It is never too early to start preparing for promotion. As you settle into your first job, make sure that you clearly understand the requirements for promotion.
Requirements differ from institution to institution, and between tracks in a single institution. Just as medical specialties differ, the job description for a junior faculty member and the expectations for promotion may be a bit different for you, as a surgeon, than they are for a colleague in pathology, for example. Make sure that you know what your department chair expects and, if necessary, seek clarification from the Dean of Faculty.
The typical first promotion requires clinical excellence, and some sort of academic and teaching record. It also requires the beginning of regional and even national visibility.
Some of these things are easy to track. Obviously, you will keep a record of grants, scientific presentations and publications. But it is easy to overlook some other things. Don't make the mistake I made! When I was put up for promotion from Assistant to Associate Professor, I had a good record of publications and had gotten my first grants. I had letters of recommendation from outside individuals. The promotions committee sent my dossier back with the question, but what teaching activities does she have? Fortunately, I had kept a record of medical student lectures and small group sessions and was able to provide ample documentation within a day or two. I was promoted that year without difficulty.
Things you should do:
Fulfill and exceed expectations, and maintain a file documenting your accomplishments
Keep copies of evaluations from patients, students, and residents
Keep a list of all the presentations you give, including those to lay audiences
Keep copies of any teaching materials (slide sets, videos) that you have developed for educational purposes
Keep a list of all formal education presentations (lectures, small group sessions)
Make contact with more senior individuals at other institutions
The easiest way to do this is by simply starting a file, or a series of files, and setting materials aside as you work.
Making contact with more senior individuals at other institutions is crucial, not only for networking, but because these people can then be asked to write letters of recommendation. Many junior faculty members do not realize that letters from people who trained you or who are collaborators in research may be discounted by the promotions committee.
The ideal letter of recommendation for you should:
Come from a person more senior in rank at another institution of comparable or higher prestige
Attest to the quality of your work without being a collaborator or formal mentor
Put your work (or patient care, if you are on the clinical track) into context
Compare your work favorably with those promoted at their own institution
If you are on a clinical track, letters may come from referring physicians around the region (and from referring physicians in your own institution).
Finally, start thinking about your goals and philosophy. You will probably be asked to write a personal statement. It is never too soon to think about what you are trying to accomplish. The vision you articulate early in your career can help shape your future.