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The Miller-Coulson Academy of Clinical Excellence at Johns Hopkins Bayview Medical Center
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The Miller-Coulson Academy of Clinical Excellence at Johns Hopkins Bayview Medical Center

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  • 1. The Miller-Coulson Academy of Clinical Excellence at Johns Hopkins Bayview Medical Center
    Scott Wright, MD, Steven Kravet, MD, MBA, Colleen Christmas, MD, Samuel Durso, MD, Kathleen Burkhart, MPA, David Hellmann, MD
    Rationale for the Academy
    Background
    Measurement —The Clinical Portfolio
    • To demonstrate, particularly to trainees and junior faculty, that patient care is valued in academic medicine.
    • 2. To advocate for the busy academic clinician.
    • 3. To generate new knowledge and advance the understanding of related content areas through research.
    • 4. To advance metrics to measure clinical performance at Hopkins.
    • 5. To create a community of collaboration (a ‘Think Tank’) around excellence in patient care; leading to educational and clinical programs.
    • 6. To highlight excellence in patient care as the goal that is to be aspired to – resulting in higher quality care delivery.
    • 7. To improve clinician morale – with hopes for impact upon retention and recruitment.
    Academic medical centers are committed to the tripartite missions of research, education, and patient care. It is not known how to recognize clinicians who spend a majority of their time and excel in caring for patients.
    • The definition was operationalized into a measurement tool, the ‘clinical portfolio’; a 30+ page document assembled by those nominated by peers for membership in the Academy.
    • 8. Select components of the portfolio:
    • 9. Productivity
    • 10. Clinical Draw to Institution
    - Proportion of patients coming from >25 miles & out of state
    • Input from Referees (patients, physician-colleagues, nurses, & trainees)
    • 11. Quality Improvement Initiatives
    • 12. Clinical Presentations
    • 13. Clinical Leadership
    • 14. Interface with Researchers
    • 15. Awards for Clinical Accomplishment
    • 16. The portfolios were evaluated and scored by an ‘external review board’ (akin to a study section).
    • 17. Our experiences have found the clinical portfolio to be discriminative and reliable. There was consensus among the reviewers, and with the internal committee, about those to be accepted for membership in the Academy (this cycle: 9 of the 18 nominees were accepted to become members).
    Defining Excellence in Patient Care in Academia
    Informed by
    Meetings with institutional leaders
    • Department Chairs
    • 18. Deans
    • 19. Promotion Committee Chairs
    • 20. University President
    Meetings with national leaders
    • Professors from top academic medical centers
    • 21. Representatives from ABIM, ACP, NBME, AMA
    Systematic review of the medical literature
    Qualitative studies
    Quantitative studies
    Resultant definition:
    Achieving a level of mastery in the following 6 areas as they relate to patient care:
    i. communication & interpersonal skills
    ii. professionalism and humanism
    iii. diagnostic acumen
    iv. skillful negotiation of the healthcare system
    v. knowledge
    vi. scholarly approach to clinical practice, and
    Exhibiting a passion for patient care, and
    Explicitly modeling this mastery to medical trainees.
    Conclusions
    Academy Members and Programs
    • The scholarly approach and rigor of the work leading up to the launch of the Academy has influenced the tremendous support from stakeholders, particularly institutional leadership.
    • 22. The members of this ‘working’ Academy are committed to the primacy of patient care and to influencing institutional culture.
    Select Programs
    • Annual ‘Excellence in Patient Care’ Symposium
    • 23. Clinical Excellence Blog
    • 24. Research studies ongoing
    • 25. ‘Unknown Case Vignette’ Medical Grand Rounds with Academy members as discussants
    • 26. ‘Excellence in Patient Care’ curriculum
    * We are indebted to the Miller and Coulson families for their generosity, and to the Johns Hopkins Center for Innovative Medicine for their support.