Academic tenure, introduced by the American Association of University Professors in 1915, is a status that protects employed faculty members from summary dismissal and, thereby, intends to preserve their academic freedom. Initially tied to financial security through salary guarantees, academic tenure has evolved into a concept associated less with monetary support and strict scholarly productivity than at its inception, primarily owing to the growing number of clinician educators with highly competitive salaries at university-affiliated academic health centers. Achievement of tenure continues to require significant additional time and effort, but modifications in the requisite probationary period and the allowance at some institutions of tenure for part-time faculty have offset some costs, while still maintaining leadership opportunities for the individual and academic benefits for both the individual and the institution. How institutions balance their own financial risk and the demands on faculty members is likely to determine the future of tenure.

This study employed a design-based research methodology to develop a theoretically sound approach for designing instructional treatments. The instruction of interest addressed the broad issue of physician wellness among medical school faculty, with particular emphasis on physician self-diagnosis and self-care. The theoretically sound approach comprised a domain theory and design framework. The domain theory was posited subsequent to an examination of the literature, and subjected to expert examination through three cycles of instructional treatment development. The design framework for crafting the treatment was created from components of existing frameworks, and evolved with the cycles of development. The instructional treatment was designed to be delivered to a web browser from a server using a Python microframework to preserve the anonymity of the end user. Experts in three relevant knowledge domains verified that the instructional treatment embodied the domain theory, and was suitable for use as a practical instructional treatment. Subsequently, a limited-time pilot deployment was initiated among practicing faculty physicians (N=273) to solicit user feedback. Responses were obtained through a survey instrument created for the purpose and hosted on a remote website. Although the response rate was low (12%), the responses were encouraging and useful for guiding future research and treatment development.