Fellow: Adam Cohen, Pediatric Hospital Medicine Fellow, Baylor College of Medicine/Texas Children’s Hospital
Article: Murthy, Vivek K., et al. “An Inquiry Into the Early Careers of Master Clinicians.” Journal of Graduate Medical Education 2018; 10(5):500-506. doi:10.4300/jgme-d-18-00208.1
Summary: This study was a retrospective qualitative interview study designed to identify early career experiences and behaviors of peer-defined master academic clinicians. Investigators conducted individual semi-structured interviews with 17 members of UCSF’s Department of Medicine Council of Master Clinicians. Interviews were recorded and transcribed prior to the use of a general inductive approach for thematic analysis, which included descriptive coding, recognition of themes and patterns, and refining of themes into 4 major findings. These 4 overlapping themes of the early habits of master clinicians included: (1) consistent learning efforts such as reading, teaching and patient outcome tracking, (2) rigorous skill development focused on communication, physical exam, and clinical reasoning, (3) cultivating habits of mind including humanism, joy in work, humility, and rigor in analysis, and (4) a clinically rich environment including high patient volume, peer learning and practicing outside their comfort zone. The authors found that their analysis correlated to papers describing habits during later careers, suggesting that expert physicians adopt these behaviors early and maintain them throughout their professional lives. Finally, the authors created a list of strategies and action items for early career physicians based on the study findings.
Key Strengths: This study was based on sound qualitative methodology and well established themes of clinical excellence which correlated well with the results obtained. The interview guide was semi-structured and allowed for novel ideas to be obtained during the interview process. The results do well to codify and organize areas of deliberate practice which many physicians discuss in general terms, but are not built into the curriculum of many training programs. Finally, the action steps suggested by the authors for students, residents and early career physicians could be integrated into medical training programs to help establish early habits of clinical mastery.
Key Limitations: The general inductive approach to qualitative data used by the authors is based on a pre-defined framework, which could result in biases. It is also not meant to generate novel hypotheses and theories, unlike other common qualitative methods such as grounded theory or phenomenological approaches. Participants were peer-defined experts, and therefore, may not reflect clinical mastery if a criterion based definition existed. Participants were also from a single academic center, largely male, and largely trained at that same academic center. Lastly, retrospective questioning is prone to recall bias.
Major Takeaway: Master clinicians were able to define specific habits of their early careers that helped them establish their expertise. These habits fall under the domains of deliberate learning practices, rigorous skill development, mental attitudes and participation in a clinically rich environment.
How this article should impact our practice: This article contributes to the ongoing study of clinical mastery and is the first of its kind to focus specifically on early career habits. Creating a culture and education system which encourages these habits may be a way to enhance the clinical skills of early career physicians.
Article: Murthy, Vivek K., et al. “An Inquiry Into the Early Careers of Master Clinicians.” Journal of Graduate Medical Education 2018; 10(5):500-506. doi:10.4300/jgme-d-18-00208.1
Summary: This study was a retrospective qualitative interview study designed to identify early career experiences and behaviors of peer-defined master academic clinicians. Investigators conducted individual semi-structured interviews with 17 members of UCSF’s Department of Medicine Council of Master Clinicians. Interviews were recorded and transcribed prior to the use of a general inductive approach for thematic analysis, which included descriptive coding, recognition of themes and patterns, and refining of themes into 4 major findings. These 4 overlapping themes of the early habits of master clinicians included: (1) consistent learning efforts such as reading, teaching and patient outcome tracking, (2) rigorous skill development focused on communication, physical exam, and clinical reasoning, (3) cultivating habits of mind including humanism, joy in work, humility, and rigor in analysis, and (4) a clinically rich environment including high patient volume, peer learning and practicing outside their comfort zone. The authors found that their analysis correlated to papers describing habits during later careers, suggesting that expert physicians adopt these behaviors early and maintain them throughout their professional lives. Finally, the authors created a list of strategies and action items for early career physicians based on the study findings.
Key Strengths: This study was based on sound qualitative methodology and well established themes of clinical excellence which correlated well with the results obtained. The interview guide was semi-structured and allowed for novel ideas to be obtained during the interview process. The results do well to codify and organize areas of deliberate practice which many physicians discuss in general terms, but are not built into the curriculum of many training programs. Finally, the action steps suggested by the authors for students, residents and early career physicians could be integrated into medical training programs to help establish early habits of clinical mastery.
Key Limitations: The general inductive approach to qualitative data used by the authors is based on a pre-defined framework, which could result in biases. It is also not meant to generate novel hypotheses and theories, unlike other common qualitative methods such as grounded theory or phenomenological approaches. Participants were peer-defined experts, and therefore, may not reflect clinical mastery if a criterion based definition existed. Participants were also from a single academic center, largely male, and largely trained at that same academic center. Lastly, retrospective questioning is prone to recall bias.
Major Takeaway: Master clinicians were able to define specific habits of their early careers that helped them establish their expertise. These habits fall under the domains of deliberate learning practices, rigorous skill development, mental attitudes and participation in a clinically rich environment.
How this article should impact our practice: This article contributes to the ongoing study of clinical mastery and is the first of its kind to focus specifically on early career habits. Creating a culture and education system which encourages these habits may be a way to enhance the clinical skills of early career physicians.