“You’re Going to Have This Feeling and It’s Going to Be a Good Feeling”: Why Clinical Affiliate Faculty Pursue Promotion and What They Gain

<b><i>Phenomenon</i></b>: Clinicians employed by hospitals affiliated with medical schools play vital roles in undergraduate medical education. Clinical affiliate faculty (CAF) have opportunities for academic advancement to reward activities aligned with the school's mission, yet many do not pursue promotion. While the challenges underlying these outcomes are well-described, the motivations, expectations, and experiences of those who do pursue and attain promotion remain underexplored. Inquiry into these experiences may reveal actionable facilitators and institutional practices that make promotion more effective in recognizing and sustaining CAF engagement. <b><i>Approach</i></b>: In our roles as faculty affairs deans, we conducted a qualitative study to explore what motivates CAF to pursue promotion and their expectations and experiences of successful promotion. We conducted semi-structured interviews between 2023 and 2024 with 24 CAF from one US medical school who were promoted in rank between 2018 and 2023. We used reflexive thematic analysis to analyze the interview transcripts, and our interpretation was informed by social cognitive career theory and the social cognitive model of career self-management. <b><i>Findings</i></b>: Three overarching themes captured CAF experiences of promotion: (1) intrinsic and extrinsic motivation, (2) symbolic capital, and (3) professional affirmation. CAF motivation to pursue promotion was rooted in their belief that it was an attainable goal,-a belief supported by reflection, empowering social influences, and intrinsic traits. The expectation that successful promotion would position them to advance their own careers and support the careers of others further fueled their motivation. In addition to these anticipated outcomes, successful promotion provided CAF personal fulfillment, validated their contributions to undergraduate medical education, legitimized their identities as clinical educators, fostered a sense of belonging to the medical school, and inspired greater engagement with the school. Importantly, some CAF achieved promotion despite challenges related to their socioeconomic background and their identities as individuals underrepresented in medicine. <b><i>Insights</i></b>: This study expands our understanding of what motivates CAF to pursue promotion and their expectations and experiences of successful advancement. The findings offer insights into how promotion reinforces CAF legitimacy as clinical educators and strengthens their sense of belonging to the medical school, thereby empowering them to contribute meaningfully to the institution. The findings also illuminate practical strategies to improve promotion processes and mitigate the contextual influences of socioeconomic status, gender, and race/ethnicity to ensure all CAF can achieve these outcomes.