Institutional Setting Subcommittee Report for the LCME Self-Study Task Force
Executive Summary
The Institutional Subcommittee of the LCME Institutional Self-Study Task Force met several times in the fall of 2004 and engaged actively through e-mail to complete the school’s quantitative and qualitative database, examine the weaknesses and strengths of the institutional setting, and analyze the school compliance with LCME standards for the institutional setting.
The summary report was drafted in March 2005, revised, and adopted by the subcommittee in April 2005.
The subcommittee noted important strengths in the institutional setting. Having the Dean serve also as CEO of Johns Hopkins Medicine has promoted cohesiveness and integration of the School of Medicine and the Hospital. The senior leadership of the School of Medicine broadly represents the diversity of the faculty and demonstrates the effectiveness of an experienced team. The strength of the academic environment is reflected in part by the School of Medicine receiving more research funding from the National Institutes of Health than any other medical school in the country. The graduate and housestaff programs create nearly unlimited opportunities for medical students to learn clinical medicine and engage in research.
The subcommittee noted that full compliance with LCME standards for institutional setting was lacking in one area; our School of Medicine does not have by-laws. To achieve full compliance, the School will need to draft and adopt by-laws.
The subcommittee also identified an opportunity for the School to further strengthen the institutional setting by creating a school-wide faculty development programs. Some departments and graduate programs in the School do have formal faculty development programs. The Department of Medicine, for example, has a nationally funded program to help faculty develop teaching skills. The Graduate Program in Clinical Investigation also offers an annual summer course in Methods in Clinical Investigation that helps fellows from many departments develop research skills. The subcommittee recommends that the School create position in the dean’s office to promote and coordinate programs that help all the faculty develop their skills in teaching, conducting research, and providing patient care.
A. Governance and Administration
- Describe how institutional priorities are set. If planning is a regular institutional activity, discuss how it has facilitated accomplishment of the School’s academic purpose, research prospects, and goals of the clinical enterprise.
The mission of the Johns Hopkins University School of Medicine (JHUSOM) is to provide international leadership in the education of physicians and medical scientists in biomedical research and in the application of medical knowledge to patient care. Institutional priorities for the JHUSOM are set within the context of the strategic priorities for Johns Hopkins Medicine, i.e., collaborative mechanism for the management and operation of the JHUSOM and the organizations that comprise The Johns Hopkins Health System. The strategic priorities for Johns Hopkins Medicine are as follows:
a. Achieve the highest possible standards of quality in research, education and patient care, and full compliance with internal and external requirements.
b. Coordinate growth across the research, education, and patient care missions of Johns Hopkins Medicine.
c. Provide the human resources and infrastructure for Johns Hopkins Medicine to operate efficiently and effectively.
d. Develop relationships necessary to fulfill the mission of Johns Hopkins Medicine.
e. Set and achieve financial targets and maintain a strong financial position across Johns Hopkins Medicine.
The Johns Hopkins Medicine planning process is overseen by the Executive Office of Johns Hopkins Medicine (of which David Nichols, M.D., Vice Dean for Education is a member), under the direction of Toby Gordon, Sc.D., Vice President, Strategic Planning and Market Research. Dr. Gordon and her team conduct an annual situational assessment of the current status of Johns Hopkins Medicine and its member organizations, including the JHUSOM. Each member organization of Johns Hopkins Medicine develops a strategic plan that is based on the information derived from the Johns Hopkins Medicine situational assessment. This strategic plan consists of the organization’s vision and values, the situational assessment, long-range goals and their relationship to Johns Hopkins Medicine strategic priorities, and annual operating plan, including management objectives, targets, and budgets. This strategic plan must be reviewed and approved by the senior leadership of the JHUSOM and, ultimately, by Edward Miller, M.D., Dean/CEO of Johns Hopkins Medicine.
Within the JHUSOM, each clinical department engages in an annual planning process that is presented in summary form by the chair to the Dean/CEO, the President of the Johns Hopkins Health System, the Chief Financial Officer of Johns Hopkins Medicine, and to other leaders of Johns Hopkins Medicine. This process facilitates accomplishment of the School’s goals in research, teaching, and patient care. These meetings, for example, have played a role in prompting the development of a hospitalist service at Johns Hopkins Hospital and Johns Hopkins Bayview to improve both patient care and the clinical education of medical students and residents. These planning meetings also facilitate review of research accomplishments and help identify the need for new resources such as increased laboratory space.
2. Evaluate the role of the governance structure in the administrative functioning of the medical school. Is the governance structure appropriate for an institution of this size and characteristics? Describe any situations that require review by or approval of the School’s governance board.
The governance structure of Johns Hopkins Medicine and JHUSOM has been created to ensure that the teaching and research missions of the School of Medicine are well integrated with the missions of the University and The Johns Hopkins Hospital in providing clinical care and service. The Dean/Chief Executive Officer of Johns Hopkins Medicine is the chief academic officer of the School of Medicine. In addition, the President of The Johns Hopkins Health System Corporation and The Johns Hopkins Hospital, who also serves as the Executive Vice President of Johns Hopkins Medicine, has a reporting relationship to the Dean/CEO of Johns Hopkins Medicine. The Dean/CEO also serves as the Vice President of Medicine for the Johns Hopkins University. Dr. Edward D. Miller, the current Dean/CEO, is the first person in Johns Hopkins history to hold the combined positions of Dean of the Medical Faculty and Chief Executive Officer of Johns Hopkins Medicine. As such, he is responsible for the people, resources, and facilities for all aspects of teaching, research, and patient care and has the ability to assure that each of these missions is adequately supported.
The Presidents of Johns Hopkins Bayview Medical Center and Howard County General Hospital report to the President of The Johns Hopkins Health System Corporation (who also serves as President of The Johns Hopkins Hospital and has a reporting relationship to the Dean/CEO). The Dean/CEO receives guidance and advice from the faculty and department directors through the Advisory Board of the Medical Faculty, which meets monthly and is chaired by the President of the University. The Dean/CEO is assisted in his duties by his management team, including vice deans, associate deans, assistant deans, and management of the Hospital and Health System. This governance structure is appropriate for an institution of the size and the characteristics of The Johns Hopkins University School of Medicine.
Although Johns Hopkins Medicine has a clear and cohesive governance structure, the School of Medicine has no formal by-laws. The self-study process is prompting the School of Medicine to write policies for organization and governance.
2. Evaluate the relationship of the medical school to the university and clinical affiliates with respect to:
a. The effectiveness of the interactions between medical school administration and university administration.
b. The cohesiveness of the leadership among medical school administration, health sciences center administration, and the administration of major clinical affiliates.
The governance of the School of Medicine and Johns Hopkins Medicine is intended to enhance the effectiveness of interaction between the Medical School Administration and University Administration. The President of the University chairs the School of Medicine’s Advisory Board of the Medical Faculty, which meets monthly and receives guidance and advice from the faculty and department directors. Through these structures and meetings, the Dean/CEO and the President of the University interact effectively. The Dean/CEO also serves as the Vice President of Medicine for The Johns Hopkins University. The President of The Johns Hopkins University serves on the Board of Johns Hopkins Medicine and Chairs the Executive Committee of the Board of Johns Hopkins Medicine.
The cohesiveness of the leadership among the different components of Johns Hopkins Medicine is facilitated by its structure and by the broad integrated role of the Dean/CEO. With all the Presidents of the different components of Johns Hopkins Medicine reporting to him through the President of The Johns Hopkins Health System Corporation, the Dean/CEO is well positioned to facilitate coordination of The Johns Hopkins Hospital, Health System, School of Medicine, and the other medical components.
3. Assess the organizational stability of the medical school administration (Dean, Dean’s staff). Has personnel turnover affected medical school planning or operations? Are the number and types of medical school administrators (Assistant/Associate Deans, other Dean’s staff) appropriate for efficient and effective medical school administration?
The medical school administration has been stable. Dr. Edward D. Miller, Dean/CEO, has held his position since 1997. Mr. Richard Grossi, Chief Financial Officer for Johns Hopkins Medicine has served as the financial officer of the School of Medicine for 26 years, and Ms. Mary Foy, the Registrar, has served in her capacity for 37 years. The little turnover that has occurred in the Dean’s office has been prompted by promotion. For example, Dr. Elias Zerhouni served as the Executive Vice Dean of the School of Medicine until he was chosen two years ago to become Director of the National Institutes of Health. New positions have been added in the Dean’s office in a timely fashion to meet new opportunities or address new concerns. For example, in November 2001, the position of Vice Dean for Research was expanded to include a new Vice Dean for Clinical Investigation. Dr. Michael Klag now serves in this role.
Moreover, when Dr. H. Franklin Herlong retired as Dean of Students after 15 years, two additional assistant dean positions were created to help serve the new Associate Dean for Students. The expansion in the Dean’s staff devoted to students reflects Dr. David Nichols’ (Vice Dean for Education) and Dr. Edward Miller’s (Dean/CEO), commitment to expand and to enhance the mentoring of medical students. The desire to assist under-represented minority medical students has prompted Dean Nichols to recruit Dr. Crystal Simpson into a new assistant dean position that focuses on recruiting, retaining, and promoting under-represented minority medical students.
B. Academic Environment
4. Evaluate the graduate programs in basic sciences, including involved departments, numbers and quality of graduate students, quality of course work, adequacy of financial support, and overall contributions to the missions and goals of the medical school. Describe the mechanisms for reviewing the quality of the graduate programs in basic sciences and comment on their effectiveness.
The School of Medicine takes responsibility for administering 15 graduate programs, including those that grant the M.A. degree (1 program), the M.S. degree (1 program), and the Ph.D. degree (13 programs). In all, there are 628 graduate students in these programs.. The graduate students in the School of Medicine are considered among the best in the world, and they pursue a rigorous and high quality of coursework. Their achievements contribute mightily to the school’s research and teaching missions.
To ensure that each graduate program adheres to the highest academic standards, the Advisory Board of the School of Medicine has established the M.A./Ph.D. Committee as a venue for: a) formal School of Medicine administrative approval of all M.A., M.S., and Ph.D. theses; b) ongoing discussion of issues and policies that face our graduate programs and their students; and c) periodic review of individual graduate programs. The M.A./Ph.D. Committee is comprised of the directors of each graduate program, the Associate Dean of Graduate Student Affairs, the Registrar, two students selected by the Graduate Student Association, and a senior (in rank) School of Medicine faculty member experienced in matters relevant to graduate education but who is also not a program director. The M.A./Ph.D. Committee meets monthly during the academic year. Two of these meetings are devoted largely to presentation and approval of degree candidates by their program directors; the remaining meetings allow opportunities for discussion of policies that directly affect student benefits and responsibilities.
5. Evaluate the impact of residency training programs and continuing medical education activities on the education of medical students. Describe any anticipated changes in graduate medical education programs (numbers of residents, shifts and sites used for training) that may affect the education of medical students.
There are 25 residency training programs at Johns Hopkins providing the training of 715 residents. The residency programs at Johns Hopkins are highly rated nationally and, therefore, attract some of the best residents in the nation. These residents play an important role in teaching the medical students during basic rotations and clinical electives. Indeed, Johns Hopkins is unusual in that 10% of the salary of residents at The Johns Hopkins Hospital is paid by the School of Medicine. This arrangement both acknowledges and promotes the important teaching role that residents have with medical students.
Johns Hopkins also has an active office of Continuing Medical Education that sponsors a diverse group of courses. CME courses help faculty keep their knowledge up-to-date and also allow faculty to practice and sharpen their teaching skills. Some of the CME approved courses, such as Medical and Surgical Grand Rounds, provide a weekly institutional program benefiting medical students rotating on those services.
No major (> 10%) expansion in residency programs is anticipated. No change in the sites used for training medical students or residents is anticipated, with three exceptions: (1) surgical residents will be removed from Sinai Hospital to allow for an increase in surgical residents at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center; (2) residents in obstetrics/gynecology will be reduced at Greater Baltimore Medical Center; and (3) ophthalmology residents will be removed from Sinai Hospital.
6. Evaluate the research activities of the faculty (areas of emphasis, levels of commitment, quality, quantity) in the context of the mission and goals of the medical school.
Given its goal of being a world leader in creating new knowledge to improve the health of individuals and the public, it is not surprising that JHUSOM have a large number of faculty who devote their careers to research. The size of the research faculty ensures that virtually every area of medical research—from basic science to epidemiology to clinical—is under active investigation. In all departments, both basic and clinical, the faculty are committed to integrating discovery into their educational interactions with medical students. The high ranking of the JHUSOM in terms of extramural support received from the National Institutes of Medicine (#1 in recent years) speaks to the quality and quantity of research faculty and their level of commitment. Additionally, the School of Medicine has been innovative in both introducing and leading in new research areas (Cell Engineering, Genetic Medicine) and reorganizing existing programs in the Basic Biomedical Sciences.
7. Assess the adequacy of the resources (equipment, space, graduate students) for research. Evaluate the amount of intramural support for research and the level of assistance available to faculty members in securing extramural support.
The Johns Hopkins School of Medicine has achieved its high ranking in NIH dollars received for investigation by committing substantial resources to its research mission. The School of Medicine has a total of 903,247 net assignable square feet of research space and has made major commitments to expansion. In the last five years, the School of Medicine has built two new buildings devoted to research, accounting for 195,721 net assignable square feet of additional research space. The McKusick-Nathans Institute for Genetic Medicine, under the leadership of Dr. Aravinda Chakravati, brings together over six departments to address the genetic basis of complex disorders and other genetic research problems. The Institute for Cell Engineering, under the supervision of Dean Chi Dang, is comprised of four core research programs related to stem cell biology that spans eight clinical and basic science departments. The Institute for Basic Biomedical Sciences (IBBS), under the directorship of Dr. Stephen Desiderio, represents the extensive research and training activities of eight basic science departments (Biological Chemistry, Biomedical Engineering, Biophysical Chemistry, Cell Biology, Molecular Biology and Genetics, Neuroscience, Pharmacology and Physiology). In addition, the IBBS is currently overseeing an expansion of basic research efforts into major research areas that span basic science to clinical applications as well as commercialization. The first of these areas is represented by the Center for High Throughput Biology, a cluster of independent investigators and research cores dedicated to the development, implementation and provision of emerging technologies. Research efforts within the IBBS are deeply and broadly distributed, with substantial commitments to biochemistry, structural biology, biophysical chemistry, molecular biology, genetics, population biology, drug action and design, brain sciences and psychiatric research, systems biology and physiology, bioengineering, cell biology, functional anatomy, stem cell biology, cancer research, immunology and host defense, epigenetics, computational biology, bioinformatics, developmental biology, sensory systems and metabolic control. The Institutional commitment to these programs totals well over $70 million. Intramural support for the conduct of research is also extensive. For example, the School of Medicine funds its own “Physician Scientist Awards”, which allows selected junior faculty to devote more time to research and thereby enhance their opportunities to secure extramural funding.
The self-study process has identified an opportunity to enhance the research and teaching missions of the School of Medicine by developing systematic programs to help faculty develop their skills as educators.
8. Assess the impact of research activities on the education of medical students, including opportunities for medical students to participate in research.
Research is a vital part of the Institution’s mission and a significant majority of our students participate in investigational pursuits at some point during their time here. The summer after the first year of pre-clinical sciences is used by the majority of students to take part in such research. However, the third- and the fourth-year curriculum affords extraordinary flexibility so that many students also undertake research electives in addition to their clinical rotations. All of these experiences count toward credits required for graduation. In addition, some students seek more in-depth, longitudinal research experiences and take a leave of absence from the medical school curriculum. Students participate in these experiences both here and at other institutions. The funding for these pursuits, as well as those mentioned above, come from various sources, including Howard Hughes Fellowships, Howard Hughes Cloisters program, Doris Duke Fellowships, Sarnoff Fellowships, and Institutional Grants.
