HMS Clinical Department Review Program

The scope of the reviews aligns with their overarching aim to evaluate departmental activities, contributions, and achievements—as well as related challenges, and opportunities. The reviews are intended to provide constructive and actionable feedback in support of strengthening and sustaining the highest standards of excellence in research, education, and clinical care within each affiliate-based academic department and across HMS. 

While department reviews are focused on the educational, research, and clinical missions the scope of these reviews is intended to be comprehensive and holistic. The review encompasses an evaluation of the learning environment, academic milieu, and academic supports provided to clinical faculty and learners. This evaluation entails an examination of the effectiveness of leadership as well as operational processes, structures, and resources relevant to supporting faculty, students, trainees, staff, and the patients and communities the department serves. Factors such as the national stature of the department and its effectiveness in meeting institutional goals and HMS expectations are other important areas of consideration. In addition, the review will cover the effectiveness of interdepartmental collaboration within the hospital as well as the department’s collaboration with its counterpart departments across HMS. For reviews organized as part of the evaluation process for establishing recognition by HMS as an affiliate-based academic department, the review process will also include an examination of evidence that the department has the readiness and capacity to fulfill criteria and meet expectations for an affiliate-based academic department at HMS. 

The reviews rely on the utilization and integration of findings drawn from department-led self-study, relevant institutional and benchmark data, testimony from members of the department community, and invited peer review via a committee of field experts outside of the HMS community. As such, the review process provides a platform to foreground perspectives of clinical faculty, trainees, and department leadership; derive lessons from successes, trends, and feedback; and leverage the expertise, experience, and insights from the external review committee. 

Although typically relying on data germane to a look-back period of five years, the review is centered on evaluating and resolving current challenges and is forward-looking with a focus on identifying opportunities to build on strengths, address any identified gaps or weaknesses, and advance the department’s strategic goals and mission. 

The template for the department reports and the charge to external review committees are structured to facilitate systematic assessment of these key domains across each department review. In addition to reporting on these general domains, departments are encouraged to articulate their unique contextual challenges, interests, and aspirations in order to elevate their priorities for the review. 

For reviews establishing recognized status as a new academic department, the candidate department is expected to marshal evidence demonstrating their readiness and capacity to fulfill criteria and meet expectations for an affiliate-based academic department. 

The clinical department reviews are conducted jointly between HMS leadership and affiliate hospital leadership involving strong collaboration with department leadership and under the auspices of the Dean of the Faculty of Medicine. 

The affiliate institution leadership provides HMS with a list of departments to be reviewed at their institution within the coming academic year. Ordinarily, each established affiliate-based academic department is reviewed on a cadence of every 5-10 years, according to priorities set by HMS affiliate hospital leadership. Adjustments to timing may be proposed to plan for and respond to specific contextual challenges or opportunities. 

Scheduling and timeline

The review process begins with notification from the Dean for Clinical and Academic Affairs to the department that a review will take place, along with a request for preparation of a comprehensive and detailed report of departmental activities over the previous five-year period (view guide at this link). In an orientation meeting, the department head and department administrator are briefed on the processes for preparing this report, selecting external reviewers, and setting an agenda for the review. Given the time necessary to engage the departmental community and to collate data to prepare their report, the timeline for scheduling a review is typically between 6-9 months following this orientation. 

The review will be conducted over two consecutive days, during which time reviewers will meet with selected hospital, school, and departmental leadership as well as with early career, mid-career, and senior faculty, and trainees. Ordinarily, the reviews are conducted virtually, but an in-person review can be considered when there is a compelling rationale to do so. 

Preferences for scheduling are ascertained to ensure that the department has adequate time to prepare and can avoid scheduling conflicts that would impose a major burden or interfere with strong departmental participation (e.g., major institutional or grant deadlines, professional meetings, or other planned events). The HMS Office for Clinical and Academic Affairs will then confirm dates for the review based on these parameters and the availability of hospital leadership and the Dean.

Reviewer selection

Reviewers will be selected and invited by the Dean for Clinical and Academic Affairs, with input from the Department Head to ensure that the invited reviewers have content expertise that aligns with the department’s interests and priorities.  The reviewers are typically national leaders in academic medicine who serve or have recently served as chair of clinical departments at peer institutions or nationally recognized programs in the corresponding field. To avoid or manage any conflicts that would diminish an objective and fair review, Department chairs will be asked to disclose any major conflicts of interest with potential reviewers. Reviewers with previous experience at the department’s institution or at HMS as a trainee or member of the faculty may be considered, as can individuals who served previously on an HMS external review committee. 

Departmental Report

The Department Head will oversee preparation of a detailed and structured departmental report. The suggested outline below highlights the information that is expected in the report. Whereas most of the report is in narrative form, the inclusion of summary data in tables and figures is highly encouraged. The report is due four weeks ahead of the scheduled review. 

Because of the variation across departments, there is no “typical” clinical department at Harvard Medical School on which to model a standard report. The report should include detailed information on the faculty and on the teaching, research, and clinical programs of the Department. The report should profile interval changes and identify relevant trends in these key areas. Where appropriate, the information should be provided by division or other sub-departmental unit; financial information is to be provided in the aggregate and should correspond to the major types of department activities. The chair’s executive summary and each section of the report should include a discussion of the challenges and opportunities that face the department as well as of plans that are formulated to meet those challenges.

Please consult the suggested report outline below for further guidance. Please note that concision is valued highly.

For reviews establishing recognized status as a new academic department, the candidate department should prepare a detailed report that addresses each of the topics in the guide. In addition, the report should include a section that provides a point-by-point summary of how the criteria and expectations for an HMS affiliate-based academic department will be met with supporting relevant documentation and data. This report should also respond to any concerns or questions that have been raised during review and discussions of the initial preliminary proposal. 

Preparation of the Agenda

The Department Head will work with the Office for Clinical and Academic Affairs to identify departmental leaders, faculty, and trainees who will be available to meet with reviewers during the two-day review. They will also identify department chairs of other departments at their institution and other individuals whose input will be informative in a meeting with reviewers. When relevant, the Department Head may advise whether there is a recommended reviewer for meetings with specific members of the department for the best alignment of expertise. 

Pre-review meetings

Prior to the two-day review, the Dean for Clinical and Academic Affairs (DCAA) will meet with the Department Head to discuss priority areas of focus for the review. Often, the HMS Dean for Medical Education and HMS Dean for Faculty Affairs will join this meeting to discuss specific issues that overlap in scope.  The DCAA also meets with the hospital leadership and the chair of the external review committee to discuss priorities that will inform the charge to the committee. 

The Dean of the Faculty of Medicine, Dean for Clinical and Academic Affairs, and hospital leadership charge the external review committee and answer their questions at the beginning of Day 1. 

Immediately following the charge, the Department Head meets with the review committee. After the charge and this meeting, the members of the review committee meet with department faculty, trainees, and other leaders in brief sessions over the ensuing two days. Occasionally, reviewers might ask to arrange a meeting with a specific individual and request additional data. The OCAA will facilitate these requests during the review. 

The review concludes with an oral report delivered by the external review committee to the HMS Dean, DCAA, and hospital leadership. 

Following the visit, the reviewers will prepare a confidential report that will be sent to the Dean; the Dean will share the report with the CEO/president of the hospital. The purpose of the report is to summarize findings and recommendations that will be useful to the Department as well as to HMS and hospital leadership. The Dean and hospital leadership will communicate the results of the review to the Department Head, who, in turn, will provide feedback to department members as appropriate. Typically, the report is shared in its entirety with the Department Head, but this decision is left to the hospital leadership. Whereas the Department Head is encouraged to discuss findings with the department members as appropriate, we ask that the report not be shared in its entirety in order to protect confidentiality. The Department Head may, however, excerpt key information for discussion or slides that can be shared. 

HMS Clinical Department Review Program REPORT GUIDE AND SUGGESTED OUTLINE

Printable version of the Program Guide

Please note that all of the information below, when relevant, should be captured by the report. Department Heads may choose to organize the presentation of some of the data under subheadings in a way that is more logical for their department. When possible, the following information should be presented in tables or figures. Survey data relevant to the department that has been collected for ACGME accreditation and for institutional assessment of faculty and patient engagement should be both summarized in the report and also included in the appendices.

Department Chair’s Narrative

• Executive summary
• Department at a glance
  • Leadership and organizational chart
  • Divisions, programs, and services
  • Sites and locations of clinical care delivery, training, and research
  • Residency and fellowship programs
  • Numbers of faculty, residents, and fellows
  • Numbers of non-faculty MD providers, APPs, and staff
• High level summary across research, educational, and clinical domains
  • Notable accomplishments and strengths
  • Areas of opportunity and focus
  • Areas of concern and for improvement
  • Barriers to success and anticipated challenges
• List key recommendations from the most recent review and describe relevant outcomes (if appropriate/applicable)
• Goals, plans, and strategic opportunities over the next five years
   

Clinical Activities

• Executive summary
• Clinical services organization
  • Divisions, programs, and other units
  • Sites of clinical care delivery
    • Indicate which sites host students & trainees
    • Indicate level and type of services provided
• Breadth and volume: Department as a whole and subspeciality units
  • Clinical strengths
  • Clinical FTEs
    • Adequacy of clinical provider staffing and of their support staff
  • Numbers & types of clinical visits and procedures, if relevant
    • Comprehensiveness of services offered
    • Sub-specialty, tertiary, and quaternary care
  • Identified service gaps
  • Growth/regression of services (past 5 years)
  • New programs launched or planned (strategic goals)
• Quality and safety

  • Describe how quality is measured for providers and services in the department (e.g., patient outcomes, wait times, 360s, regional and national ranking (e.g., USNWR, Press Ganey), Leapfrog safety grades,

    Magnet designation, OPPE/FPPE, JCAHO, etc.) and include a summary of these quality measures

• How does the department’s clinical performance compare with relevant national benchmarks for patient outcomes?
  • Patient-reported data on access and satisfaction
  • Identified areas for improvement
  • Accreditation status and citations, if any
• Indicators of clinical excellence and distinction
  • Reputation/recognition/national standing [best in class care]
  • Centers of Excellence
  • Clinical innovation and patents, if relevant
  • Referrals from outside of the region
  • Faculty leadership in national networks, cooperative groups, and specialty societies
• Alignment of clinical services with hospital initiatives and goals
• Department’s capacity to meet clinical service needs of other departments and collaborate effectively
• Financial performance of practices
• Constraints and resource availability

Research Activities

• Executive summary
• Description of research programs
  • Basic science
  • Translational
  • Clinical trials
  • Epidemiologic and outcomes
  • Quality and safety
• Departmental infrastructure and resources supporting research
  • Personnel to support study design; clinical trials support; statistical analyses; large database storage, access, and interrogation (including genomics, proteomics, etc.); IRB submission; grants management and other research assistance
  • Equipment
  • Bridge and seed funding
  • Conferences and workshops
• Funding (sources and amounts of awards)
• Extramural funding
  • NIH and other federal research grants and contracts
  • NIH Training Grants
  • Industry-Sponsored research
    • Investigator initiated
    • Sponsor initiated
  • Foundation funding
  • Philanthropic research support
  • Other
• Intramural funding
• Departmental
• Institutional
• Harvard Medical School
• Trends in peer reviewed and total support over the past 5 year period (e.g., comparison to peers based on Blue Ridge Institute for Medical Research Rankings data).
• Novel research programs
• Key publications (optional)

Educational Activities

• Executive summary
• Medical student teaching
  • List of faculty contributions to HMS pre-clinical and other courses and HMS student mentorship
  • List of core and elective clinical clerkships hosted; number of HMS students taught/year; sites where HMS students are taught; numbers and institutions of non-HMS medical students taught, if any
  • Course and Clerkship Learning Outcomes and Student Feedback
  • HMS will provide Learning Environment survey data for departments hosting HMS students for core clinical clerkships
• Graduate student teaching
• List of didactic courses taught
• Faculty participation as primary advisor or on DAC
• Labs hosting MMSc and PhD students
• Number of graduate students hosted from Harvard and from outside of Harvard, if any
• Residency and clinical fellowship programs
• Residency program(s)
  • ACGME credentialed residency program(s, tracks, and number of trainees/year, for which department is the primary or sole site
  • ACGME program residents hosted by department for rotations as a secondary site for a core or elective rotation (primary and other secondary institutions hosting residents; number of trainees/year; indicate number of non-HMS trainees, if any)
  • Residency match performance
  • Current status of graduates (past 5 years)
  • List of training sites
  • Educational conferences and research opportunities and protected time for residents
  • Director and core faculty
  • ACGME correspondence, program status, and surveys from past 5 years
• Fellowships
  • Specialty areas, duration of fellowship, and trainees/cohort
  • Hosted by department as the primary or sole site or for rotations as a secondary site for a core or elective rotation
  • List of training sites
  • ACGME accreditation status and trainee feedback
• Continuing Medical Education
  • Number & kind of courses taught and cadence

  • Faculty involved & number of attendees

     

Faculty Development and Support

• Executive summary
• Faculty engagement and satisfaction
  • Please list institutional and departmental standardized surveys addressing faculty (e.g., Press Ganey, AAMC Standpoint Survey, Maslach Burnout Inventory, etc.) and cadence, summarize key findings and trends, and include in appendix
  • Percentage completion of annual career conferences; summary of faculty satisfaction and statement of how data are tracked and used to support faculty
• Academic resources for faculty
  • Mentoring programs for early career faculty and trainees
• Departmental academic conferences (describe attendance data)
  • Career development programming and support
  • Support for protected time; (distinguish allocation related to administrative and clinical service from time for teaching and research); indicate departmental, institutional, and other sources of support for this time
  • Support for professional development outside of the hospital affiliate (e.g., for courses, conference travel, etc.)
• Academic productivity
  • Number of unique peer-reviewed original research or other scientific publications with departmental faculty or trainee as author or co-author (annually for past 5 years)
  • Number of peer-reviewed research publications with first, second, second to last, and/or last authorship (annually for past 5 years)
  • Faculty development/retention
• Appointments and promotions
  • Faculty numbers across ranks
  • Promotions (past 5 years)
  • Average time at rank for current faculty
  • Department processes and personnel supporting faculty promotions
• Faculty recruitment and retention
  • Faculty hires (past 5 years)
    • Via search
    • Via training program
    • Other
  • Faculty departures
    • Retirement
    • Departure for another academic institution (include destination and whether recruited to a leadership position)
    • Other
• Workforce adequacy and plans for expansion or reduction
  • Specific hires planned
  • Anticipated retirements or departures
  • MD equivalent health providers without faculty appointments

Leadership/Administration

• Leadership
  • Organizational chart with leadership for programs, divisions, and sites if applicable
  • Leadership opportunities for talent retention
  • Leadership development training
• Governance
  • Committees (include membership & selection)
  • Process for decision making and soliciting perspectives
• Communication with department faculty, trainees, and staff
• Community-building (meetings, town halls, retreats, etc.)
• Departmental culture and milieu

Department Finances: annual and five-year total – showing historical trend

• Income: stratified and aggregate
  • Clinical Income (gross and net)
  • Research Support (direct and indirect)
  • Hospital Support
  • HMS Support
  • Endowment Income
  • Philanthropic support
  • Income from royalties, IP, and investments
• Expenses: Total
  • Salaries & Fringe
  • Aggregate Faculty Salaries – compare to AAMC standards; comparable institutions
  • Incentive Compensation
  • Operating Expenses
  • Research Overhead
  • Capital Expenses

Resources

• Space
  • Research Space: support/sq. foot
  • Clinical Space
  • Administrative Space
  • For departments with core clerkships, educational space for medical students
  • Description of geographical location of sites and issues relating to co-location and transportation
• Major Equipment
• Institutional core resources
• Level and quality of IT infrastructure
  • Computational and other software resources
  • IT support
• Administrative and ancillary support
  • Please describe adequacy of staffing, co-location when relevant, recruitment, retention, and vacancy rate (past 5 years) for
    • APPs and other clinical staff support
    • Administrative support
• Fund-raising/marketing/P-R

Strategic Plan

• Strategic planning approach and participation
• Synopsis of existing plan and date of last plan
• Alignment with hospital and health system strategic plan

Appendices

• Full faculty list: Format should be Excel spreadsheet (sorted by rank) and should include the following columns: Name, Degree(s), Academic Appointment, Year at Appointment, Years Since First appointment, Full time/Part time, Specialty, Primary Work Site; Secondary Work Site(s), and Apportionment of Time;

  • Current department faculty biosketch or CV

  • Faculty composition slides produced by the HMS Office for Faculty Affairs

PLEASE SUBMIT 2 OR MORE HARD COPIES AS REQUESTED ALONG WITH ELECTRONIC COPY OF REPORT AND APPENDICES 4 WEEKS PRIOR TO REVIEW

Printable version of the Program Guide