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CLINICAL DISCIPLINE NON-TENURE TRACK
PROMOTION FORMS – ACADEMIC YEAR 2017-18
*CANDIDATE’S PERSONNEL & APPOINTMENT INFORMATION MUST BE ENTERED AS LISTED IN BANNER/HR FRONT END*
Candidate: Last Name, First Name & Middle (if applicable)UIN #: UIN #
College: Select College for Primary Appointment
Select Unit Type: Unit Name%FTE:%FTE %
Joint Appointment College: Select Joint College (if applicable)
Select Joint Unit Type: ASDFASDF%FTE: %FTE%
Courtesy Appt. (0%FTE/UNPAID): Select Courtesy Appt. CollegeSelect Unit Type: Unit Name(s)
Present Personnel Appointment:
Rank: Select Rank of Clinical Unit NameJoint Rank:Joint Rank
Tenure Code: Select CodeJoint Tenure Code: Select Joint Code
Appointed or Promoted to Present Rank: Select Month – Year
Courtesy Rank (if applicable): Select Courtesy Rank
Proposed Personnel Action:
Rank: Select Rank of Clinical Unit NameJoint Rank:Joint Rank
Tenure Code: Select CodeJoint Tenure Code: Select Joint Code
Faculty Candidate Attestation:
To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate.
I do not have a conflict of interest or a dual relationship with the Paper Preparer, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures.
Faculty Candidate: Last, First Name & Middle (if applicable)
Name (Print)SignatureDate
Paper Preparer Attestation:
To the best of my knowledge, the information to which I have access that is provided in this dossier (i.e., non-confidential components) is true and accurate.
I do not have a conflict of interest or a dual relationship with the Candidate, as defined by Section 2.F.3 (Voting and Dual Relationships) and Section 3.D (Responsibility for the Case) of the Clinical Non-Tenure System Promotion and Tenure Guidelines, Part I: Campus Policies and Procedures.
Paper Preparer: Last, First Name
Name (Print)SignatureDate
Paper Preparer is also the Unit Executive Officer/Equivalent: YES NO
ENDORSEMENTS: UNIT, COLLEGE, AND CAMPUS
Candidate: Last Name, First Name & Middle (if applicable)
ENDORSEMENTNON-ENDORSEMENT(COMPLETE FOR APPLICABLE REVIEW LEVELS)
Type Name
Unit Executive Officer (U.E.O.)/Equivalent Name/SignatureDate
Type Name
Joint U.E.O./Equivalent Name /Signature (if applicable)Date
Type Name
Regional Dean Name and Signature (if applicable)Date
College Dean or Unit Director Name and SignatureDate
Joint Dean Name and Signature (if applicable)Date
ENDORSEMENTNON-ENDORSEMENT
______
Provost and Vice Chancellor for Academic Affairs Date
ENDORSEMENTNON-ENDORSEMENT
______
Vice Chancellor for Health AffairsDate
Table of Contents
cover Page...... 1
ENDORSEMENT PAGE………………………………………………………...... 2
Table of Contents
ACADEMIC AND EMPLOYMENT INFORMATION
1.Nature of Present Appointment
2.Education
3.Post-Doctoral Information
4.Licensing and/or Certifications
5.Academic & Professional Positions Since Terminal Degree and Post-Doctoral Training
SUMMARY OF COMMITTEE REVIEWS
Voting Justifications
STATEMENT OF COLLEGE NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTY
I. TEACHING ABILITY AND PERFORMANCE
A. ACTIVITIES
1.a. Annual Report of Faculty Teaching Effort – AY14-15
1.b. Annual Report of Faculty Teaching Effort – AY15-16
1.c. Annual Report of Faculty Teaching Effort – AY16-17
2. Graduate Students
2.a. Graduate Student Advising and Supervision at UIC
2.b. Graduate Student Exam Committees at UIC
3. Undergraduate Advising and Supervision at UIC
4. Residents and Post-Doctoral Fellows Supervised at UIC
5. Direction of Research Associates, Visiting Scholars, and Technicians at UIC
6. Contributions to Instructional Techniques, Software and Teaching Materials at UIC
7. Other Teaching Activities External to UIC
B. EVALUATION OF TEACHING AND RELATED ACTIVITIES AT UIC
1. Summary of Student Evaluations of Faculty Teaching.*
2. Formal Recognition of Distinction in Teaching at UIC
3. Candidate's Statement on Teaching Goals, Approaches and Accomplishments
C. OTHER SIGNIFICANT TEACHING RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD
II. RESEARCH/SCHOLARSHIP ABILITY AND ACHIEVEMENT
A. HONORS AND AWARDS ETC SINCE RECEIVING TERMINAL DEGREE
B. INVITED COLLOQUIA AND SYMPOSIA
C. OTHER INVITED PRESENTATIONS (e.g., LECTURES, WORKSHOPS, etc.)
D. OTHER EVIDENCE OF RECOGNITION
E. LICENSING/CERTIFICATION SINCE RECEIVING TERMINAL DEGREE
F. SPONSORED RESEARCH ACTIVITIES
G. PUBLICATIONS, PAPERS, AND OTHER SCIENTIFIC, CREATIVE OR SCHOLARLY WORKS
1. Publications or Other Creative Work Relevant to the Discipline (BEFORE)
2. Publications or Other Creative Work Relevant to the Discipline (SINCE)
3. Work Completed and Accepted for Publication
4. Work in Progress
5. Papers and Poster Sessions Presented at Professional Meetings
6. Other Scientific Contributions, Creative or Scholarly Works
H. OTHER SIGNIFICANT RESEARCH/SCHOLARSHIP RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD
I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED RESEARCH, CREATIVE OR SCHOLARLY WORK
III. SERVICE
A. ADMINISTRATIVE RESPONSIBILITIES
B. SERVICE TO THE DEPARTMENT/COLLEGE
C. SERVICE TO THE UNIVERSITY
D. SERVICE RELATED TO PATIENT CARE
E. SERVICE RELATED TO STUDENTS
F. SERVICE TO THE PROFESSION/DISCIPLINE
G. PUBLIC SERVICE
H. OTHER SIGNIFICANT SERVICE RECOGNITION/ACHIEVEMENT NOT COVERED IN THE FIVE-YEAR PERIOD
I. CANDIDATE'S STATEMENT OF CURRENT AND PLANNED SERVICE ACTIVITIES
IV. CANDIDATE'S STATEMENT OF INTERDISCIPLINARY WORK - OPTIONAL
V. EVALUATIONS
A. PEER EVALUATION OF FACULTY TEACHING
Statement of Unit’s Policy for the Evaluation of Teaching
1.Peer Review of Classroom/Laboratory Teaching
2.Peer Review of Clinical Teaching
3.Letters from Former Trainees/Students and Peers
B. EXTERNAL LETTERS OF REFERENCE
1. List of Referees Contacted
2. Copy of Letter(s) of Request for Referee’s Comments
3. List of all Materials Sent to Each Reviewer
4. Referee’s Information
C. LETTERS OF SUPPORT SOLICITED BY THE U.E.O./PAPER PREPARER (with input from the candidate)
D. LETTER(S) FOR COURTESY APPOINTMENT(S) (IF APPLICABLE)
E. EVALUATION FROM DEPARTMENTAL COMMITTEE
F. EVALUATION FROM COLLEGE P&T COMMITTEE
G. EVALUATION FROM COLLEGE’S PROCESS FOR REVIEW OF CLINICAL NON-TENURE TRACK FACULTY
H. EVALUATION FROM UNIT EXECUTIVE OFFICER / EQUIVALENT
I. EVALUATION FROM DEAN
1.Evaluation from Regional Dean (if applicable)
2.Evaluation from College Dean
ACADEMIC AND EMPLOYMENT INFORMATION
1.Nature of Present Appointment
a.Percentage of time (total UIC employment): 100% Other %
2.Education
a.Highest degree:
b.Year awarded:
c.Institution:
d.Department:
e.Dissertation/thesis title:
f.Thesis Advisor Name:
3.Post-Doctoral Information
(Clinicians should include residency/fellow training.)
a.List Post-Doctoral appointments:
b.Name of Post-doctoral Advisor:
4.Licensing and/or Certifications
Provide a list of all professional licensing and/or certifications with dates.
(If pending, give expected date of completion.)
1)
2)
3)
4)
5)
5.Academic & Professional Positions Since Terminal Degree and Post-Doctoral Training
List in chronological order academic, professional, and other relevant positions held SINCE the terminal degree and Post-doctoral training, with inclusive dates, rank or title, and name of institution. Include information for appointment at UIC and account for gaps in academic career, if pertinent. If necessary, attach extra page(s). It is not necessary to add page numbers in this section.
# / Dates / Rank/Title / Institution/Organization1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
SUMMARY OF COMMITTEE REVIEWS
Candidate: Last Name, First Name & Middle (if applicable)
College: Select College for Primary AppointmentRegional Site: Select Regional Site
Joint Appt. College: Select Joint College
Unit(s): For Joint Appts. List All Units with (%FTE) Next to each Unit
Unit P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Joint Unit P&T Committee Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Joint College or Regional Site P&T Committee Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
College P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
College Executive Committee P&T Review (if applicable):
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Campus P&T Committee Review:
* Give a figure (“0”, if appropriate) in each of the six categories*
Total # of MembersYES NO ABSTAINABSENTNOT ELIGIBLE**
Name of Chair: Signature: Date:
Voting Justifications
**Include brief explanation(s) as to why members were “Not Eligible” (NE) to vote for each level and/or include Voting Justifications if needed, as inserted page(s) in the PDF. It is not necessary to add page numbers in this section.
Committee members are considered Not Eligible (NE) to vote if they have voted at a previous level in the process or if the proposed rank of the candidate is greater than their own.
STATEMENT OF COLLEGENORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
Associate Professor of Clinical Discipline
The Clinical Discipline Track is used in the clinical departments for faculty who are primarily involved in patient care, teaching, and service. To be eligible for this track, a faculty member must be salaried greater than 50% for University-related activities. Primary commitment by the faculty member to College of Medicine programs is expected and frequently demonstrated through contributions to the mission of the department by development of a clinical practice. Faculty in this track are not in the tenure track or tenured and will be required to sign waiver of tenure agreements.
Faculty at the Associate Professor of Clinical Discipline rank should have demonstrated excellence in teaching and patient care programs including development of a high quality and substantial clinical practice. Alternatively, this rank may be used to recognize only excellence in educational activities. In this case not only teaching excellence but also educational leadership and scholarship must be demonstrated by publications about topics such as teaching innovations, curricular development, or development of graduate medical education programs. Faculty should have received local recognition as a clinician and/or teacher.
Promotion of faculty in the Clinical Discipline Track depends primarily on teaching and patient care and on stature in the practice of medicine. Individuals in this track will frequently be key contributors to a department's clinical activities. Promotion to Associate Professor of Clinical Discipline requires clear documentation of excellence in teaching and patient care. Scholarly activity and recognition related to the practice of medicine or education should be demonstrated.
Professor of Clinical Discipline
The Clinical Discipline Track is used in the clinical departments for faculty who are primarily involved in patient care, teaching, and service. To be eligible for this track, a faculty member must be salaried greater than 50% for University-related activities. Primary commitment by the faculty member to College of Medicine programs is expected and frequently demonstrated through contributions to the mission of the department by development of a clinical practice. Faculty in this track are not in the tenure track or tenured and will be required to sign waiver of tenure agreements.
Faculty at the Professor of Clinical Discipline rank should have demonstrated a high level of professional accomplishment in teaching and patient care programs and should be recognized at the regional level for achievement in at least one of these two areas. It is expected that faculty will have developed a high quality and substantial clinical practice. In some instances this title will be appropriate to recognize major contributions in a singular area, such as teaching, administration, or service, especially when these contributions and achievements are broadly recognized either within or outside the University.
Promotion of faculty in the Clinical Discipline Track depends primarily on teaching and patient care and on stature in the practice of medicine. Individuals in this track will frequently be key contributors to a department's clinical activities. Promotion to Professor of Clinical Discipline requires clear documentation of excellence in teaching and patient care. Scholarly activity and recognition related to the practice of medicine or education should be demonstrated.
STATEMENT OF UNIT NORMS, EXPECTATIONS, AND STANDARDS OF EXCELLENCE
**Include Statements for all Ranks within the Clinical Discipline Non-Tenure Track
(Include as separate page(s).It is not necessary to add page numbers in this section.)
If the unit does not have department-specific norms, indicate that the
department follows the College of Medicine Norms.
DESCRIPTION OF COLLEGE PROCESS USED FOR PEER EVALUATION OF CLINICAL NON-TENURE TRACK FACULTY
The College of Medicine does not have a separate process for peer evaluation of full-time clinical non-tenured track faculty at the College level.
**If the department has a separate process, include it below or as a separate page(s).
It is not necessary to add page numbers in this section.
I.TEACHING ABILITY AND PERFORMANCE
For sections 2 through 7, in chronological order, list data for the candidate SINCE the last personnel action. (post-doctoral data may not be included). Note any release time for sabbatical, fellowships or any other reason.
A. ACTIVITIES
1.a. Annual Report of Faculty Teaching Effort – AY14-15
Name: Department:
Date report prepared:
DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sectionscited in parentheses.) / Scheduled
Contact
Hours per
Year / Preparation
Hours per
Year / Total Hours
per Year
1.0 / Course and program planning, organization and coordination
1.1 / Classroom/Laboratory course
1.2 / Clinical clerkship
1.3 / Residency or fellowship
1.4 / Continuing medical education
2.0 / Lectures and seminars
2.1 / Course leading to profession or graduate degree
2.2 / Course for residents or fellows
2.3 / Continuing medical education
2.4 / Course leading to undergraduate degree
2.5 / Course leading to technical certificate
3.0 / Laboratory or other scheduled small group teaching
3.1 / Planner, coordinator, supervisor of the session
3.2 / Supportive role in laboratory or small group session
4.0 / Clinical teaching/attending
4.1 / Undergraduate clinical teaching
4.2 / Resident teaching rounds
4.3 / Combined resident/medical student rounds
4.4 / Ad hoc clinical teaching
5.0 / Research training/independent study
5.1 / Medical student
5.2 / Masters degree candidates
5.3 / Ph.D. candidate
5.4 / Resident
5.5 / Postdoctoral fellow
6.0 / Counseling/guidance
6.1 / Medical or graduate student
6.2 / Resident or fellow
7.0 / Educational committee work
7.1 / Local education committee
7.2 / College/campus education committee
7.3 / Education committee for national organization
8.0 / Curriculum development
9.0 / Other (describe on a continuation page)
TOTALS
Please note: One report for each of the three years prior to review should be provided. Hours attributed to teaching should correspond to the% effort engaged in teaching, and be reported separately from clinical and research time.
(type Faculty Member name here)(signature)(type Dept/Head name here)(signature)
Faculty MemberDepartment/Head
1.b. Annual Report of Faculty Teaching Effort – AY15-16
Name: Department:
Date report prepared:
DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sectionscited in parentheses.) / Scheduled
Contact
Hours per
Year / Preparation
Hours per
Year / Total Hours
per Year
1.0 / Course and program planning, organization and coordination
1.1 / Classroom/Laboratory course
1.2 / Clinical clerkship
1.3 / Residency or fellowship
1.4 / Continuing medical education
2.0 / Lectures and seminars
2.1 / Course leading to profession or graduate degree
2.2 / Course for residents or fellows
2.3 / Continuing medical education
2.4 / Course leading to undergraduate degree
2.5 / Course leading to technical certificate
3.0 / Laboratory or other scheduled small group teaching
3.1 / Planner, coordinator, supervisor of the session
3.2 / Supportive role in laboratory or small group session
4.0 / Clinical teaching/attending
4.1 / Undergraduate clinical teaching
4.2 / Resident teaching rounds
4.3 / Combined resident/medical student rounds
4.4 / Ad hoc clinical teaching
5.0 / Research training/independent study
5.1 / Medical student
5.2 / Masters degree candidates
5.3 / Ph.D. candidate
5.4 / Resident
5.5 / Postdoctoral fellow
6.0 / Counseling/guidance
6.1 / Medical or graduate student
6.2 / Resident or fellow
7.0 / Educational committee work
7.1 / Local education committee
7.2 / College/campus education committee
7.3 / Education committee for national organization
8.0 / Curriculum development
9.0 / Other (describe on a continuation page)
TOTALS
Please note:
One report for each of the three years prior to review should be provided.Hours attributed to teaching should correspond to the% effort engaged in teaching, and be reported separately from clinical and research time.
(type Faculty Member name here)(signature)(type Dept/Head name here)(signature)
Faculty MemberDepartment/Head
1.c. Annual Report of Faculty Teaching Effort – AY16-17
Name: Department:
Date report prepared:
DESCRIPTION OF TEACHING ACTIVITIES(Provide additional detail in the sectionscited in parentheses.) / Scheduled
Contact
Hours per
Year / Preparation
Hours per
Year / Total Hours
per Year
1.0 / Course and program planning, organization and coordination
1.1 / Classroom/Laboratory course
1.2 / Clinical clerkship
1.3 / Residency or fellowship
1.4 / Continuing medical education
2.0 / Lectures and seminars
2.1 / Course leading to profession or graduate degree
2.2 / Course for residents or fellows
2.3 / Continuing medical education
2.4 / Course leading to undergraduate degree
2.5 / Course leading to technical certificate
3.0 / Laboratory or other scheduled small group teaching
3.1 / Planner, coordinator, supervisor of the session
3.2 / Supportive role in laboratory or small group session
4.0 / Clinical teaching/attending
4.1 / Undergraduate clinical teaching
4.2 / Resident teaching rounds
4.3 / Combined resident/medical student rounds
4.4 / Ad hoc clinical teaching
5.0 / Research training/independent study
5.1 / Medical student
5.2 / Masters degree candidates
5.3 / Ph.D. candidate
5.4 / Resident
5.5 / Postdoctoral fellow
6.0 / Counseling/guidance
6.1 / Medical or graduate student
6.2 / Resident or fellow
7.0 / Educational committee work
7.1 / Local education committee
7.2 / College/campus education committee
7.3 / Education committee for national organization
8.0 / Curriculum development
9.0 / Other (describe on a continuation page)
TOTALS
Please note:
One report for each of the three years prior to review should be provided.Hours attributed to teaching should correspond to the% effort engaged in teaching, and be reported separately from clinical and research time.
(type Faculty Member name here)(signature)(type Dept/Head name here)(signature)
Faculty MemberDepartment/Head
2. Graduate Students
2.a.Graduate Student Advising and Supervision at UIC
Check here if none and explain
# / Name of Student / Beginning and Completion Dates / Degree; Thesis Title; Role(Chair, advisor, or committee member)
1
2
3
4
5
6
7
8
9
10
2.b. Graduate Student Exam Committees at UIC
Check here if none
# / Academic Year / # of Committees1
2
3
4
5
3. Undergraduate Advising and Supervision at UIC
Including that related to Honors College. (Service and activities related to student organizations in Section 3, E)
Check here if none
# / Name of Student / Semester and Year / Nature of Advising/Supervision (e.g – independent study, Honors College Capstone, Honors College Fellow work)1
2
3
4
5
6
7
8
9
10
4. Residents and Post-Doctoral Fellows Supervised at UIC
Check here if none