has engaged in, but not necessarily led, education scholarship initiatives (e.g., made national presentations on teaching and learning, and contributed to academic articles on education); and/or

v. Has engaged in continuous quality improvement of their own educational practice via peer observation, portfolio-based assessment, and/or 360 evaluations of their educational roles/leadership.

b. Clinical Activities

It is an expectation that those at the rank of Associate Clinical Professor should exhibit clinical contributions for MOST the following items (items with an asterisk [*] are required):

ii. Is recognized as a local or regional site lead in an area of focus, be it in primary care or other disciplines (e.g., specialty clinic director or associate director);

iii. Has regularly contributed to clinical quality improvement, practice peer review, or other improvement in clinical practice via clinical scholarship (e.g., development/implementation/revision of practice guidelines at the local, regional, or national level; leadership in accreditation or quality improvement in one’s own clinical discipline);

iv. Maintains clinical competence as professionally mandated*;

v. Maintains a valid license with the College of Physicians and Surgeons of Ontario or other professional regulatory body*;

vi. Maintains privileges granted by a hospital/clinic, if providing clinical services within that hospital/clinic*; and/or

vii. May have received commendation from peers or patients or organizations reflecting a high level of clinical competence and expertise.

c. SRC

It is an expectation that those at the rank of Associate Clinical Professor should exhibit SRC contributions via at least one (1) of these possible routes:

i. Contributing conference abstracts or publications in peer review journals which show impactful clinical-, community-, or policy-relevant work;

ii. Participation in scholarly leadership (e.g., act as a local principal investigator or co-investigator in multi-centre clinical trials; mentors learners or junior faculty in project work);

iii. Practice review and clinical quality improvement initiatives resulting in revisions of local/site practice;

iv. Proven track record in teaching innovation and/or education scholarship/research and/or education quality improvement (e.g., accreditation, IQAP);

v. Engages in Indigenous SRC that enriches the School or another group of importance to the faculty member; and/or

vi. Participation in community-based scholarship to decrease health disparities in structurally marginalized populations; and/or

vii. Contributions via creative or innovative routes to advancing clinical medicine and/or the intersection of humanities and medicine (e.g., engages in journalistic activities, Indigenous artistic activities, narrative medicine, graphic medicine, or other medical humanities).

d. Service and Leadership

It is an expectation that those at the rank of Associate Clinical Professor should exhibit administrative and/or community service via at least one (1) of these possible routes:

i. Active leader of university, hospital, provincial or national committees or societies (e.g., Clinical Faculty Affairs Council, Patient Safety Committee, councils, boards, or council member of provincial organizations at a minimum);

ii. Teaching administration, coordination (e.g., site clinical preceptor coordinator);

iii. Engagement within regional or remote community-based organizations (including Indigenous communities that are geographically disparate from the University) to advance the health of others; or

v. Participate in community engagement to decrease health disparities in structurally marginalized populations or service within the Procedures or University.

An Associate Clinical Professor who has demonstrated and maintained excellence in the areas of teaching, SRC and clinical and community service with contributions meeting or exceeding the requirements for promotion outlined in the Procedures may be recommended by their Department Head as well as the DAPC, to the Dean/VPMA, to be promoted to the rank of Clinical Professor.

5. Clinical Professor

The rank of Clinical Professor is the highest rank that the University can bestow to a Clinical Faculty member, and its conferral will be in recognition of high achievement. A candidate for appointment or promotion to the rank of Clinical Professor is expected to have established a record of performance that is substantially greater than the record of performance required to achieve the rank of Associate Clinical Professor. There is an expectation that an individual shall be at the Associate Clinical Professor rank for at least 3 years in total before being promoted to Clinical Professor, unless there are overriding considerations (e.g., promotion to a similar rank at another institution, consideration of an individual’s previous work in the case of those who are newly appointed to the School but have substantial contributions at the Associate Clinical Professor rank or equivalent previously). Individuals who are being hired from another institution at the rank of Clinical Professor may seek a Continuing Appointment without a probationary period.

A Clinical Professor is expected to be recognized nationally and/or internationally for their expertise or have been deemed to have made exceptional contributions that go above and beyond normal leadership or service expectations (at the local level). Although high achievement over a sustained period will be expected of a successful candidate for the rank of Clinical Professor, length of service alone will not be a criterion for promotion.

There is a minimum expectation of 200 hours and/or scholarly contribution equivalent for full-time faculty at this rank, and 100 hours and/or scholarly equivalent for part-time faculty at this rank.

The following criteria are the expectations of those within the Clinical Professor rank:

a. Teaching and Educational Activities:

It is an expectation that those at the rank of Clinical Professor should exhibit Teaching/Educational Activities contributions via at least two (2) of the following possible routes:

i. Has proven to be an enthusiastic, effective and devoted leader in the educational program (e.g., program director, fellowship training director, curriculum/course development) with a demonstrated commitment to creating an innovative, EDI-aligned, and accessible learning environment;

ii. Has engaged consistently in education scholarship (e.g., made national presentations on teaching and learning, and contributed to academic articles on education);

iii. Recognized as an innovative and/or excellent teacher in their discipline (e.g., one who embodies EDIA in their educational practice) as evidenced by national or international-level teaching awards or commendations or nominations or via the developed courses, curriculum or assessment models;

iv. Contributed at the national or international level to scheduled lectures/seminars, pillar-related examination development or delivery;

v. Invited speaker at medical society meetings, grand rounds, accredited continuing professional activities nationally or internationally; and/or

vi. has engaged in continuous quality improvement of their own educational practice via peer observation, portfolio-based assessment, and/or 360 evaluations of their educational roles/leadership.

b. Clinical Activities

It is an expectation that those at the rank of Clinical Professor should exhibit clinical contributions for most of the following items (items with an asterisk [*] are required):

i. Recognized by peers at a provincial, national, or international level as being an outstanding professional who has made significant contributions to the practice of medicine (significant contributions include the improvement of health care delivery including the establishment of new clinical programs, innovative care delivery models, or demonstration of scholarship related to quality improvement);

ii. Regular contributions to clinical quality improvement, practice peer review, or other improvement in clinical practice via clinical scholarship (e.g., development/implementation/revision of practice guidelines at the local, regional, or national level; leadership in accreditation or quality improvement in one’s own clinical discipline);

iii. Maintains clinical competence as professionally mandated*;

iv. Maintains a valid license with the College of Physicians and Surgeons of Ontario or other professional regulatory body*;

v. Maintains privileges granted by a hospital/clinic, if providing clinical services within that hospital/clinic*;

vi. Is considered a role model for others with regards to displaying the qualities of academic clinical citizens within the School including but not limited to: person- centred, culturally respectful, civil, collaborative with interprofessional and/or interdisciplinary colleagues, supportive and encouraging of generalism;* and

vii. May have received commendation from peers or patients or organizations reflecting a high level of clinical competence and expertise.

viii. They must contribute hours or the scholarly equivalent at a similar annual rate to an Associate Clinical Professor.

c. SRC

It is an expectation that those at the rank of Clinical Professor should exhibit SRC contributions via at least one (1) of these possible routes:

i. Consistent contributions to advancing research and scholarship via conference abstracts or publications in peer review journals which show impactful clinical-community, or policy-relevant work;

ii. Participation in scholarly leadership (e.g., principal investigator, co-investigator of peer-reviewed and other research grants);

iii. Practice review and clinical quality improvement initiatives resulting in revisions of regional or multi-site practice OR participation in writing groups for national or international practice guidelines;

iv. Leadership in teaching innovation and/or education scholarship/research and/or education quality improvement (e.g., accreditation, IQAP);

v. Leadership in community-based scholarship to decrease health disparities in structurally marginalized populations or service within a community, the Procedures or University;

vi. Leadership in clinical innovations and practice to improve the healthcare system in meaningful ways to advance patient care within the Procedures (and affiliated healthcare organizations or institutions) or University; or

vii. Contributions via creative or innovative routes to advancing clinical medicine and/or the intersection of humanity and medicine (e.g., engages in journalistic activities, Indigenous artistic activities, narrative medicine, graphic medicine or other medical humanities).

d. Service and Leadership

It is an expectation that those at the rank of Clinical Professor should exhibit academic administration and/or community service contributions via at least two (2) of these possible routes:

i. Has been appointed in a decanal role, chair or divisional director within the Procedures or elected to office in a leading national, or international professional organization;

ii. Has performed administrative or policy functions in the University, locally, regionally, nationally or in a national or international professional organization (e.g., assistant/associate Chair, assistant/associate Dean/VPMA, Director, etc.);

iii. Development or leadership of initiatives pertaining to peer support, clinician wellness, mentorship, and other support activities at a provincial or national level;

iv. Leadership or co-leadership of initiatives within regional or remote community-based organizations (including Indigenous communities that are geographically disparate from the University) to advance the health of others;

v. Consistent track-record of scholarly, innovation, and/or research-related leadership (e.g., leading quality improvement measures, advising or contributing to a new health technology entrepreneurial venture, leading multi-centre trials, serving as the head of a research centre); and/or

vi. Longstanding and/or celebrated track-record of community involvement to advance the health, wellbeing, or education of others within a University affiliated community (e.g., Brampton, University main campus, regional sites).

6. Clinical Professor Emeritus/Emerita

The title of Clinical Professor Emeritus/Emerita recognizes meritorious service to the University by an individual professor retiring from the University. It recognizes the value the individual has earned with the University. Emeriti appointments are not automatic but are initiated by the individual’s Department Head, with recommendations to the Dean/VPMA and Provost.

Eligibility

i. Upon retirement, a Clinical Faculty Member whose service is strongly identified with the University and deemed worthy of continuing recognition, may be recognized with the title of Clinical Professor Emeritus/Emerita.

ii. The individual, at the date of retirement, should have attained the rank of Clinical Professor and should have had at least 10 years of full-time service as a Clinical Faculty Member at the University, although exceptions may be made in special circumstances.

iii. With the approval of the President (or the Board in the case of the President) an appropriate emeritus title may also be awarded to a senior academic administrator who retires from the University after serving one or more terms in the administrative position.

Teaching record, community service, leadership and SRC will be considered in the decision to grant Clinical Professor Emeritus/Emerita status. Those within this rank will not be required to maintain licensure within Ontario or privileges at healthcare organizations.

This recommendation is made by the Dean/VPMA to the SAPC. The SAPC will scrutinize each proposal and either:

i. Support the recommendation and forward it to the Vice-Provost, Faculty Affairs for final approval, or

ii. Not support the recommendation, in which case the decision shall be final.

The Vice-Provost, Faculty Affairs will decide each case on its individual merits.

Notwithstanding the provisions above, if the Vice-Provost, Faculty Affairs believes that a person should not hold the title of Clinical Professor Emeritus/Emerita, in spite of complying with the conditions, they will advise the person of this position, in writing. The Vice-Provost’s decision is final.