Laying fears to rest: CFAR & promotion in the COVID era

Back in April, when the COVID pandemic was still “new,” I wrote in my Chair’s Column that, “Academic activities have…taken a backseat to enable full focus on clinical care…" and that we understood that ‘regular’ work has been turned upside down by the pandemic!

This was true then, and is now.

The pandemic has hit us hard — requiring redeployment to manage COVID activities, halting research, closing schools and daycares, and causing tragedy in LTC. The pressure, uncertainty and anxiety has resulted in an overall — and understandable — sense of fatigue.

We are not all feeling the pain to the same extent. As they say, we’re in the same storm, but may be in very different boats.

For those of you approaching Continuing Faculty Appointment Review (CFAR), this may have significantly compounded your anxiety. I want to assure you that the University supports you: we have your backs! 

The purpose of CFAR is simply to determine if you’ve met the terms and expectations set out at the time of your probationary appointment — that is, in the academic plan you completed. And if not, why not?

All academic plans are built around the three pillars of academic medicine: clinical care, teaching and scholarship. A formal mentor is appointed to help you along the way and a one and a half year check-in with the appropriate Vice-Chair is in place to correct issues early.

We have worked hard over the past several years to simplify the CFAR process — clarify what we’re looking for — in brief, we want to know that:

• Our clinician-teachers (CTs) are consistently demonstrating teaching effectiveness;
• Our clinicians in quality and innovation (CQIs) are participating in QI teaching and engaged in QI projects;
• Our clinician-educators and clinician-investigators (CEs and Cis) are on their way to scholarly output (based on research or creative professional activity metrics) — that there is evidence that this work would not have happened without them;
• Our clinician-scientists (CSs) have demonstrated their potential as successful researchers, with grants submitted if not received, and papers published or in press, and;  
• Finally, we want to know that you are conducting yourselves professionally, with colleagues, staff and learners.

We are aware that there are both modifiable and non-modifiable barriers to your academic success. Among the former are mentorship, access to appropriate resources, an appropriate clinical workload and having a position description that is aligned with your strengths and aspirations.

It is for this reason that we implemented the 1.5 year check-ins with new recruits, to review:

• The Academic Plan: are you on track?
• Work-life balance: how are you doing?
• Balance of time (time management)
• Teaching: type, quality, quantity
• Completion of graduate training/Master Teacher Program?
• Research/CPA: focus, productivity, etc.
• Quality/quantity of mentorship

These check-ins appear to be working; the success rate for all position descriptions at three years has improved, although many CI and CS faculty members require a little longer to establish themselves.

The COVID pandemic is non-modifiable! There is no question that, for many of you, COVID has thrown a wrench into your academic career plans. How could it not?

Some of you have been able to pivot your scholarly focus to capitalize on COVID funding, for example with respect to provision of COVID care/virtual care, teaching in the virtual environment, and research regarding risks and consequences of COVID infection.

Some of you have been unable to do much of anything other than keep your clinical activities going. Others of you have been deeply enmeshed in the COVID response and had to abandon almost everything else. For this, we are very, very grateful. 

So please do not worry if this COVID bump in the road — crater in the road — has thrown you off course. We are here to help you get back on track, when able.

Just as we “stop the three-year probationary clock” due to parental leave, illness, or myriad other personal situations, your physician-in-chiefs (PICs), department division directors (DDDs) and I agree that diversion to other activities or inability to perform expected activities due to COVID is also a legitimate reason to “stop the clock.”

If you are up for CFAR in 2022, you will be contacted in the fall and asked if you wish to proceed or defer for a year due to COVID. Tell us what you would like to do. We will review these requests one by one based on your date of appointment and input from PIC and DDD.

The only policy we cannot ignore is that an initial CFAR review must be completed by the time you reach five years on faculty. If the pandemic continues longer than anticipated, this may change, but let’s hope the arrival and rollout of vaccines puts an end to this all soon.

Some of you have also asked about COVID and senior promotion. Since there are no expectations of progression through the ranks at a particular pace, COVID may very well delay time to senior promotion but will not preclude you getting there.

As noted earlier, some of you are fortunate enough to be sailing through this storm relatively unscathed, while others are barely hanging on. In a recent article in the BMJ, the authors reported that the proportion of women submitting first author research papers to journals has declined since the pandemic began. They speculate that these effects of COVID are due to systematic differences in child care responsibilities by gender. Indeed, a recent Nature paper noted that in the US, mothers spend ~ 2X as much time on housework/child care than male partners and that even in gender-egalitarian countries, women still do ~ 2/3 unpaid work. 

Thus, we can anticipate that there will likely be differential impact of COVID on career progression based on many factors, including gender. We will do our best to offset these effects and will revisit our policies and procedures on an ongoing basis as the pandemic continues.

At this point, all we ask of you is to keep safe, keep healthy, be kind and look out for others floating in less stable boats than yours, and continue to bring your best to your patients and learners.

Happy New Year!