Policies and practices that promote faculty retention at AUSOM- a Pilot Study

Objective Faculty satisfaction and retention are one of the key areas that most of the educational institutions are focused. The faculty turnover can hamper the teaching and research goals of the higher educational institutions. A lot of resources involved in the recruitment of faculty including time, it is imperative that higher educational institutions try to keep and retain the faculty members. The attrition rate and turnover of the faculty at Avalon University School of Medicine (AUSOM) are minimal. The objective of this pilot study is aimed at exploring the policies and procedures that are practiced at AUSOM which foster the faculty retention at Avalon. Methods The research study conducted is a quantitative method. The survey form was used to perform the survey, and the questionnaire developed on the Likert scale of one to five. The survey form also included the qualitative questions like to mention the most important factor in retaining the teachers in higher education and open-ended question for further comments. Results Faculty perceived that faculty development activities, student feedback and satisfaction, promotional policies and tenure procedures, research opportunities, attractive salary packages, annual incentives and hikes, working environment, living conditions, and quality of life play a role in retaining the faculty members at higher educational institutions. Faculties are satisfied with these factors, policies, and procedures at AUSOM. Conclusion The policies and procedures that are practiced at AUSOM is the reason for the high retention of faculty members at Avalon. Arja S, Acharya Y, Fatteh S, Fateh A MedEdPublish https://doi.org/10.15694/mep.2018.0000268.1 Page | 2


Introduction
A motivated professor is one of the crucial pillars to have for an efficient and fruitful education in any educational institution. In the past 20 years of education amelioration, teachers are in the center of both problems and solutions of the school. Motivating professors for a high level of performance has been continually a challenge for school leaders.
The factors which can promote the faculty satisfaction and retention at academic institutions include compensation packages, career growth, supervisory support, working conditions, team cohesion, job security, training and development, and organizational culture & policy (Masum, Azad and Beh, 2015). Due to increase in complexity of the work done by the teachers and their involvement in the governance of medical schools, faculty development activities designed to promote leadership in medical education seems essential for the faculty members (Steinert, Naismith and Mann, 2012).
For the past many years, there was uncertainty regarding the funding, healthcare delivery, changing workforce (Bunton and Mallon, 2007), and curricular changes made the medical schools to change their hiring policies and tenure policies. There was also a tremendous evolution of faculty affairs and faculty development offices during the period 2000-2010 (Sonnino et al., 2013).
Faculty turnover can have effects on mission goals, outcomes achieved, teaching and research goals. In most of the higher educational institutions, faculty departure occurs in the first one to three years of joining. Faculty turnover can threaten teaching and research goals (Bucklin et al., 2014). It is challenging to form a standard set of policies and practices that would work equally efficient on the faculty of all education institutes across the globe. Because of the diversity in the faculty, the motivational factors maybe differ from groups to groups. This study enlightens the academic and administrative factors that would influence the motivational levels among the teachers of the institution.

Background
The program at Avalon University School of Medicine is a four-year MD program which requires students spending two years of time for the basic sciences courses on the island, and they spend the rest of the two years in the USA to complete their clinical rotations in various teaching hospitals. There are thirteen full-time and two part-time faculty members in the basic science program and approximately 150 faculty members in the clinical department. The faculty to student ratio in the basic sciences is 1:8. Each faculty member in the clinical program is assigned two students at any point, but no more than three students at one time.
The current mix of faculty (gender, ethnicity, academic discipline) is appropriate for the attainment of institutional educational goals and to the current student body. There is a healthy mix of experienced and younger faculty members that ensures a balance of wisdom and new ideas. The basic science faculty is evenly split between senior professors, associate professors, and junior (assistant) professors. AUSOM faculty demographics are consistent with that of the student population with regards to gender and ethnicity. A total of twelve faculty members departed in the last ten years. The turnover of faculty and attrition rate is minimal at Avalon (on average 1.2 faculty members per year in the last ten years). AUSOM has no difficulty in hiring and retaining faculty.
The process of faculty recruitment at AUSOM considers its mission (Avalon University School of Medicine, 2018) to serve a diverse student body. This policy establishes the commitment to providing all students with a comprehensive medical education. The faculty also emphasizes the development of attributes of professionalism, compassion, honesty, and commitment to serve the local and global community. Candidates for the appointment for faculty positions are expected to demonstrate excellent scholarship, commitment to teaching, research activity, and committee participation. They should demonstrate the ability to work with and respect other members of the faculty. Candidates are also expected to play an essential role in the peer review, selection, appointment, and promotion and tenure evaluations of all new and existing faculties. A doctoral degree, master's degree or Doctor of Medicine degree is required for faculty appointments. AUSOM policy states that clinical faculty must be board-eligible or board-certified in their specialty.

Faculty Search Committee
Once the vacancy for a full-time faculty position is identified, the president appoints an Ad Hoc faculty search committee which consists of three members. The administration appoints two members, and one member is appointed from the faculty senate. This committee is charged with the responsibility of reviewing and recommending a suitable candidate. The president's office is responsible for the advertising process.
Upon completion of a search and screening process (either through phone interviews, personal interviews, or both), the committee will make its recommendations in writing. Supporting data should include the following; the candidate's credentials, evaluations, and transcripts, written testimonies of the candidate's performance and calibre submitted by academic colleagues, administrators, or supervisors with which the candidate was closely affiliated in a previous occupation and the list of publications of which the candidate has authored or participated in or scholarly activity in the field of interest. The committee's recommendations are forwarded to the associate dean of basic sciences/dean of clinical sciences for review and approved by the executive dean. The president notifies the name of the selected candidate to the board of trustees.

Role of faculty members in governance at AUSOM
The AUSOM faculty has the direct responsibility for decisions related to the medical education program. Faculty members serve on the following committees: continuous quality improvement (CQI), admissions, curriculum, research, promotions, and disciplinary. Faculty members correspondingly provide additional input by serving on the faculty selection and promotion and tenure committees. The department chairs and basic science faculty comprise the faculty senate. The executive dean relies on the advice of the faculty senate for many important issues as needed. Additionally, faculty participation is proven significant in establishing policies and procedures through the faculty senate (combined basic and clinical science meetings).

Methods
We did a cross-sectional survey study among the faculty and administrative members utilizing the online survey. Only the current faculties and administrative members were included voluntarily for the participation. All basic sciences faculty members and administrative members, a total of seventeen members, received the survey form. Thirteen full-time faculty members in the Basic Sciences program including executive dean and associate dean of basic sciences received the survey form. The other four administrative members who received the form are clinical dean, chief operations officer, associate dean of admissions, and the president. The survey was anonymous and approval was obtained from the Research and Ethics committee, AUSOM.
The survey was conducted using the fourteen quantitative and two qualitative questionnaires (1 open and 1 closed). The quantitative questions were formulated using two different types of Likert scales and response converted into continuous variables for analysis (1 to 5). Data analyzed using Stata 15 (©Stata corp). Mean, Median, IQR, CI, and SEM were calculated for each quantitative question. The response to the qualitative questions is included directly "as it is" to maintain its significance. with the scale reliability coefficient of 0.92. The validity of the questionnaire is verified internally by the continuous quality improvement committee of the university.

Results/Analysis
We received 14 completed surveys (82.35% response rate) from the faculties and administrative staffs. The first sets of 8 questionnaires were based on the Likert scale, responses within: strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). The response was tabulated and analyzed for the distribution pattern (Table-1). Similarly, statistical analysis was performed for its significance (Table-2    The second sets of 6 questionnaires were based on the Likert scale, responses within very ineffective (1), ineffective (2), neutral (3), effective (4), and very effective (5). The response was tabulated and analyzed for the distribution pattern (Table-3). Similarly, statistical analysis was performed for its significance (Table-3).

Qualitative:
The faculties and administrative staffs were also asked to mention the most important factor in retaining the teachers in higher education. Faculty development activities in teaching, assessment, and evaluation methods (n=4/14) and Similarly, one of the suggestions was: "A kind and friendly environment with nonjudgmental leaders who are easily accessible should also help."

Discussion
Faculty development activities have shown changes in the behaviours of faculty members and they are valued by the faculty members (Steinert et al., 2006). Avalon University School of Medicine has given great importance for the faculty development activities. Opportunities for faculty members to participate in professional development programs to enhance their teaching, research skills, and knowledge within their discipline or career advancement are available.
AUSOM offers a series of programs to enhance teaching, and to develop evaluation and assessment skills. The examples of programs available are essential skills in medical education (ESME) and ESME-assessments offered by International Association of Medical Education in Europe (AMEE), and other courses which can enhance the skills in research methodology. AUSOM also supports the faculty attending seminars, and continuing medical education (CME) programs. Faculty perceive that availability of faculty development activities is one of the most important factors in retaining the teachers (table 2; question1; mean is 3.71, median and mode are 4). Faculty are satisfied with the availability of faculty development activities at Avalon (table 4; question 9; mean is 4.21, median and mode are 4).
Student satisfaction and feedback is another most significant motivating factor for faculty members. But the literature has shown that multisource evaluation and evidence collected through online administration, when possible, can provide a solid base from which justification can be made to fair and transparent decisions about faculty contract renewal, annual incentives, and promotion and tenure (Berk, 2013).
The student evaluations of faculty members at Avalon are conducted through online survey forms every semester which covers teaching methods, assessment methods, and feedback provided by the faculty members to students. The students evaluate the following teaching skills: demonstrates in-depth knowledge of the subject, organizing the presentations and teaching methods, stimulated the student's interest in the topic, using classroom time and space appropriately, utilizing variety of teaching methods including group discussions, encouraging discussions and questions, and accessibility to the students outside the class. Faculty at Avalon sees student evaluation, and feedback is one of the most important factors to retain the teachers in higher education (table 2; question 2; mean is 3.71 and median and mode are 4 and 5 respectively). Faculty members are satisfied with the way student evaluations are conducted and the way they are receiving the feedback at AUSOM (table 4; question 10; mean is 4.29 and median and mode are 4.5 and 5 respectively).
There is growing evidence that academic institutions are redefining the definition of scholarship due to changes in the health care services and changes in the relationships between universities and medical schools ( Barchi and Lowery, 2000). Some medical colleges are revising the appointment, promotion, and tenure procedures to incorporate an expanded definition of scholarship (Nora et al., 2000).
The promotion and tenure policies at Avalon are transparent and straightforward. AUSOM published its standards of promotion and tenure in faculty handbook which are approved by the faculty senate and the board of trustees. The faculty is ranked in the order junior lecturer, senior lecturer, assistant professor, associate professor, and professor. Tenure-track can be given to the faculty who worked continuously for four years at Avalon, and it can be granted based on the contributions in teaching, research, and university activities. The recognition of tenured status is based on the academic accomplishments of the professor/associate professor, distinguished committee services, extent of institutional commitment and continual, creative endeavours on a long-term basis.
The faculty retention, promotion, and tenure committee which is composed of three faculty members reviews all relevant appointments. After that, this committee recommends the academic rank of all appointees. Promotions are based on merit and performance as well as on comparable work in the candidate's field of interest. The faculty retention, promotion, and tenure committee assess the adequacy of the evidence submitted. In evaluating the candidate's qualifications, the faculty retention, promotion, and tenure committee exercise reasonable flexibility. Effective teaching is an essential criterion for appointment or advancement. But in addition to teaching, scholarly work, contribution to the university standing committees, involvement in the school's growth and commitment are considered at the time of advancement and promotion.
The decision of the committee will be forwarded to the Executive Dean and the President for final approval. Faculty sees that effective promotional policies and tenure procedures are one of the most important factors in retaining the faculty members at higher educational institutions (table 2; question 3; mean is 3.50 and median and mode are 4). Faculty are also satisfied at AUSOM with the availability of effective promotion and tenure policies, and they are effectively implemented (table 4; question 11; mean is 4.07 and median and mode are 4).
Faculty also perceives research opportunities and involvement in research activities as one of the factors to retain the faculty members in higher education institutions. Faculty at Avalon sees that availability of research opportunities and allowing the teachers to attend educational/ professional development conferences, and seminars are one of the most important factors in retaining the teachers in higher education (table 2; question no.4; mean is 3.64 and median and mode are 4). Faculty are satisfied with effective policies are in place to participate in research and to attend educational conferences/seminars at AUSOM (table 4; question 12; mean is 4.29 and median and mode are 4). AUSOM fully supports the research activities and projects approved by the research and ethics committee of the university.
Facilities available on campus, salary packages, annual incentives offered, and promotion and tenure procedures are firmly believed to account for faculty dissatisfaction (Seraj et al., 2014). Faculty at Avalon perceive that effective salary packages (table 2; question 5; mean is 3.86 and median and mode are 4) and annual incentives and hikes (table 2; question 6; mean is 3.50, median and mode are 4) are considered as important factors in retaining the faculty members in higher education. Faculty at AUSOM are satisfied with salary packages offered (table 4; question 13; mean is 3.79 and median and mode are 4) and annual hikes and incentives (table 4; question 14; mean is 3.86 and median and mode are 4).
The associate dean of basic sciences and executive dean evaluate the faculty members at the end of the year. This evaluation is considered during annual review for the incentives and salary hikes of the faculty members. The executive dean's evaluation is based on the students' evaluations, teaching methods, and effectiveness of teaching. Updates of the syllabus, course materials, and learning objectives, involvement in research and contribution to committees are also considered. A copy of this evaluation will be given to faculty members.
Faculty at Avalon also perceives that working environment, living conditions, and quality of life play a role in retaining the teachers in higher education (table 2; question 7; mean value is 4.00, the median is 4 and mode is 4 & 5). They are overall satisfied with the working environment at Avalon and living conditions, and quality of life on the island of Curacao is promoting the retention of teachers in higher education ( This study is conducted among the faculty members of basic sciences (biomedical courses) and administrative members. The survey was sent for a total of seventeen members (thirteen faculty members and four administrative members who are also involved in either teaching or recruitment of faculty members). Total 14 forms are filled by the members voluntarily (82.35% response rate). Even though the response rate is high, relatively the sample size is small. But the policies and procedures that are practiced at Avalon can be replicated at larger institutions.

Conclusion
A total of twelve faculty members left the basic sciences program of Avalon in the last ten years. Out of them, seven faculty members worked at least for seven years at Avalon which is noteworthy. As mentioned in the background, faculty turnover and the attrition rate are minimal. The reasons for the high retention of faculty members at AUSOM are opportunities available for faculty members to participate in professional development to enhance their teaching, research skills, and knowledge within their discipline or career advancement. Opportunities are available to the faculty members at Avalon to receive feedback from students and the dean periodically. The other factors are promotional policies in place for the faculty members, and tenure-track positions are granted for the faculty members who meet the requirements as mentioned in the faculty handbook, annual incentives are given to the faculty members based on their performance and fair compensation.

Take Home Messages
Faculty development activities enhancing the skills and competencies of faculty members in teaching, assessment methods, and research methodology is the key factor in retaining the faculty members.
Opportunities to the faculty members to receive the multi-source feedback from students and the administration are also a key factor in retaining the faculty members. Well-placed and implemented promotional and tenure policies also promote faculty retention. The other factors which play a role in retaining the faculty members are working environment, living conditions and quality of life, and effective salary packages including annual incentives.