Featured Topic Research Report Publications and Extramural Activities of General Internal Medicine and Medicine Subspecialty Clinician–Educators: A Multicenter Study Robert R. Kempainen, MD, Edward F. McKone, MD, Gordon D. Rubenfeld, MD, MSc, Craig S. Scott, PhD, and Mark R. Tonelli, MD Abstract Purpose Generalist clinician– educators may have more difficulty than specialists satisfying common promotion criteria (peer-reviewed publication and extra- mural reputation). This study compared publication rates and participation in extramural activities among subspecial- ist and generalist clinician– educators, and sought to determine the views of clinician– educators on the use of publi- cation and reputation in determining their promotion. Method A cross-sectional questionnaire was deliv- ered to 526 clinician– educators identi- fied by the chairs at ten randomly se- lected U.S. medical schools in 2002. Results A total of 270 clinician– educators re- sponded. Medicine subspecialist clinician– educators reported more peer-reviewed publications than did general internal med- icine (GIM) faculty (mean 26.4 versus 10.2, p  .003). Independent predictors of hav- ing a greater number of peer-reviewed publications were subspecialty membership (p  .01), less time spent in clinic (p  .01), focus of scholarship (p = .01), aca- demic rank (p  .01), higher quartile of National Institutes of Health funding re- ceived by respondent’s department (p  .01), and years on faculty (p = .03). A greater proportion of GIM faculty reported spending most of their protected time on scholarly activities less amenable to publi- cation (p = .05). A greater proportion of subspecialists felt peer-reviewed publica- tion should be required for promotion (p  .01), but a minority of both groups felt this should necessarily entail original research. Conclusion Subspecialist clinician– educators gener- ate significantly more peer-reviewed publications than do their GIM col- leagues. Clinician– educators hold diverse views on the role of publication and rep- utation in determining their promotion. Acad Med. 2005; 80:238 –243. Clinician– educator faculty play a piv- otal role in patient care and medical edu- cation at U.S. medical schools. Although teaching and patient care are generally believed to be the most important aspects of this position, 1–4 the extent to which clinician– educators should be required to publish in peer-reviewed journals and establish a regional or national reputation to gain promotion is unclear. 1,5,6 Al- though department of medicine and pro- motion committee chairs consider clini- cal and teaching skills the most important aspects of a clinician– educator ’s perfor- mance, 3,4 clinician– educators perceive extramural reputation, clinical research, and other forms of written scholarship as more important determinants of their promotions. 5,7 Clinician– educators in primary care may be particularly disadvantaged in meeting expectations for reputation and publica- tion compared with their specialist coun- terparts. 5,8,9 Some authors believe the work of generalist clinician– educators is less amenable to publication and that generalists have fewer opportunities to lecture outside of their home institu- tions. 5 We found medicine subspecialist clinician– educators in our institution had significantly greater numbers of peer-reviewed publications than did gen- eral internal medicine (GIM) faculty, but we did not identify differences in the time they had available for scholarship. 10 Sub- specialist clinician– educators also were more likely to give lectures outside their home institutions and to hold extramural committee memberships. These results suggest that requirements for peer-re- viewed publication and reputation could result in fewer GIM clinician– educators gaining promotion. Further study, how- ever, was needed to determine the gener- ality of the findings. We performed a multicenter, cross-sec- tional survey focusing on the research, teaching, clinical, and administrative ac- tivities of internal medicine clinician– educator faculty. The roles and expecta- tions of clinician– educators vary substantially between institutions. 1 Our primary objective was to determine whether medicine subspecialist clinician– educators had more peer-reviewed publi- cations and higher levels of participation in extramural academic activities than did GIM clinician– educators and to seek explanations for any observed differ- ences. For this reason, we did not address scholarly activity other than publications, and we focused on clinician– educators who had designated time available for Dr. Kempainen is assistant professor, Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis. At the time of the study, he was a fellow at the University of Washington School of Medicine, Seattle. Dr. McKone is assistant professor, Department of Internal Medicine, University of Washington School of Medicine, Seattle. Dr. Rubenfeld is associate professor, Department of Internal Medicine, University of Washington School of Medicine, Seattle. Dr. Scott is professor, Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine, Seattle. Dr. Tonelli is associate professor, Department of Internal Medicine, University of Washington School of Medicine, Seattle. Correspondence should be addressed to Dr. Kempainen, University of Minnesota School of Medicine, Division of Pulmonary, Allergy, and Critical Care, MMC 276, 420 Delaware Street S.E., Minneapolis, MN 55455. Academic Medicine, Vol. 80, No. 3 / March 2005 238