Department of Pediatrics Activity and Progress Report*

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Instructions for completing

the Department of Pediatrics Activity and Progress Report

Revised11/9/2011

The intent of this report is to provide a standardized format for all faculty members to record their activities for the 12-month period indicated on the Report. This information will be used to help assess your progress each year in conjunction with your discussion with your Division Head and with the Department Chair/Vice Chair; it will also be used by the Departmental Promotions Committee at the time of consideration of promotion or reappointment. Please record each activity only once (e.g., lectures given, etc.). Information that is on your CV should not be duplicated here except where indicated. An up-to-date CV in the UW format should accompany this progress report.

Clinical Service: A) Calculate outpatient clinic responsibilities as ½-days per annum; i.e., a weekly full day clinic would be represented as 44 x 2 = 88 ½-clinic days per annum, taking into account 4 weeks vacation, 2 weeks holidays and 2 weeks conferences out of each 52. B) Distinguish between ward team attending (in weeks) and specialty service attending (in weeks). Non clinicians: Leave this section blank.

Teaching: A) Include information on lectures given (title, audience, and location), names of UW courses taught and level of responsibility in the course. B) For faculty who will be submitting a promotions package in 2011, include the name of the five faculty members who will be completing teaching effectiveness evaluations to discuss with your Division Head at your annual meeting. Regional (e.g., WWAMI), National and International teaching activities should be included on CV and not repeated in the Activity and Progress Report.

Administration / Public Service / Advocacy: Include committee membership, offices held in an organization, advisory roles, and quality improvement activities. It is noted that many faculty members are not expected to have administrative or public service responsibilities and thus minimal activity in these areas would not be considered a “deficiency”. Inclusion of this information is used to protect junior faculty members from too heavy an administrative/service/advocacy load and conversely to assure that extensive activities in these areas are acknowledged for senior faculty members.

Scholarly Activity: A) Include grant related activities, projects both funded and unfunded, and funding record so that others can determine if a junior faculty member is making satisfactory progress in becoming an independent investigator. B) State scholarly focus

Mentors: A. Include those individuals whom you consider a mentor and the specific area in which you consider that mentoring is occurring. B. List in the Table pre- and post-doctoral trainees whom you have mentored in the past ten years. This can be for clinical care, teaching, research, career or other areas. Only list individuals for whom you have been engaged in a substantial and meaningful mentoring role. We ask for the last 10 years because this information is important in training grants from the department. If you provided this information, please just update this for the last year. C. List junior faculty whom you have mentored in the past year and the areas in which you have provided mentoring (e.g., "Research" or "Career").

Other: Identify areas of recognition and accomplishment that would otherwise not appear on this form. It is also intended to identify extenuating personal or professional experiences that may have influenced the faculty member’s activity level or progress in the prior year.

2012DEPARTMENT OF PEDIATRICS ACTIVITY AND PROGRESS REPORT*

Name:

Division: FTE:

Pathway (select one):Clinician-Educator

Physician-Scientist

Full Time Clinical Faculty

Research Faculty

Date of Initial Appointment:

Date of Mandatory Promotion (for current assistant professors):

Period of Report: January 1, 2011 through December 31, 2011

What do you feel has been the major impact of your work this year?

What are the accomplishments of which you are most proud?

What are the barriers that you have encountered this past year in trying to accomplish your goals?

1. Clinical Service

1. Outpatient Clinic Attending:

1. Seattle, Bellevue, Federal Way, Everett, Olympia:

1. Regional:

1. Inpatient Attending:

1. Consult Service:

1. Other:

1. Compliments/recognition for clinical care:

1. Goals for Coming Year (if the same as last year, restate them noting that they are the same as last year):

1. I consider that my CLINICAL ACTIVITY: was below expectations ; met expectations ; exceeded expectations

Comments:

1. Teaching

1. Teaching at Seattle Children’s, UW, HMC and FHCRC:

1. Students:

1. Residents:

1. Fellows:

1. Regional (e.g., WWAMI), national and international- Include on CV and do not repeat here; summarize here briefly only NEW activities in the past year:

1. Teaching effectiveness evaluations (for faculty submitting a promotions package in 2010). Names of at least five faculty members (who will be completing these evaluations) to be discussed with your Division Head at your annual meeting:

1. Goals for Coming Year (if the same as last year, restate them noting that they are the same as last year)

1. I consider that my TEACHING ACTIVITY: was below expectations; met expectations; exceeded expectations

Comments:

1. Administration / Public Service/ AdvocacyResponsibilities

1. Hospital (include percent funded effort and immediate supervisor):

B.Division (include percent funded effort and specific activities):

C.Medical School / Department -related (include percent funded effort and immediate supervisor):

1. Local (non-hospital, non-medical school):

E.National/International (include on CV; summarize here briefly NEW activities in the past year):

F.Goals for Coming Year (summarize here briefly NEW activities in the past year):

G.I consider that my ADMINISTRATION / PUBLIC SERVICE / ADVOCACY (select applicable area) ACTIVITY: was below expectations ; met expectations;exceeded expectations

Comments:

1. Scholarly Activity

1. Scholarly focus:

1. Completed Scholarly Activity (e.g., research project, curriculum development, book chapter, etc.):

1. In Progress scholarly activity and “in progress” or “submitted” manuscripts; do not include “in progress” or “submitted” manuscripts on CV:

1. New scholarly activity (planned to start in next 12 months):

1. External & Internal Funding:

Funded – include on CV only

Submitted – Include here

Not funded – Include here (not on CV unless it was really close, good priority score, etc) with priority score and percentile if available, and resubmission plans if applicable

Planned –

F.Goals for Coming Year (if the same as last year, restate them noting that they are the same as last year):

1. I consider that my SCHOLARLY ACTIVITY: was below expectations; met expectations; exceeded expectations

Comments:

1. Mentoring and Areas of Mentoring

1. Indicate the individual(s) who are serving as your mentor (inside and outside the Department):

1. The table below is intended to be a list of individuals for whom you have had a meaningful (not just occasional) mentoring role:

Table: Predoctoral and Postdoctoral Trainees for the Past Ten Years

1. Past trainees
2. Current trainees

1. List the junior faculty for whom you serve as mentor and include the areas in which you are mentoring (e.g., research; career; describe other):

1. Nominations for faculty mentoring award:

VI.Other:

Please return this form to the Chair’s office (via e-mail to: or regular mail: Box 359300/T-0211) no later than March 1st.

* This Activity / Progress Report and the faculty member’s CV will be reviewed by the Division Head and Chair annually, and by the Departmental Promotions Committee at the time of consideration of promotion / reappointment.