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Institute for Patient Care Clinical Affilations Program

How was the Program developed?

The Clinical Recognition Program reflects the work of many people in Patient Care Services. As part of the Collaborative Governance Structure, the Professional Development Committee convened to define a framework for a professional recognition program. Membership was comprised primarily of staff clinicians representing the six disciplines in the Program. The committee researched the field of skill acquisition and, in particular, studied the work of Drs. Hubert and Stuart Dreyfus and Dr. Patricia Benner. They met with groups of MGH clinicians and examined narratives – stories of clinical practice – written by MGH staff. Through the committee’s work a picture of MGH practice emerged and is described through the themes and levels of practice.
Following the completion of the Professional Development Committee’s work, the Clinical Recognition Steering Committee convened in April 2002. Membership was drawn from the Professional Development Committee as well as other clinicians and managers new to the program. The Steering Committee was charged with developing systems and processes to facilitate implementation. This involved designing the Review Board and the portfolio. Once this was done educational strategies for clinical leadership and clinicians were developed to assure that all staff had access to the information necessary to understand this program. Finally the Steering Committee will provide oversight and evaluation.

Who is included in the Program?

The Clinical Recognition Program includes the following clinicians:
  • Staff Nurse Direct Care Providers, Resources Nurses, ARNs and T-nurses (Emergency Department)
  • Staff and Senior Occupational Therapists
  • Staff and Senior Physical Therapists
  • Staff and Senior Respiratory Therapists
  • Speech-Language Pathologists
  • Clinical Social Workers

How does the Clinical Recognition Program define levels of clinical practice?

The program asks applicants to analyze their practice as it relates to the following critical themes:

  • Clinician-patient relationship
  • Clinical knowledge and decision-making
  • Teamwork and collaboration
  • Movement (for Occupational Therapy and Physical Therapy only)

Clinicians in all disciplines incorporate these themes as they deliver care. As they gain knowledge and integrate their clinical experiences, the way in which they practice within and across each theme evolves and matures.

The Clinical Recognition Program describes criteria within each theme that define four levels of clinical practice:

  • Entry level clinician
  • Clinician
  • Advanced Clinician
  • Clinical Scholar

Clinicians practicing at the Entry level are learning to apply newly acquired knowledge and skills to a multitude of patient care situations. Entry level clinicians initially draw on learned facts and rules to organize care and guide practice. As they gain experience, they are increasingly able to recognize the uniqueness of each patient situation and modify care to meet each patient’s needs. The Entry level clinician understands the role of other disciplines and consults with peers in designing a plan of care.

Those practicing at the Clinician level have acquired broad experience in caring for patients, and have often developed a sound understanding about the care of a particular patient population. They routinely draw on learned facts and experience as well as an understanding of possible outcomes when designing a plan of care. They have learned to recognize patterns in clinical practice, and use this knowledge as they make clinical decisions. They have confidence in their own decisions and abilities, they personalize care for each patient, and they act as resources to colleagues and strong advocates for patients.

Clinicians at the Advanced Clinician level have typically acquired in-depth knowledge about the care of a particular patient population and an appreciation for the many factors that influence care. In caring for each patient, they constantly consider not just the possibilities – or what could happen – but the probabilities – or what is most likely to happen given the clinical and organizational factors at hand. Instinctively, they use this information to continually tailor their patients’ care to ensure the best outcomes. Advanced Clinicians value the contributions of peers and colleagues in other disciplines, and routinely consult with and serve as resources to others.

Clinicians at the Clinical Scholar level demonstrate exquisite foresight in planning patient care, are recognized as experts in their areas of specialization, and are adept at negotiating conflict and in collaborating with others. Clinicians at this level are reflective by nature and readily integrate knowledge gained by reflection into their practice. They are able to respond intuitively to patient needs and to comfortably engage in clinically sound risk taking.  Clinical Scholars welcome new perspectives and seek out opportunities to share knowledge and insights with colleagues. Skilled at creative problem solving and in working with others, they routinely lead efforts to strengthen the many organizational systems that support patient care.

How does staff participate in the Clinical Recognition Program?

Each clinician works with his/her director to analyze practice in light of the criteria defined in the program. Together they determine the clinician’s practice level and set goals for the clinician’s future development. Recognition at the first two levels – Entry and Clinician – occurs for all clinicians at the unit or department level. Clinicians who meet criteria for the Advanced Clinician or Clinical Scholar level can choose to seek recognition at one of these levels or can choose to remain at the Clinician level.

A clinician seeking recognition at either the Advanced Clinician or Clinical Scholar level begins the recognition process by obtaining the endorsement of his/her director and initiating an application to be formally recognized as an Advanced Clinician or Clinical Scholar. The clinician then assembles a professional portfolio, including a cover letter, resume, letters of support, and a clinical narrative that describes his/her practice and illustrates how it meets the criteria for the level of recognition being sought. The portfolio is submitted to an interdisciplinary review board for consideration. Clinicians seeking recognition at these levels also participate in an interview with members of the review board as part of the application process.

 

 

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