Enhancing equity in academic surgery promotion practices.

Background: Black, Indigenous, People of Color (BIPOC) in medicine and women faculty have lower 10-year promotion rates than their White and male peers, despite controlling for productivity metrics. Promotion standards vary across institutions, but there is likely a common need to improve transparency and consistency while mitigating bias, inequity, and the harm of additional equity work that is commonly expected of Black, Indigenous, People of Color and women faculty (the so-called minority tax).

Methods: A promotion advisory committee consisting of clinical and research faculty at all ranks specified expectations for a faculty member at the associate or full professor ranks, with 10-15 examples given for each "mission" (clinical, research, and education). A standardized promotion criteria guide for assistant and associate professors (junior faculty) was created. Achievement of approximately 15 criteria across all categories is needed for promotion. In addition, a new domain of "advocacy, community service, and social justice" was created to supplement consideration of promotion readiness but not to serve as the sole criterion. Junior faculty completed a self-evaluation informed by the aide, which was reviewed at a meeting between the division chief and the promotion advisory committee, and later by the division chief and the faculty member to discuss promotion readiness based on promotion advisory committee feedback. In the second year of this process, division chiefs and junior faculty were sent a web-based survey (REDCap) of sliding scale questions (1: no utility and 100: maximum utility) to assess their perspective on the value of the aide and expanded criteria with respect to standardization and fairness in the promotion process. Subgroups were compared via a Wilcoxon rank sum test.

Results: Thirty-two of 54 junior faculty completed the self-evaluation for a second consecutive year and elected to evaluate the new promotion process. The response rate was 59.3%. Responses were compared according to subgroups: Black, Indigenous, People of Color versus Non-Black, Indigenous, People of Color, women versus men, and time of anticipated promotion. The majority of junior faculty felt that the process was helpful in promotion planning and increased standardization. In addition, junior faculty felt that the added domain adequately acknowledged the contribution to service outside of education, clinical excellence, and research. There was no significant difference in the perception of the new promotion process by gender or race. Black, Indigenous, People of Color faculty found that it helped to make the promotion process more predictable (P = .068); however, it may be considered unduly time-consuming (P = .084). Women felt that the promotion process was generally improved with the addition of the process; however, they were more likely to feel that it was less beneficial for gender equity/parity than male faculty members (P = .34). Women represented faculty with a lower average clinical Full-Time Equivalents (P = .018). Those faculty with an upcoming anticipated promotion in the next year found that the process was helpful in the yearly discussions between a junior faculty member and a division chief (P = .057). The division chief survey response rate was 83.3% (10/12), and all of the chiefs participated in a meeting with the promotion advisory committee. Division chiefs reported that the intervention made the promotion process more standardized and equitable, without undue time burden.

Conclusion: The University of Chicago's publicly available promotion aide and faculty evaluation process was well received and is a potential model for other institutions seeking to improve equity in their promotion process.