Massachusetts General Hospital Patient Care Services
Excellence Every Day

EXCELLENCE EVERY DAY PORTAL 

click here

PCS Home Page Nursing Chaplaincy Institute for Patient Care Occupational Therapy Orthotics & Prosthetics Physical Therapy Respiratory Care Services Social Service Speech Language & Swallowing Disorders Clinical Resources MGH Internal Access Only
Patient Care Services

 

Institute for Patient Care Clinical Affilations Program

One of the questions most frequently asked by clinicians when they hear about the Clinical Recognition Program is, "How will I know my practice level?" This question cannot be answered by completing a checklist or counting up the years of employment. It requires that you think about your practice and the impact you have had on patients, families, and colleagues.

To help you assess your level of practice, we recommend the following steps.

  1. Read through the attached descriptions of each level of practice. You’ll find that the descriptions refer to "themes" or aspects of clinical practice: clinician/patient relationship, clinical knowledge and decision-making, teamwork/collaboration, and movement (for Occupational Therapy and Physical Therapy only). Within each theme, four levels of practice are described:

As you read through the descriptions, make note of the differences between each level. Think of specific examples of clinical practice that would "fit" with the criteria being described.

  1. Once you have a sense of the levels, reflect on your own experiences with patients. The more specific you can be in your reflection, the better. For example, as you review the theme of clinician-patient relationship, think about experiences you have had working with specific patients and families. Look at the criteria for the various levels of practice within this theme. What level of practice best characterizes your experiences with regard to the clinician/patient relationship? You might find it helpful to think about someone who represents your "ideal" in the way he/she relates to patients. How does this person’s practice fit the criteria described in the levels? How does it compare to your practice?

Similarly, as you think about your clinical knowledge and decision making, ask yourself which level best describes how you use your knowledge to make decisions about patient care, how you organize and prioritize your patient care responsibilities, or how you seek out and use resources.

In considering the collaboration/teamwork theme, think about how you work with your colleagues in clinical practice and how these interactions have evolved over time. Consider the nature of your professional relationships with colleagues within and outside of your discipline, how you contribute to an interdisciplinary approach to care, and how you help create an environment that supports excellence in patient care.

Movement is a fourth theme that applies to occupational and physical therapists only. In thinking about this theme, consider your ability to use your observational and manual skills to analyze, facilitate, or inhibit movement patterns. Reflect on how you use your hands in examining and treating patients and whether you modify your interventions to meet individual needs.

  1. Having analyzed your own practice in light of the descriptions of the levels, ask yourself, "At which level do I practice most consistently?" You may well find that there is a range to your practice – that you generally practice at one level but, depending on the situation, may "visit" a different level. Ask yourself, "Where do I live in my clinical practice? Do I practice mostly at the Advanced Clinician level, or do I visit the Advanced level from time to time, with most of my practice being that of the Clinician?" You will likely find that your practice matches a particular level most consistently.

Look at the level where you think you practice most of the time. Challenge your findings. For example, closely examine the criteria at the next level. Can you think of examples from your own experience that fit this description? If so, how often do they occur?

Take your time in completing this reflection. It will give you an important starting point in thinking about where your clinical practice lies.

  1. Once you have given some thought to your own practice, make an appointment to talk to your manager/director. Use the meeting to talk about your practice. Discuss specific examples.

  2. Through your manager/director, you will be recognized at the Entry or Clinician level. If you and your manager/director agree that your practice is at the Advanced Clinician or Clinical Scholar level, decide if you would like to move forward and submit a portfolio to the Clinical Recognition Program’s peer review committee. The committee will review your portfolio, interview you about your practice, and determine whether you meet the criteria for the level you have identified.

 

To complete a portfolio for recognition at the Advanced Clinician or Clinical Scholar level, ask your manager/director for an application packet or click here to view the Application Packet.

 

Clinical Recognition Program

Levels of Practice

Physical Therapy and Occupational Therapy

Clinician/Patient Relationship

The interpersonal engagement or relational connection between the clinician and the patient and/or family

 

Entry

Clinician

Advanced Clinician

Clinical Scholar

Rapport and communication

  • Is aware of own values and recognizes how one’s own values affect interactions and relationships
  • Demonstrates comfort in establishing and maintaining rapport with patients
  • Beginning to perceive subtleties in patient/family dynamics and incorporates this insight into interactions with both
  • Provides accurate information/input regarding a patient’s PT or OT needs to the health care team
  • Is open to others’ values
  • Is able to interact effectively with wide variety of patients/families, modifying own communication style as needed
  • Increasingly aware of complex patient/family dynamics and impact on clinical impression
  • Recognizes importance of patient assuming responsibility for portions of own care
  • Respects others’ values
  • Increasingly aware of complex patient/family dynamics and actively seeks to validate perceptions for purpose of factoring them into clinical impression
  • Recognizes importance of patient assuming responsibility for portions of own care and makes this a key component of intervention strategy
  • Respects others’ values and suspends judgment
  • Intuitively uses self in the therapeutic relationship as a means to enhance care
  • Effectively adjusts approach to patient/family communication, thereby maximizing rapport and facilitating open exchange of information
  • Empowers patients and family to take control of their wellbeing; employs focused patient/family education to that end

 
 

Clinician/Patient Relationship (continued)

 

Entry

Clinician

Advanced Clinician

Clinical Scholar

Interface with clinical decision making

 

 

 

  • Considers knowledge of patient and family when implementing standards of care
  • Effectively gathers pertinent, subjective data from patient/ family to make clinical decisions
  • Efficiently gathers pertinent, subjective data from patient/family to make clinical decisions
  • Clusters information to understand patient life roles, functional needs. This data drives examination, evaluation and intervention.
  • Listens carefully to patients and uses them as a primary source of data
  • Negotiates realistic goals and intervention plan based on patient’s values.

Advocacy

  • Recognizes need for advocacy and brings individual patient needs to the interdisciplinary team.
  • Recognizes common advocacy issues across patients.
  • Recognizes common advocacy issues across patients and seeks assistance to organize and plan approach to achieve advocacy goals beyond the individual patient
  • Consistently voices and supports professional opinion even if it differs from other interdisciplinary team members.
  • Sees advocacy as a key professional role of the PT/OT.
  • Confidently approaches MD, other health professionals, third party payers, etc. to advocate for patient’s needs
  • Use knowledge gained with patients to advocate for issues of health/public policy.
  • Consistently identifies patient and systemic needs across disciplines and advocates beyond discipline- specific issues.

Cultural Competence

  • Recognizes that cultural differences need to be considered in developing clinician-patient relationships. Focus is on identifying cultural norms
  • Identifies a variety of cultural factors that may impact treatment goals and outcomes
  • Understands factors that impact developing rapport with patients of various cultural backgrounds, and considers those factors in developing treatment plan and projecting outcomes
  • Effectively elicits cultural beliefs and values from patients and integrates these into overall patient management

Notes - Clinician/Patient Relationship:

 

 
 

Clinical Decision Making

Understanding attained through formal and experiential learning

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Self-assessment

  • Developing accuracy in self-assessment within a limited scope of practice (e.g. diagnosis specific)
  • Recognizes limitations in knowledge and skills
  • Employs active experimentation as a learning mode and reflection on results directs development of treatment skills
  • Accurately self-assesses across a range and complexity of diagnoses
  • Recognizes limitations in knowledge and skills, and developmental needs for gaining expertise in a more specialized aspect of care
  • Reflects on results of active experimentation issued as a method to develop treatment skills and achieve outcomes
  • Able to identify own developmental needs for gaining expertise in a more specialist aspect of care.
  • Analyzes clinical decision making and identifies multiple sources of error
  • Continually critically evaluates own decision-making and judgments
  • >Accurately identifies boundaries of knowledge and skill and efficiently confers with referral source regarding patient needs
  • Demonstrates exquisite foresight in anticipating own developmental needs, often developing skills outside PT area of specialization

Clinical Reasoning:

- Knowledge

- Examination

- Evaluation/dx

- Prognosis

- Intervention

- Exercise prescription

  • Knowledge tends to be compartmentalized into diagnostic categories
  • Demonstrates a solid knowledge base and framework for practice across a range of patient complexity. Sees diagnosis as a framework to initiate decisions about examination.
  • Understands the range of variability within diagnosis and integrates data that does not "fit" into clinical decision making
  • Patient’s medical diagnosis serves to establish context in which examination data are gathered and evaluated, but does not drive the decision making process per se

Clinical Decision Making (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Clinical Reasoning:

- Knowledge

- Examination

- Evaluation/dx

- Prognosis

- Intervention

- Exercise prescription

(continued)

  • Assessments reflect more short-range predictions vs. view of patient at end of episode of care.
  • Developing skills in prioritization of patient assessment/examination procedures
  • Utilizes other staff as primary source of knowledge and to assist with clinical interpretation of new information
  • Identifies relationship between impairments and function, but may tend to view functional training as an end in itself vs. one way to achieve impairment resolution
  • Assessments reflect the ability to integrate pathophysiology, co-morbidities and psychosocial issues. Clinical impression is made within the context of individual needs and goals
  • Clinician begins to predict outcomes across an episode of care.
  • Takes initiative to identify learning needs and resources.
  • Transfers skills and knowledge to a variety of patient care situations.
  • Efficiently identifies and plans for patients’ needs.
  • Clinician confidently and efficiently predicts outcomes beyond a single episode of care and considers the long-term needs of the patient.
  • Takes initiative to identify learning needs and resources. Follows through and shares information with peers in a timely manner.
  • Transfers skills and knowledge confidently into unfamiliar situations and efficiently identifies new learning needs.
  • Efficiently identifies and plans for patients’ needs, including patients who will not benefit from PT/OT
  • Anticipates individual variation in patient response and has a variety of options and resources to meet patient needs.
  • Accurately and efficiently clusters findings from multiple data sources and identifies meaningful patterns based on prior experience.
  • Patient care is outcome driven, with outcomes defined in terms of goals that have been established in conjunction with the patient and his/her identified needs.
  • Selectively designs and implements exercise program that focuses on most critical issues to be addressed.
  • Recognizes the relative relevance of data from many sources and relies on minimum data set necessary to form decisions. Recognizes when further tests and measures will not add value to the clinical decision making process.

Clinical Decision Making (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Clinical Reasoning:

- Knowledge

- Examination

- Evaluation/dx

- Prognosis

- Intervention

- Exercise prescription

(continued)

  • Demonstrates beginning skills in weighing impact of co-morbidities / anticipated disease progression
  • Recognizes scope of intervention strategies to include direct, compensatory, and consultation. Primarily uses direct intervention methods
  • Consistently plans for patient needs, able to recognize when plan needs revision. Modification of plan is more likely the result of a reflective process than an automatic one.
  • Provides broad-based treatment approach that includes all patient identified problems that relate to functional limitations.
  • Sees key impairments as related to functional problems and prioritizes goals and treatments accordingly.
  • Utilizes varied manual techniques along with other methods of intervention to achieve outcomes
  • Continually progresses patient-based, on- ongoing reassessment.
  • Treatment approach reflects prioritized problems.
  • Seeks guidance to integrate specific pathophysiology and surgical intervention into the development of exercise programs
  • Efficiently clusters information from a variety of sources.
  • More selective and efficient utilization of manual techniques, along with other methods of intervention to maximize outcomes given increased managed care pressures.
  • Demonstrates clinically sound risk-taking
  • Treatment approach is selective and prioritizes problems. Selectively utilizes functional activities to achieve desired outcomes.
  • Specifically integrates pathophysiology and surgical intervention into development of exercise programs.
  • Identifies when findings do not fit together and one’s PT or OT tools cannot validate the suspected cause of patient’s problem. Confidently approaches MD or other health professionals to advocate for patient’s needs.
  • Highly selective and efficient in the use of manual techniques in combination with other methods of intervention to achieve predicted outcomes given managed care pressures.
  • Demonstrates thorough and consistent foresight in anticipating patients’ developmental needs.

Clinical Decision Making (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Evidence-based practice

  • Recognizes research as the basis of practice
  • Seeks broad-based information, which is diagnosis driven.
  • Utilizes resources and seeks appropriate assistance to validate research information for sound, clinical decision making.
  • Through the readings of scientific literature is able to identify current issues and trends in practice
  • Evidence drawn from the literature is actively pursued to support clinical practice.
  • Incorporates research findings into clinical practice.
  • Articulates theoretical foundation for practice and uses available evidence from a variety of sources to inform clinical decision making
  • Identifies gaps in the available evidence base for practice and helps to bring into focus the research questions critical to moving practice forward.

Accountability and responsibility

  • Recognizes the responsibility and accountability for his/her own clinical practice in relationship to the immediate needs of the patient
  • Sees lack of patient progress as immediately implicating own skills and abilities as less than adequate.
  • Recognizes the need to prioritize and organize care

 

  • Assumes responsibility for communicating with and educating other team members, as needed, to facilitate integration of patient’s PT and OT needs into current plan of care (including d/c plan).
  • Able to let go of need to "make every patient better" having learned to share responsibility for care with patient.
  • Life experience and knowledge gained outside of the professional work environment adds to the skill in managing patient care needs.
  • Demonstrates involvement in activities that contribute to the improvement of the unit/department/profession.
  • Experiences a sense of accountability for patient progress toward goals if not progressing as anticipated asks self "what have I not figured out?"
  • Demonstrates leadership in activities that contribute to the advancement of the unit/department/profession.
  • Demonstrates exquisite foresight in anticipating and pursuing patient’s developing needs across entire episode of care.

Clinical Decision Making (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Education/Consultation

- Patient and Family

 

 

 

- Student

 

 

 

 

 

 

  • Consistently incorporates patient/family education into treatment plans
  • Participates in community education
  • Participates in clinical education program with observational/part-time clinical experiences
  • Demonstrates basic knowledge of the teaching-learning process.

 

 

  • Adapts patient/family education plan based on individual needs
  • Participates/assists in the planning of community education
  • Participates in clinical education program with entry-level students and interns
  • Develops clear objectives and plans student learning activities. Provides feedback of student performance.
  • Efficiently adapts patient/family education plan based on individual needs
  • Participates in clinical education program with all levels of students. Works with individuals that are involved in transitional degree and residency programs
  • In conjunction with the student, individualizes goals/learning activities. Evaluates student performance against clear standards and communicates strengths/developmental needs to participants.
  • In consultation with the patient, develops a specific education plan which allows patient to have maximal control
  • Educates PT’s/OT’s and other disciplines beyond the facility via publications/presentations
  • Works efficiently and effectively with all students/staff on educational and professional development issues
  • Efficiently/effectively identifies student/staff learning needs and knowledge gaps. Assists in development of learning goals/plans to facilitate development of clinical skills.

Clinical Decision Making (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Education/Consultation

(cont.)

- Consultation

  • Educates team about professional role
  • Consults with other health care team members regarding patient needs for services.
  • Consults with less experienced staff and peers to maximize patient outcomes.
  • Achieves credibility; consultation is sought by peers and members of the health care team in planning patient care.
  • Identifies and utilizes appropriate resources to provide outcome-focused consultation.
  • Recognizes common characteristics within specific diagnostic groups and is effective in influencing the development of disease specific management (e.g. pathway development.)

Notes - Clinical Decision Making:

 

 


Collaboration/Teamwork

Collective work for the good of the patient and family, built on communication of clinical and ethical understandings between healthcare providers

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Interdisciplinary team

  • Demonstrates comfort in role as a team member and is developing awareness of professional boundaries
  • Seeks and values collaborative relationships with other disciplines to enhance patient management
  • Developing skills in negotiation/managing conflicts in roles
  • Peer development focuses on learning needs of individual peers
  • Educates team members, as needed, to facilitate integration of patient’s PT and OT needs into plan of care
  • Instills confidence in colleagues
  • Recognizes the need for consultation and institutes referrals that will result in mobilization of resources to meet patient and family needs
  • Consistently demonstrates the flexibility and ability to accommodate the needs of the service and the patient on a daily basis
  • Effective in alerting team to needs of patient that may extend beyond scope of one’s clinical practice
  • Skillfully negotiates conflict to promote collaboration
  • Implements unique and innovative approaches to meeting developmental needs of self and others
  • Views team education as central part of role and integrates into daily routines.

Collaboration/Teamwork (continued)

 

Entry Level

Clinician Level

Advanced Clinician Level

Clinical Scholar

Support Personnel

  • Utilizes a variety of support staff to assist with achievement of patient goals
  • Assimilates pertinent data, communicates to selected team members and delegates appropriately to achieve desired outcomes
  • Efficiently assimilates pertinent data, communicates to selected team members and delegates appropriately to achieve desired outcomes and maximize ability to manage entire caseload
  • Clearly defines own role and that of various support personnel and is able to accurately and efficiently match a patient’s needs to appropriate support resources to achieve optimal outcomes

System

  • Contributes to the effective operation of the his/her department
  • Identifies the value of operations improvement activities
  • Identifies problems related to practice and/or systems
  • Identifies systems or practice issues and potential solutions as part of professional role.
  • Actively participates in operations improvement activities
  • Challenges and shapes the system to maximize the benefits for patient care
  • Peer development focuses on elevating the standard of practice as a whole
  • Leads/coordinates operations improvement activities impacting his/her work area and/or patient population

Notes - Collaboration/Teamwork:

 

 


Movement

 

Entry Level

Clinical Level

Advanced Clinician Level

Clinical Scholar

Motor coordination and skill

- Palpate

- Facilitate vs. inhibit movement

  • Developing skills in being able to facilitate desired movement pattern while assisting patients with functional activities
  • Developing skills of palpation as tools of clinical practice
  • Skills of palpation, observation, and guidance play an important role in decision making and are effectively incorporated into clinical practice
  • Selects hands-on techniques for the purpose of examination and/or achieving desired patient outcomes
  • Efficiently selects and adapts skills of palpation, observation, and guidance based on previous experience
  • Employs highly refined skills of palpation, observation, and guidance of movement as tools of clinical practice
  • Uses hands-on techniques selectively and in a manner that supports rather than detracts from the primary focus, that of understanding the patient’s problem.

Analyze movement and respond

- Judgment

- Planned vs. automatic responses

  • Developing skill in analyzing movement and identifying normal vs. abnormal movement patterns
  • Effectively plans for and applies hands-on techniques
  • Recognizes need to modify planned intervention, but specific action may require reflective rather than automatic process
  • Demonstrates skill in identifying key components of movement related to impaired functional performance. Seeks guidance for complex patients.
  • Anticipates key components of movement related to improving functional performance
  • Demonstrates ability to automatically adjust hand placements to achieve desired patient response
  • Analysis of movement is used as a guide to patient care (i.e. linking the movement that is observed or felt to an intrinsic sense of what is "normal" and determining how it relates to the patient’s ability to function)
  • Is able to finely adjust hands-on techniques to meet the needs of individual patient care situations

Notes - Movement:

 

 

 

PCS Home | Chaplaincy | Excellence Every Day Portal | Institute for Patient Care | Nursing | Occupational Therapy | Orthotics & Prosthetics | Physical Therapy

Respiratory Care | Social Service | Nursing | Speech Language Swallowing Disorders | Clinical Resources | Search PCS | Contact PCS

MGH Home Page | MGH Intranet | MassGeneral Hospital for Children | Partners Healthcare

Massachusetts General Hospital 55 Fruit Street, Boston MA 02114 / (617) 726-2000 / TDD: 617-724-8800