Similar to many other academic health centers (AHCs), Penn Medicine, which comprises the Perelman School of Medicine of the University of Pennsylvania (PSOM) and its health system, is challenged to achieve an appropriate balance within its tripartite mission: education, research, and patient care. However, it is also fair to say that at Penn Medicine, as at other AHCs,1 there existed a culture that valued clinicians less than researchers or academic leaders—or at least that was the perception. The Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center was created in 2009 to address a similar issue there.1
This concern came to the fore at Penn Medicine in 2012, with the arrival of a new executive vice president (EVP)/dean, and was crystallized by an institution-wide strategic planning process (SPP) that was launched at that time. Among the several work groups that contributed to the SPP was the Pathway to Clinical Excellence Working Group (CEWG). This group was able to develop a working definition of clinical excellence (available from the authors upon request). In addition, the CEWG called attention to:
- 1) The systemic problems Penn Medicine’s clinicians were facing in their efforts to achieve clinical excellence; and
- 2) The cultural challenges at Penn Medicine in which busy and skilled clinicians were considered less empowered and less highly valued, compared with researchers and academic leaders.
The CEWG submitted a white paper urging Penn Medicine to recognize and value its most outstanding clinicians, to bring them together within a structure that would give voice to Penn Medicine’s clinical enterprise, and to better enable the clinicians so honored to serve as role models for medical students, residents, and faculty.
In this Innovation Report, we describe the development and achievements of Penn Medicine’s Academy of Master Clinicians (AoMC) in the hope that our lessons learned may be of help to other AHCs facing similar challenges. We report on the steps taken to develop the AoMC, the manner in which it functions, and what it has and has not been able to achieve since its inception in 2013. We conclude with a brief discussion of what we believe underlies any success the AoMC has had, and the extent to which it has accomplished its goals and influenced the culture at Penn Medicine.
In response to the white paper, in October 2012, the EVP/dean appointed a leader (J.H.G.) and charged an ad hoc committee comprising past winners of the institution’s previous award for clinical excellence, the I.S. Ravdin Master Clinician Award, to lay the foundation for the AoMC and develop an implementation plan. The members of this ad hoc committee were incorporated into the AoMC as founding members. To begin, a mission statement was crafted as follows:
The Academy of Master Clinicians is the highest clinical honor for a Penn Medicine physician today, and is a commitment to leadership in exceptional patient care at present and in the future. The work of the Academy is to recognize and promote clinical excellence in all entities of Penn Medicine by fostering the highest standards of patient care, with a dedication to the art of medicine, education, professionalism, humanism, collegiality and citizenship.
Thus, from its inception the AoMC was distinct in its focus on clinical excellence, not necessarily on educational scholarship, which is the focus of other academies described in published reports.2,3 Selection criteria (List 1), which operationalized the working definition of a Master Clinician, and the mission statement were developed. Eligibility criteria and a nomination process were established in the spring of 2013. The eligibility criteria stipulated that the nominee must be an active clinician with at least six years’ experience, devoting at least 50% of time to clinical practice, in any of the fully owned entities of Penn Medicine, as well as its academic affiliates. Nominations could come from any faculty member, nurse, or staff member, but most typically from department chairs and division chiefs, and had to include a supporting letter from the chair or chief if he or she was not the principal nominator. Two additional letters of support were required, as was the nominee’s CV and, importantly, a two-page personal statement from the nominee expressing his or her core philosophy on patient care, commitment to professionalism, and other areas relevant to being a Master Clinician.
The program was initially announced in a July 2013 letter sent to all faculty, nurses, and staff from the EVP/dean and the CEO of Penn Medicine, introducing the AoMC and defining the nomination process, with applications due in October of that year. A Web site was also created in 2013.4 Applicants were evaluated by a selection committee (initially composed of the AoMC founding members), relying on a predefined selection process and ordinal rating form (Supplemental Digital Appendix 1, http://links.lww.com/ACADMED/A472). Other criteria promoting the inclusion of all Penn Medicine entities, as well as diversity, were considered. Successful candidates were elected for a five-year, renewable term.
The EVP/dean and CEO announced each year’s elected AoMC members in a yearly e-mail each December to all faculty. An institution-wide special recognition dinner was held for each incoming class in February or March of each year. A one-time financial award of $10,000 was given to every Master Clinician in support of their time to participate in AoMC activities. The program was supported by Penn Medicine and an initial unrestricted philanthropic gift. A fundraising initiative designed to fully endow the AoMC was launched in November 2014, and continues with substantial success. The department chairs were not asked to financially support the AoMC but were encouraged to consider modifying Master Clinicians’ service obligations to enable participation as AoMC members.
Sixty-four applications were received in 2013, and 22 members (34%) were elected into the AoMC. This inaugural class was announced in November 2013 and held their first monthly meeting in January 2014. In 2014 and 2015, 46 and 50 applications, respectively, were received, and 14 (30%) and 17 (34%) members were inducted. Over the first three years a total of 160 applications were received, and 53 (30%) were elected to the AoMC. Thus, to date, 2% of all 2,111 full-time Penn Medicine faculty, excluding the research track, have been elected to the AoMC. Most of the AoMC members were in one of the two clinical tracks at Penn Medicine (clinician–educator and academic clinician). The majority of members are at the professor (32; 62%) or the associate professor (18; 34%) rank. Of the 53 members elected over three years, 21 (40%) are female. The ages of AoMC members are as follows: 1 (2%) is < 40 years old; 9 (17%) are 40 to 49; 21 (40%) are 50 to 59; and 22 (41%) are 60 years of age or older. By year 3, virtually all of the 18 clinical departments within Penn Medicine were represented, as were all of Penn Medicine’s hospitals and clinical entities. In summary, elected members of the AoMC represent a broad spectrum of entities, departments, and gender, while overrepresenting the institution’s senior clinicians.
The business of the AoMC is conducted by discussion and committee work at its monthly meetings. During the first year’s deliberations, many topics were explored, but the decision was made to first focus on how AoMC members might interact with and mentor PSOM students. Three programs were implemented. First, two AoMC members were assigned to join each of the four medical student “houses” that were established by the School of Medicine to create smaller communities with students across all classes, and to foster interactions, peer advising, and camaraderie among students. The AoMC members participate in the houses’ educational and social programs and serve as mentors for the students. First implemented in December 2014, the second program provided “open access” for students interested in working with any of the members of the AoMC who volunteered to participate in the program. The students are able to work one-on-one with faculty in their offices or other clinical venues, typically during their first two years of medical school. Finally, students are introduced to the AoMC as part of their orientation, which now includes a presentation by AoMC members on topics such as “What it means to be a doctor.”
Another working group focused on professionalism and produced a statement on professionalism that was then approved by the EVP/dean. AoMC members take an active role in the PSOM Advance Program, the school’s professional development program for faculty. AoMC members will participate in new courses for onboarding faculty and act as instructors for existing courses. In 2016, the AoMC has taken an active role in PSOM’s initiative to enhance resilience and prevent burnout among the faculty and continues to play a major role in Penn Medicine’s faculty wellness initiative.
A portion of the AoMC monthly meetings has been devoted to talks from Penn Medicine leadership, representing the PSOM, the hospital administration, the clinical practice plan, and quality improvement programs. Thus, members of the AoMC were provided with exposure to the major initiatives and senior leaders of Penn Medicine in a forum that otherwise would not have been possible while the speakers were afforded access and feedback from the AoMC clinical leaders.
In addition to the aforementioned programs, which might be considered among the AoMC’s successes, there were several initiatives that were discussed but not implemented. These included an initiative to develop and extend team-based care to include midlevel providers, modeled after a successful interdisciplinary clinical team that already existed at Penn Medicine. This did not move forward initially, but the initiative has been reinvigorated through a new collaboration with members of the recently established Distinguished Nurse Clinician Academy. Similarly, an interest in promoting mentoring programs for faculty was also discussed, but the AoMC decided not to move forward based on the realization that mentoring, particularly for academic promotion, was the purview of the individual departments.
Finally, the AoMC achieved outcomes that came about, if not unintentionally, then certainly without as much deliberation as those already mentioned. These included the extent to which the AoMC has functioned as a cohesive group at Penn that brings together interested and engaged clinical thought leaders from across all departments and entities. Thus, when plans for a new information technology initiative or programs related to faculty affairs are considered, the appropriate administrative leader can find a ready forum at the monthly AoMC meetings to discuss initiatives and proposals.
For the Master Clinicians themselves, an unplanned if not unintended outcome has been the extent to which the AoMC, through its meetings, e-mail exchanges, and Web site, has provided a group experience that most see as supportive, engaging, and stimulating. Representative comments from AoMC members (recorded for an archival video) demonstrating the personal impact of AoMC membership are shown in List 2. While it is difficult to measure the degree to which the AoMC has brought about a cultural change in Penn Medicine, certainly it could be said that the AoMC is now a well-recognized group and an integral part of the enterprise. A recent comment from the EVP/dean was that the AoMC was “visible and impactful.”
The success of the AoMC may be attributable to several factors. First, it was developed at a point in time, coincident with the arrival of new leadership, when the institution was poised for substantive change. External factors, notably threats to the traditional role of the clinician, as well as rising concern for declining physician resilience, may have contributed to what can be considered a “burning platform.” Other factors that may have contributed to the AoMC’s success are more intrinsic. While the AoMC may be viewed by some as exclusive, in the sense that membership is limited to a small percentage of the faculty, it also is inclusive in the sense that faculty from across the institution are eligible for membership. Thus, the AoMC unites all clinical departments, hospitals, and owned practices. At an institution like Penn Medicine, this is not easily achieved. Lastly, the AoMC has found its place within the institution’s organizational structure, which already includes strong departments and centers, and existing school-based faculty development and educational programs. This can be challenging; we have learned how important it is for the AoMC to integrate and enhance—not replace—existing programs.
In summary, we have been able to demonstrate that an academy of master clinicians, conceived as a strategy for encouraging and recognizing clinical excellence, can be implemented at a large and complex AHC and can achieve several meaningful outcomes. These outcomes include important statements articulating our definition of clinical excellence and professionalism, as well as a process to recognize the institution’s most outstanding physicians. The outcomes also include programs that expose students to Master Clinicians as role models and mentors and that enable an institution’s exceptional clinicians across all clinical departments and entities to interact with each other and with the institution’s leadership. At this three-year mark, based on steady growth, high level of interest, and a favorable reception from within Penn Medicine, the AoMC appears well positioned to remain an interdepartmental, institution-wide organization that should continue to grow and evolve in importance.
A report on the outcomes and impact of the AoMC is provided to the EVP and chief executive officer on a yearly basis. In addition, at the end of each academic year, the members of the AoMC determine two to three initiatives on which to work for the upcoming year to formulate issues and potential actions. A recent initiative on physician wellness and preventing burnout was part of a health-system-wide effort to ameliorate the prevalent problem of physician burnout.
Time will tell whether the AoMC has achieved its principal goals, which are to ensure that at Penn Medicine, clinical excellence will be accorded the level of value and respect traditionally reserved for other components of the tripartite mission, and that a working environment can be created that encourages clinical excellence and professionalism. We believe that will be the case, and that an organization like the AoMC can be helpful in this regard at institutions such as ours. In pursuing these goals, we join our colleagues at other institutions who are facing similar challenges and have implemented similar programs. We hope that our collective experience can be helpful to academic health systems that are challenged to recognize and support clinical excellence.
The authors acknowledge Margaret S. Higgins for her administrative support and role in preparation of this manuscript.