1. Recognizing and Rewarding Great Clinicians

When Rosalyn Stewart, director of the Johns Hopkins Hospital Substance Use Consultation Service, was promoted to full professor in November 2020, it marked a welcome new day for many faculty members across Johns Hopkins Medicine.

That’s because Stewart was the first to be promoted on Hopkins’ new Clinical Excellence track, which recognizes and rewards faculty members whose professional focus is on providing outstanding patient care.

In the four years since then, more than 100 superlative clinicians from departments throughout Johns Hopkins Medicine have been approved for promotion on the new track — and dozens more are now at various stages of the evaluation process.

“In terms of applications, the pace has really picked up. The Clinical Excellence track is absolutely thriving,” says Hopkins psychiatrist Meg Chisolm, who initially co-led the track’s promotions committee, which is now co-led by ophthalmologist Sharon Solomon and CIM Director David Hellmann.

This momentous step forward, Hopkins leaders agree, can be directly attributed to the foundation laid by CIM’s Miller Coulson Academy of Clinical Excellence, which launched in 2008 with Scott Wright as director.

“At Johns Hopkins, we pride ourselves on doing things rigorously and objectively, but up until the Miller Coulson Academy, there was general skepticism that clinical excellence could be measured in a clear and consistent way,” notes Cynthia Rand, senior associate dean for faculty.

The design of the Miller Coulson Academy reflected nearly two years of research and interviews with experts throughout the country conducted by four Miller Coulson Scholars — Colleen Christmas, Chris Durso, Steve Kravet and Scott Wright — who were supported in their work by a gift to CIM from Johns Hopkins Medicine trustee Sarah Miller Coulson.

The scholars, who published their findings in Mayo Clinic Proceedings in 2008, were inspired by a provocative question asked in 2006 by Mrs. Anne Miller: “Why aren’t there more Dr. Philip Tumultys?” She was referring to a man who had been her doctor, a legendary Hopkins clinician known for his “back-to-basics, humanistic approach to the treatment of patients.” She was concerned that — despite their remarkable success in scientific discovery — academic medical centers were not producing skilled, thoughtful clinicians of the caliber of Dr. Tumulty.

Says Rand: “The Miller Coulson Academy really made a mark, both locally at Johns Hopkins and nationally, by developing a truly rigorous process — including extensive internal and external peer review and objective clinical metrics — for measuring excellence in clinical care.”

Shifting the Culture

While Johns Hopkins Medicine has long operated under a tripartite mission — of research, education and patient care — when it came time to evaluate faculty members for recognition and promotion, excellence in research dominated.

“That means that there were faculty members who were pulled away from their true passion — caring for patients — because they needed to put so much time into research, writing papers and traveling to conferences in order to get promoted,” says Chisolm.

That culture saw a dramatic shift with the establishment of CIM’s Miller Coulson Academy, which has cultivated a community of standout clinicians — now numbering more than 100, from across Johns Hopkins Medicine — since its start 16 years ago.

“Membership in the Miller Coulson Academy has become an aspirational goal for many for whom excellence in patient care is their raison d’être and their passion,” says Wright, holder of The Anne Gaines and G. Thomas Miller Professorship. “Joining the Academy gives one the opportunity to regularly meet with other Academy members — leading clinicians from all across the institution — who are focused on how to provide superb, patient-centered care.” Being elected to the academy is valued so highly that many academy members note their membership in the signature line of their emails.

Importantly, Academy members also serve as role models and teachers to the next generation of physicians by mentoring trainees, presenting at Ground Rounds and through continuing medical education courses.

Each year, only a small percentage of the most respected physicians who are invited to apply to the academy (after having been nominated by many peers) are ultimately offered membership. When building their portfolios, applicants must provide the names of 10 patients, 10 physician peers, 10 learners and 10 nonphysician clinical providers (e.g., nurses and medical assistants) who provide confidential assessments across eight domains of clinical excellence. One key element to the process is external evaluation: Master clinicians from top academic institutions around the country review and score the clinical portfolios that are submitted.

“As the Miller Coulson Academy advanced,” says Rand, “we were able to use its groundbreaking work as part of our rationale in our presentation to school of medicine leaders that yes, indeed, we do know how to measure clinical excellence fairly and to create a rigorous promotional pathway. Without the Miller Coulson Academy, we never would have been able to successfully make that argument.”

The Miller Coulson Academy has also made a significant impact across the broader landscape of academic medicine, with institutions including Ohio State College of Medicine, Columbia University’s Vagelos College of Physicians and Surgeons, and Harvard Medical School adopting aspects of the model for their physician training and faculty promotion.

A Clear Path Forward

When the first round of faculty candidates came up for promotion on the Clinical Excellence track in 2020, Chisolm says, “It brought tears to my eyes to discover top clinicians who had spent decades devoting themselves to the service of patients and their families, and yet they were languishing at the lower promotion ranks. What’s more,” she adds, “they had mentored younger trainees who had gone on to become physician scholars who were recognized and promoted. It was both ironic and startling.”

Now there is a clear path forward for promotion, which begins with a 360-degree review, through which nominees are evaluated by clinical peers, leaders, staff members and learners, as well as from patients and their family members (when applicable). To be promoted to associate professor, applicants must be rated in the top 25% of their field. To attain full professor, they must be rated in the top 10%. Many applicants far exceed those levels, Chisolm says.

Applicants are evaluated based on several domains of clinical excellence. “They must be clinical leaders,” says Chisolm. “Most have built clinical programs, instituting innovations and improvements in the way patient care is provided, and their work is being emulated across the country. Some have established programs in other countries.”

In addition, successful applicants must be actively engaged in teaching the next generation — teaching, mentoring and encouraging young health care professionals and family members. Finally, they must be actively engaged in the mission of discovery, pursuing quality improvement projects or participating as a clinical expert on a scientific project.

“The Miller Coulson Academy really gave us the ‘bones’ for building this new pathway, and we wanted to be very clear that ‘excellence’ is key to how clinicians will be evaluated,” Rand says.

Already the new promotion track is proving crucial to retaining top clinicians who might otherwise have been recruited away to other institutions — and to attracting clinician leaders who previously would not have considered joining Johns Hopkins. “Who wants to go from being a full professor at one institution to being an assistant professor with no real plan for promotion?” says Chisolm. “We saw firsthand how difficult it was for department chairs to recruit outstanding new faculty from outside.”

With the new Clinical Excellence track, the prospects for recruitment and retention have dramatically improved, she says. “There’s a validation that comes with this. You belong here. You are valued. That’s immeasurable.”

The timing of the new Clinical Excellence track “was just about perfect,” says Rand, “because Johns Hopkins Medicine leaders had been thinking about a broad clinical expansion, which means we need to bring in many more outstanding, clinically excellent physicians and offer them a way to build a career here.”

Rand continues, “Not only did the Miller Coulson Academy create the bedrock for the Clinical Excellence track to launch — it has been key to the expansion of clinical excellence beyond the mothership of The Johns Hopkins Hospital. We now have a basis for expanding and growing our clinical faculty and recognizing their clinical excellence.”

She pauses, then adds, “I feel like a proud godparent.”