Defining the Individual

Master Clinicians are physicians who make lifelong commitments to caring for patients and educating young and future physicians.  They spend the majority of their time teaching while simultaneously providing excellent direct patient care.  They can teach effectively all aspects of physician development to a broad range of learners.  They employ all available teaching and evaluation modalities, from the traditional to most cutting-edge, embracing innovative methods as opportunities to teach more effectively.  They support learners through advising and mentoring.  As role models, they consistently demonstrate the physician behaviors now identified as essential, including psychosocial awareness, respect for health care economics, patient-centered paradigms, and excellence in clinical sciences.

Their commitment extends beyond their immediate professional environments.  As leaders, they provide guidance to others as rapid change on all fronts complicates the path to effective physician development.  As scholars, they study the health care settings, in which they work, identifying solutions to old and new problems and disseminating their knowledge broadly.  As educators, they may hold key roles in organizations which support, monitor, and define physician education throughout the continuum of learning.

Finally, Master Clinicians embrace constant improvement of their own abilities and those of their colleagues.  As lifelong learners, they share their observations and findings, growing the entire field of medicine.  They engage in refining their skills and those of their peers, and add both quantity and detail to our understanding of how young physicians learn, what they need to learn, and how best to use precious resources to accomplish this ever-expanding task.

Attributes

Clinical Skills

• Asks significant questions
• Good listener
• Uses a systemic approach
• Integrative
• Demonstrates life-long learning
• Experienced
• Manifests a strong curiosity
• Observant
• Communicates well with patients
• Persistent
• Simplifies complex issues for listener
• Knows limits and when to ask for help
• Enjoys scholarship

Personal and Emotional Traits

• Confidence tempered with humility
• Empathetic
• Emotional intelligence
• Compassionate
• Ease with ambiguity
• Comfort with complexity 

Teaching Skills

• Open-minded
• Broad perspective
• Good communicator
• Motivation to mentee
• Willing to develop new teaching skills
• Learns from peers and students
• Patient with learners
• Passionate sharer of knowledge 

Skills and Abilities of Master Clinicians

Superior Patient Care

Among the broad domains of skills required of Master Clinicians, superior patient care is a dominant attribute.  This is a physician who cares about the patient as a person and takes total responsibility for their care.  When patients are sick, this clinician sees the patients illness in context of their entire life.  This physician is a superb history taker, listening before asking significant questions.  They have the ability to simplify complex issues.  The master clinician shows confidence tempered with humility, empathy, compassion, and integrity.  These characteristics inspire patient trust.  Finally, the master clinician advocates for the patient.  This sometimes requires challenging the system to provide the “right” care.

Direct Teaching and Supervision

Master Clinicians will play a dominant role in teaching clinical skills, including interviewing, physical examination, and complex clinical reasoning. Much of this teaching will continue to occur at the patient’s side because of the central importance of the physician-patient interaction. They will incorporate routinely scientific evidence (including best practice principles) into the teaching of clinical skills .They will also incorporate core competencies into all teaching interactions to complement curricular content from non-clinical settings (e.g., directed teaching about cost of care and resource utilization as an essential component of competence in system-based practice). Consideration of the continuum of care, differing venues of care, and care transitions are additional critical content. Explicit discussion of the physician-patient relationship will inculcate the importance of communication skills. Quality of care, patient safety, and continuous improvement will be part of their delivered education through exercises in practice-based learning.

Role Modeling

Role modeling is an explicit responsibility of “masters” in workplace learning directed toward work acculturation.  Learners greatly value non-cognitive "physicianship" qualities such as compassion, effective communication, and professionalism.  Excellent role models were identified as spending more time on teaching and patient care responsibilities with the shift toward patient-centered care.  Master Clinicians will set a tone of compassionate, ethical, high quality care that places the needs of patients first. These faculty members will have a comprehensive view of the internist’s role, but also the perspective to understand how physicians must interact with other members of the health care delivery system. They will model working effectively with colleagues in other disciplines to provide the highest possible quality of care, promoting inter-professional collaboration and communication.

Professionalism will be modeled, with emphasis on ownership of, and devotion to, patients. Master Clinicians will model continuous learning for professional development, demonstrating that there need be no dichotomy between service and education. They will model service to their patients and to the broader health care system by active participation in continuous quality improvement within their particular environment, demonstrating reflective practice in their daily work and teaching. Finally, Master Clinicians will model scholarship through the principle of lifelong knowledge acquisition, constantly applying the scientific method to patient care and medical education. They will embrace innovation, participate in developing new paradigms of teaching and medical care, and disseminate information that improves the health of individuals or populations.

Evaluator

Master Clinicians will necessarily fill a “master evaluator” role in future clinical training programs because of their deep understanding and sophisticated ability to identify competence, and its absence, in the clinical training venue. A broad range of evaluation techniques – those validated or being tested in clinical settings – will need to be employed effectively by the Master Clinician. These tools include:

1. Direct observation in a variety of settings, including patient interactions, medical procedures, and multidisciplinary conferences (assessing medical knowledge, clinical skills, communication effectiveness, and professionalism)
2. Assuring performance and determining adequacy of reflection and self-critique (assessing professionalism, practice-based learning, and system-based practice)
3. Facilitation of multi-source evaluations by patients, ancillary staff, peers and subordinates (assessing communication, professionalism, system-based practice, and practice-based learning)
4. Review of medical records (assessing medical knowledge, communication, and practice-based learning).

Mentor and Advisor

Because of their extensive contact with learners, Master Clinicians will often be sought out for formal or informal advice. For a subset of learners, particularly those envisioning an academic educator career, Master Clinicians will be obvious choices for mentorship. Specific mentoring topics include setting interim and long-term career goals and timelines; choosing projects and professional opportunities which support academic advancement; recording and organizing accomplishments into presentable formats; managing professional demands and their impact on family and extra-medical life; selecting and securing membership in appropriate intra-mural groups and national professional organizations; assessing costs and benefits of additional training and credentials relative to their career objectives; resolving difficult interpersonal issues with learners, colleagues and supervisors; establishing a national reputation; and other aspects of successful career development.

Educational Administrator and Leader

Although distinct from the above teaching/advisor roles, many formal educational leadership and administrative positions will most likely be filled by Master Clinicians.  Training program and associate program directors, clerkship and rotation directors, course directors, and many assistant and associate dean positions might be best filled by those with this career-long commitment to education. Other Master Clinicians will serve as important advisors to educational directors by helping to identify resource needs, providing a credible liaison with leaders of clinical programs, and participating in or leading ongoing program evaluation.