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Community engaged scholarship__is_faculty_work_in.2

  1. 1. Featured Topic ArticleCommunity-Engaged Scholarship: Is FacultyWork in Communities a True AcademicEnterprise?Diane C. Calleson, PhD, Catherine Jordan, PhD, and Sarena D. Seifer, MDAbstractSince Ernest Boyer’s landmark 1990 re-port, Scholarship Reconsidered: Prioritiesof the Professoriate, leaders in highereducation, including academic medicine,have advocated that faculty membersapply their expertise in new and creativeways in partnership with communities.Such community engagement can takemany forms, including community-basedteaching, research, clinical care, and ser-vice. There continues to be a gap, how-ever, between the rhetoric of this ideaand the reality of how promotion andtenure actually work in health profes-sions schools.The Commission on Community-En-gaged Scholarship in the Health Profes-sions was established in October 2003with funding from the W.K. KelloggFoundation to take a leadership role increating a more supportive culture andreward system for community-engagedfaculty in the nation’s health professionsschools. The authors prepared this articleto inform the commission’s deliberationsand to stimulate discussion among edu-cators in the health professions. The au-thors define the work that faculty en-gage in with communities, considerwhether all work by faculty in communi-ty-based settings is actually scholarship,and propose a framework for document-ing and assessing community-engagedscholarship for promotion and tenuredecisions. They conclude with recom-mendations for change in academichealth centers and health professionsschools.Acad Med. 2005; 80:317–321.The scholarship of engagement meansconnecting the rich resources of the uni-versity to our most pressing social, civicand ethical problems, to our children, toour schools, to our teachers and to ourcities. . . . I have this growing convictionthat what’s also needed is not just moreprograms, but a larger purpose, a sense ofmission, a larger clarity of direction in thenation’s life as we move toward centurytwenty-one.—Ernest Boyer, Scholarship Reconsidered:Priorities of the ProfessoriateSince Ernest Boyer’s landmark 1990report,1from which the above quote wastaken, leaders in higher education, in-cluding academic medicine, have advo-cated that faculty members apply theirexpertise in new and creative ways inpartnership with communities.1–3In theInstitute of Medicine’s November 2002Report, Who Will Keep the PublicHealthy?, leaders endorsed Boyer’s workby emphasizing the need to shift facultyroles and rewards to support facultycommitment to communities. It recom-mends that academic institutions shoulddevelop criteria for recognizing and re-warding faculty scholarship related toservice activities that strengthen publichealth practice, and that the NationalInstitutes of Health should increase theproportion of its budget allocated to pop-ulation- and community-based preven-tion research.4There is a gap, however, between recom-mendations made by national commis-sions and national governing bodies, andthe reality of how promotion and tenureactually works in health professionsschools. Generating support in academichealth centers for faculty work in com-munities is a challenge for both externaland internal reasons. Externally, the sur-vival of clinical departments and theirfaculty are dependent on the ability tomaintain a combination of clinical andresearch revenues. Other health profes-sions schools, including schools of publichealth, are equally dependent on govern-ment grants and contracts to sustainthemselves. Community-based activitiesare often not consistent with these de-mands for generating extramural sourcesof support.Internally, faculty roles and rewards poli-cies can be barriers to significant and sus-tained faculty involvement in communi-ties.5–7Untenured faculty are more likelyto receive promotion for publishing arti-cles in peer-reviewed journals than fordemonstrating an active commitment toaddressing community problems.5Fac-ulty are thus reluctant to apply their ex-pertise to community-based concerns.8Itis too professionally risky.To address these persistent challenges,the Commission on Community-En-gaged Scholarship in the Health Profes-sions was established with funding fromthe W.K. Kellogg Foundation in October2003. Comprising a diverse group ofleaders from academic institutions, pro-fessional associations, community-basedorganizations, philanthropy, and govern-ment, the commission has been chargedto take a leadership role in creating amore supportive culture and reward sys-tem for community-engaged faculty.In this article, prepared to inform thecommission’s deliberations, we define thework that faculty engage in with commu-Dr. Calleson is assistant professor, Public HealthLeadership Program, School of Public Health,Department of Family Medicine, University of NorthCarolina at Chapel Hill School of Medicine, ChapelHill, North Carolina.Dr. Jordan is director, Children, Youth and FamilyConsortium, University of Minnesota, and assistantprofessor of pediatrics, University of MinnesotaMedical School—Twin Cities.Dr. Seifer is research assistant professor,Department of Health Services, University ofWashington School of Public Health and CommunityMedicine, Seattle, Washington, and executivedirector, Community-Campus Partnerships forHealth, Seattle, Washington.Correspondence should be addressed to Dr.Calleson, Assistant Professor, Public HealthLeadership Program, CB#7469, School of PublicHealth, University of North Carolina at Chapel Hill,Chapel Hill, NC 27599-7469; telephone: (919) 966-1769; e-mail: ͗͘.Academic Medicine, Vol. 80, No. 4 / April 2005 317
  2. 2. nities, consider whether all work by fac-ulty in community-based settings isscholarship, and propose a framework fordocumenting and assessing community-engaged scholarship for promotion andtenure decisions. We conclude with rec-ommendations for change in academichealth centers and health professionsschools.Aligning Institutional Missionwith Faculty WorkIf we want faculty to be involved ͓in com-munities͔ but reward them for other ac-tivities, we are our own worst enemies.—Associate vice provost, public academichealth centerAt the core of any discussion of facultyroles and rewards, as noted by Boyer1andSandmann et al.,9is that faculty workshould be framed within the context ofthe institution’s missions, and measuresof assessment should be developed basedon the actual “work” in which faculty areengaged and to which they are commit-ted. This is especially true for faculty whoare involved in community-based workand whose institution’s mission directlysupports these activities, regardless ofwhether they are all scholarly activities.Thus, just as classroom- and hospital-based teaching, basic science research,and clinical care are critical to the aca-demic health center mission, communi-ty-based teaching, community-based re-search, and community service areequally valuable. In line with the Instituteof Medicine, we believe that community-based work that benefits communitiesand advances the institution’s missionshould count more significantly than itcurrently does toward faculty promotionand tenure decisions.Several health professions schools havecodified these values in their promotionand tenure policies, including the De-partment of Family Medicine and theSchool of Public Health at the Universityof North Carolina, the University ofWashington School of Public Health andCommunity Medicine, and PortlandState University.10–13Steiner et al.14andSteckler et al.15have published the lessonslearned and the strategies they used tochange promotion and tenure guidelinesin the Department of Family Medicineand the School of Public Health, respec-tively, at the University of North Carolinaat Chapel Hill. (The article by Steiner etal. is in this issue of Academic Medicine.)Portland State University (PSU) has alsopublished its experience with taking acampus-wide approach to promotingcommunity-engaged scholarship.Through intensive internal and externaldiscussions, PSU adopted a clearly articu-lated mission and strategic plan thatguided a series of transformational eventsin the 1990s, including revised promo-tion and tenure guidelines that recognizeand reward faculty contributions to com-munity engagement.16,17The experiences of these and other insti-tutions demonstrate that recognizing andrewarding community-engaged scholar-ship requires changes not only in thewording of policies and procedures, buteven more importantly in institutionalculture. Such changes are only possiblewhen approached from multiple leveragepoints simultaneously.8Defining ScholarshipFaculty are engaged in a range of activi-ties, not all of which should be consid-ered scholarship. Two proposed modelscan help promotion and tenure commit-tees determine whether a given facultyactivity is “scholarship.” Glassick et al.18proposed a model that evaluates facultywork as scholarship based on the degreeto which a faculty member establishesclear goals, is adequately prepared, usesappropriate methods, has significant re-sults, creates an effective presentation ofthe work, and reflects critical activity.Diamond and Adam19suggest a modelfor scholarship that “requires a high levelof discipline-related expertise, breaks newground or is innovative, can be repli-cated, documented, peer-reviewed andhas a significant impact.”Not all faculty work in communitiesmeets these definitions of scholarship. Asa junior faculty physician noted (in a ses-sion at the 2002 annual meeting of theAssociation of American Medical Col-leges ͓AAMC͔20), she provided clinicalcare that is valued by her departmentthrough leadership in an innovative clini-cal program in a poor urban community,yet she struggles to make it have a centralrole in her promotion and tenure portfo-lio. While delivering clinical service aloneis not scholarship, it is critical to advanc-ing her medical school’s mission to pro-vide care to the underserved. However, ifthis same junior faculty member haddemonstrated innovation in clinical prac-tice, potential for replication in othercommunities, documented significantpatient outcomes, and published thefindings in a peer-reviewed journal, thiswork would have met Diamond andAdam’s definition of scholarship.Defining Community-EngagedScholarshipAs a result of Boyer’s effort to expand theframework for scholarship, institutions ofhigher education are using broader defi-nitions of scholarship, encompassing acontinuum of faculty work ranging fromdiscovery, to the integration of discoverywith application, to work that is primar-ily the application of faculty exper-tise.21,22We posit that faculty work incommunities exists along this contin-uum. In this article, we use the term com-munity-engaged scholarship to reflect thisrange of faculty work in communitiesthat meets Glassick et al.’s and Diamondand Adam’s definitions of scholarship.Community-engaged scholarship can applyto teaching (e.g., service–learning), research(e.g., community-based participatory re-search), community-responsive clinical andpopulation-based care (e.g., community-oriented primary care, academic publichealth practice), and service (e.g., commu-nity service, outreach, advocacy).The positive response by the health pro-fessions to this broader conception ofscholarship has been less immediate thanin other parts of higher education. How-ever, it has gained ground recently asschools struggle to respond to the chang-ing health care system and societal expec-tations. The recent status report by theAAMC on faculty appointment and ten-ure, for example, indicates that medicalschools are introducing new facultytracks and career pathways and now rec-ognize a broader range of scholarly activi-ties.23The AAMC has also sought to ad-vance the definition of scholarship inmedical education through the develop-ment of teaching portfolios used in pro-motion and tenure decisions24andthrough a special issue of Academic Medi-cine on scholarship.25Other academic organizations are alsobroadening their views of scholarship. A1999 report of the American Dental Edu-cation Association recommends creatingfaculty tracks for educators and incen-tives for community-based clinicians toteach in dental schools,26and a 2004 re-Featured Topic ArticleAcademic Medicine, Vol. 80, No. 4 / April 2005318
  3. 3. port recommends that dental schoolsencourage a broad range of faculty schol-arship.27The American Association ofColleges of Nursing issued a 1999 posi-tion statement28on the definition ofscholarship in nursing that supports Boy-er’s model, and provides examples of thetypes of documentation needed for eachdimension of scholarship in nursing. TheAssociation of Schools of Public Health’sCouncil of Public Health Practice Coor-dinator’s 1999 Report, DemonstratingExcellence in Academic Public HealthPractice,29encourages schools of publichealth to reconsider the definition andscope of what constitutes scholarship as itrelates to public health practice as part ofthe institutional mission and faculty re-ward structures. While these discipline-specific efforts have served to generate de-bate and discussion, few academic healthcenters or health professions schools for-mally recognize or reward community-engaged scholarship. A framework andpolicy agenda are needed that integratesthis form of scholarship across the clinicaland public health arenas.Assessing Community-EngagedScholarshipThe shift initiated by Boyer regardinghow we define and conceptualize scholar-ship has led to important discussionsregarding how to best assess scholarshipin communities using Boyer’s frame-work.18,21,29,30Several projects through-out the 1990s, supported in large measureby the American Association for HigherEducation, focused on undergraduateeducation and used the term “profes-sional service” and “outreach” to describethe range of faculty work in communi-ties. Most of the resulting policy state-ments emphasize that faculty “work”with communities should be evaluatedbased on a full range of process, product,and outcome measures and should beframed within Glassick et al.’s or Dia-mond and Adam’s model of scholar-ship.18,19With their focus at the under-graduate level, however, these effortshave largely been overlooked by healthprofessions schools.The Association of Schools of PublicHealth’s report cited above focuses onfaculty assessment of academic publichealth practice and is closest to our con-ceptualization of community-engagedscholarship. Academic public health prac-tice is defined as “the applied interdiscipli-nary pursuit of scholarship in the field ofpublic health. The application of academicpublic health is accomplished throughpractice-based research, practice-basedteaching and practice-based service.”29This work, while important, has had littlereach outside of schools of public health,due to use of the term “public healthpractice” and its limited inclusion of clin-ical practice. Maurana et al.31subse-quently drew upon these prior works andexpanded to reflect a language that spansthe health professions. In their article, theseauthors emphasized that “Boyer’s model ofscholarship of discovery, integration, appli-cation, and teaching all apply to commu-nity scholarship, but the principles, pro-cesses, outcomes, and products may differin a community setting.”Process Measures for Community-Engaged ScholarshipThe process involved in collaboratingwith communities is an essential part ofthe methodology of community-engagedscholarship. The collaborative inquiryand the relationships that form betweenfaculty and communities to examine andaddress problems should be an essentialpart of a faculty member’s assessment. Inan evaluative context, these are consid-ered process measures.32Process measureswould be included with the traditionalfocus on products or outcomes such asthe number of publications in peer re-viewed journals and the number of grantsobtained as a principal investigator.Couto33emphasizes that community-based participatory research “requiresthat students, faculty members and com-munity partners listen to one another,deliberate critically about common prob-lems and issues, arrive at solutions tomutual problems creatively in a commu-nity setting, and work together to imple-ment solutions.” Other authors havemade similar observations about the im-portance of including process measuresin a faculty member’s assessment. Mau-rana et al.31noted that “communityscholarship requires the scholar to beengaged with the community in a mutu-ally beneficial partnership. Community-defined needs direct the activities of thecommunity scholar.”It is these process measures that are ahallmark of community-engaged scholar-ship. Process itself can have an importanteffect on community health improve-ment, leading to increased leadership andcapacity by communities for sustainingintervention programs, and determiningwhether communities will continue towork long-term with the faculty member.Often, community-engaged faculty arethe critical link to long-term institution-al–community partnerships.Process measures need a more centralplace in departmental and institutionalpromotion and tenure guidelines. Exist-ing tools on collaboration, partnerships,service–learning, and community-basedparticipatory research can be modifiedspecifically to measure process in com-munity-based scholarship.34,35The as-sessment questions on community schol-arship developed by Maurana et al.31using Glassick et al.’s framework alsohave great potential as process measuresto evaluate faculty.Products of Community-EngagedScholarshipAcademic products as delineated in afaculty member’s curriculum vitae arestill considered the “gold standard” forpromotion and tenure decisions, withpeer-reviewed articles and grants gener-ally regarded as having the highest value.Within a community-engaged scholar-ship framework, the nature and scope ofscholarly productivity and its dissemina-tion needs to be broadened. Faculty com-mitted to community-engaged scholar-ship need to generate products thatbalance “community priorities and uni-versity requirements for knowledge gen-eration, transmission and application.”9We propose three primary types of prod-ucts of community-engaged scholarshipthat together can achieve this balance:peer-reviewed articles, applied products,and community dissemination products.Peer-reviewed articles. The traditionallyaccepted product is usually an establishednumber of descriptive or empirical arti-cles in reputable peer-reviewed journals.These articles communicate to others inthe field lessons learned and descriptionsof innovative programs, and serve as avehicle for documenting research meth-ods and findings. Therefore, this type ofproduct retains its importance in theevaluation of community-engaged schol-arship. An increasing number of peer-reviewed journals over the last decadehave been publishing articles on service–Featured Topic ArticleAcademic Medicine, Vol. 80, No. 4 / April 2005 319
  4. 4. learning, public health practice, and com-munity-based participatory research.36–38Applied products. Applied products fo-cus on the “immediate” transfer ofknowledge into application and serve to“strengthen collaborative ties betweenacademics and practice” and enables fac-ulty to “apply disciplinary knowledge topractice” with communities.39Appliedproducts include innovative interventionprograms; policies at the community,state, and federal levels; training materialsand resource guides; and technical assis-tance. These are products that communi-ties value and that can help improvecommunity health.8Furthermore, as Riceand Richlin40argue, these applied prod-ucts allow practice to “inform and enrichtheory.” These products can be evaluatedfor evidence of scholarship by the extentto which they require a high level of disci-pline-related expertise, are innovative,have been implemented or used, andhave had an impact on learners (if educa-tional in scope), organizational or com-munity capacity, or the health of individ-uals or communities.18,19Community dissemination products.These products of community-engagedscholarship can include community fo-rums, newspaper articles, Web sites, and“presentations to community leaders andpolicy makers at state and national lev-els.”31These products provide valuableopportunities for reflective critique bypeers both in the community and in theacademy.8Impact and Project Outcomes ofCommunity-Engaged ScholarshipIn community-engaged scholarship, “im-pact” encompasses the outcomes of fac-ulty members’ efforts to foster and sus-tain change in communities and in theacademy. Impact occurs through the rela-tionships faculty members develop andsustain with communities (see the pre-ceding process section) and the products(see the preceding products section) thatthey develop together. Measures of im-pact in the community can includechanges in health policy, improved com-munity health outcomes, improved com-munity capacity and leadership, and in-creased funding to the community forhealth-related projects.21,31For the academy, impact can be measuredby the faculty member’s effort to institu-tionalize and sustain a community pro-gram or curriculum with either or bothexternal grants and in-kind institutionalfunding. This level of impact requirescommitted faculty and institutional lead-ership, since institutional systems aregenerally resistant to innovation. Othermeasures of impact address learners. Fac-ulty who incorporate service–learninginto their teaching, for example, can con-tribute to a wide range of educational out-comes including changes in student atti-tudes, career choice, skills, and knowledgerelated to working in communities.24The Challenge and Future ofCommunity-Engaged ScholarshipThe challenge for faculty whose workinterfaces with communities is that“community-based anything takes time,length and breadth.”7Commitment tothe process of developing relationshipswith communities and working throughan iterative process of developing usefulproducts can take years. Further, com-munity and institutional impacts maytake even longer to achieve and docu-ment. These factors all conspire to limit afaculty member’s ability to achieve anddocument the requirements of most pro-motion and tenure policies.Outcomes, however, are important, andfaculty and communities must work to-gether to define reasonable goals and de-velop intermediate outcomes that can behighlighted through each of the types ofproducts we describe above, while work-ing toward achieving and documentingsustained change. Faculty need to be up-front with their community partners,department chairs, and peers about therealities of what is expected of them.They need to negotiate and manage theseexpectations.Regarding the future of community-en-gaged scholarship, Weiser et al.41astutelypoint out that “a university’s values aremost clearly described by its promotionand tenure policy and by the criteria usedto evaluate faculty members.” Accordingto this dictum, most academic healthcenters and health professions schools donot truly value community partnershipsand the community involvement of theirfaculty as central to achieving their insti-tutional missions. Implementing theframework described in this article willrequire leadership on the part of nationalassociations of health professions schoolsas well as individual health professionsfaculty, deans, and department chairs. Asa starting point, we recommend that theleadership of academic health centers andhealth professions schools initiate a dia-logue about the proposed framework inrelation to their institutions’ missions andcurrent promotion and tenure policies.For its part, the Commission on Com-munity-Engaged Scholarship in theHealth Professions is pursuing a numberof strategies designed to influence sup-port for community-engaged scholarship,including engaging key stakeholdergroups, issuing reports and recommen-dations, writing editorials, and makingpresentations.42The commission is dis-seminating an online toolkit that healthprofessions faculty can use to documenttheir community-engaged scholarship forreview, promotion, and tenure decisions.The toolkit includes two main sections: aplanning section that focuses on the roleof mentors, developing one’s vision forwork with communities, and strategiesfor documenting one’s work across theacademic missions; and a faculty portfoliosection that focuses on how to prepare astrong career statement, curriculum vitae,teaching portfolio, and letters from peerreviewers and community partners.43Finally, with support from the U. S. De-partment of Education’s Fund for the Im-provement of Postsecondary Education,Community-Campus Partnerships forHealth has convened a collaborative of 10health professions schools that are workingover the next three years to build capacityfor community-engaged scholarship.44This paper was supported by a grant from theW.K. Kellogg Foundation. The authors thank theW.K. Kellogg Foundation for their deep commit-ment to community-engaged scholarship andtheir support of this work. The authors also arethankful for the helpful suggestions of the facultyin the UNC-Chapel Hill Department of FamilyMedicine and the anonymous reviewers.References1 Boyer EL. Scholarship Reconsidered: Priori-ties of the Professoriate. Princeton, NJ: Car-negie Foundation, 1990.2 Harkavy I. Organizational innovation andthe creation of the American university: TheUniversity of Pennsylvania’s Center for Com-munity Partnerships as a developing casestudy. In: Lerner RM, Simon LAK (eds). Uni-versity-Community Collaborations for theTwenty-First Century: Outreach Scholarshipfor Youth and Families. New York: GarlandPublisher, 1997:275–87.Featured Topic ArticleAcademic Medicine, Vol. 80, No. 4 / April 2005320
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