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As the prevalence of total hip and total knee arthroplasty procedures increase over the next decades, hospitals seek opportunities to improve quality outcomes while simultaneously limiting costs and mitigating risks of complications. The Joint Commission's Advanced Total Hip and Total Knee Replacement (THKR) certification is one of the highest quality standard certification programs in the nation and is the only one that collaborates with the American Academy of Orthopedic Surgeons. To obtain THKR certification, several requirements based on evidence-based clinical practice guidelines must be met. The process is described from initial identification of stakeholders to ongoing efforts to retain certification. Joint Commission THKR certification was awarded after rigorous review and on-site visit. Compliance with advanced care standards from the time of orthopedic consultation through postsurgical follow-up was reviewed. Joint Commission THKR certification provides supporting evidence of the institutions journey in processes toward delivering high quality clinical care. A multidisciplinary team with ongoing collaboration is necessary to obtain and retain certification. [ABSTRACT FROM AUTHOR]

BackgroundMaster clinicians are recognized as multidimensional experts in clinical medicine. Studying their formative clinical activities could generate insights to guide medical trainees and early career clinicians.ObjectivesTo investigate which early career activities were adopted more commonly by master clinicians than their matched peers and to characterize master clinicians' early career activities across institutions and specialties.Subjects and methodsWe surveyed master clinicians at seven medical centres about their early career activities. For master clinicians in the Department of Medicine (DOM), we also surveyed matched internist peers.ResultsOf 150 master clinician respondents, 65% were internists (DOM); 35% practiced in other specialties. Compared to their internist peers, there was a trend toward internist master clinicians reading more about their patients' conditions (6.0 vs. 4.8 h per week), reading more case reports (4.0 vs. 2.1 per month), engaging in more frequent teaching duties and devoting less time to research.ConclusionsThe early career activities identified in this study can be adopted by clinicians pursuing clinical excellence and promoted by training programs that seek to foster life-long learning.

Background: Master clinicians are recognized as multidimensional experts in clinical medicine. Studying their formative clinical activities could generate insights to guide medical trainees and early career clinicians. Objectives: To investigate which early career activities were adopted more commonly by master clinicians than their matched peers and to characterize master clinicians' early career activities across institutions and specialties. Subjects and Methods: We surveyed master clinicians at seven medical centres about their early career activities. For master clinicians in the Department of Medicine (DOM), we also surveyed matched internist peers. Results: Of 150 master clinician respondents, 65% were internists (DOM); 35% practiced in other specialties. Compared to their internist peers, there was a trend toward internist master clinicians reading more about their patients' conditions (6.0 vs. 4.8 h per week), reading more case reports (4.0 vs. 2.1 per month), engaging in more frequent teaching duties and devoting less time to research. Conclusions: The early career activities identified in this study can be adopted by clinicians pursuing clinical excellence and promoted by training programs that seek to foster life‐long learning. [ABSTRACT FROM AUTHOR]

Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians.

There has been growing interest in the past century in improving understanding of the development and treatment of psychopathology of children, with increasing government funding of research in the past two decades. However, child and adolescent psychiatry excellence in clinical care has not been well-documented in the existing literature. This article provides examples of clinical excellence in paediatric mental health to supplement existing guidelines for the clinical practice of paediatric psychiatry. A review of the literature identified 204 unique peer-reviewed articles that were then further evaluated for applicability and relevance to the definition of clinical excellence as outlined by the Miller-Coulson Academy of Clinical Excellence (MCACE). Cases were then identified and selected for each domain of clinical excellence as they apply to child and adolescent psychiatry and to provide a model for patient care. Clinical excellence in child and adolescent psychiatry has not previously been defined or extensively documented. The Miller-Coulson Academy of Clinical Excellence (MCACE) has developed a systematic method to measuring excellence in clinical care and created a definition of clinical excellence. The MCACE defined the domains of clinical excellence as communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skilful negotiation of the healthcare system, knowledge, scholarly approach to clinical practice, exhibiting a passion for patient care and modelling clinical excellence, and collaborating with investigators to advance science and discovery. There are numerous case examples in the literature that represent mastery in paediatric psychiatry in these areas. Clinicians in paediatric mental health will likely benefit from future research on evidence-based approaches to training and education in these domains of clinical excellence. [ABSTRACT FROM AUTHOR]

Abstract Background Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists’ Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice. Methods This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach. Results Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants’ experiences with using the instrument: Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour. Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation. Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance. Conclusion Increased awareness of non-technical skills when using Nurse Anaesthetists’ Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists’ Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student’s learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

Experts in the field of palliative care in the United States (U.S.) have defined competence, or "good," mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or "great," applicable to palliative care specialists of all professions will elevate the field in the U.S. by providing an aspirational target usable for individual assessment and self-assessment, highlighting the common ground between team roles, and promoting a deeper understanding of teamwork, utilization, and productivity. We call for research that utilizes inclusive methods and broad representation of diverse voices to design a vivid, practical, and evidence-based definition of clinical excellence for palliative care specialists. [ABSTRACT FROM AUTHOR]

Background: Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice. Methods: This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach. Results: Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants' experiences with using the instrument: Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour. Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation. Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance. Conclusion: Increased awareness of non-technical skills when using Nurse Anaesthetists' Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists' Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student's learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments. [ABSTRACT FROM AUTHOR]

Neocolonialism has led to an imbalance in the production of knowledge and a clunky imposition of frameworks and models of practice that do not meet the needs of local communities. In contrast they can serve the central function of colonialism by draining valuable resources. Inequity of science diplomacy has diluted local voices and given precedence to colonialist knowledge and models of practice. It is argued that clinical, training and research excellence applies to those activities that meet and fulfil the clinical, training and research needs of the community in which they are embedded. Through personal reflection on contrasting Middle Eastern settings (Palestine and the UAE), the call is for the source of knowledge production and the driver for innovation to be daily clinical experiences listening to families in the community. This will result in policy and practices that are meaningful and impactful as illustrated by way of three examples: (1) a narrative approach to exploring suicide (2) an "all-hands-on-deck" clinical pathway for Autism assessments which transformed the lives of children and families with little additional resource, but with a fundamental shift in approach from "top down" to "bottom up" one as part of an organization-wide "Patient First" approach and (3) a rights-based, collective approach to developing mental health strategy. These examples are linked in terms of taking a shared "listening approach" but are applied to different levels moving from personal individual narratives to community clinical service to national strategy., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dabbagh.)

Objective/hypothesis: To apply the domains of clinical excellence, as published by the Miller-Coulson Academy of Clinical Excellence, to the field of otolaryngology-head and neck surgery (OHNS) as a framework for evaluating and improving clinical excellence.Methods: A search of PubMed, Scopus, the Cochrane Library, and the National Institute for Health and Care Excellence (NICE) databases was performed and 229 publications were reviewed.Results: Case reports and other articles were selected that exemplify each of the distinct domains of clinical excellence within our specialty.Conclusions: The Miller-Coulson Academy's domains of clinical excellence are relevant to OHNS and can provide a framework for fostering clinical excellence in otolaryngologists. The many examples of excellent care by otolaryngologists found in the published literature can inspire otolaryngologists to provide outstanding care to all patients consistently and to advance our specialty.Level Of Evidence: N/A Laryngoscope, 131:E2153-E2158, 2021. [ABSTRACT FROM AUTHOR]

Background: Hospitals are the most important and largest institution in each countrychr('39')s health system which health care services are carried out on a large scale. One of the most important processes to improve the quality of health services is accreditation in the country. This study aimed to identify challenges, obstacles and providing solutions in hospital accreditation. Materials and Methods: This research is a qualitative one which conducted using content analysis approach in the north of the country in 2017. Twenty-five people consisted of two heads of hospitals, three hospital managers, three matrons, four supervisors, ten nurses, three people responsible for accreditation selected as contributors to the study using a targeted sampling approach. After the interview with Maxqda software, coding was performed and necessary analysis was carried out. In order to obtain data validity, two methods of reviewing the participants and reviewing experts were used. Results: Analyzed data was categorized in the 98 initial codes, 16 concepts and 5 main categories. The main issues included resource challenges, organizational challenges, technical challenges, negative consequences and solutions. Conclusion: Pathology helps the organization to focus on problems and by collecting and analyzing data and identifying risky spots, managers and planners will find methods to develop and solve the problem. Particularly, the correct implementation of the accreditation process can lead to comprehensive clinical excellence.

Delivering clinical excellence is fundamental to the success of a 21st century dental school's mission and yet, our ability to define clinical excellence in practice remains surprisingly elusive. In this paper, Peter Thomson explores the complex and multi-faceted nature of clinical excellence, confirming its pivotal role throughout knowledge creation, teaching, training, lifelong education and clinical practice. Ultimately, our ability to deliver optimal patient care, manage new and emergent disease and enhance prevention and health promotion for the future require dental education and clinical service to be better aligned and more fully integrated with general healthcare provision for all. [ABSTRACT FROM AUTHOR]

Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians. [ABSTRACT FROM AUTHOR]

This engaging symposium opens up the question of therapeutic work with young adults in a consistently engrossing way that is refreshingly unpredictable and richly diverse. Particularly important is the appropriately extensive space given to the cultural context of therapy in late modernity; the impact and implications of the Zeitgeist for working therapeutically with young adults; the contested place of training with this client group; and the demonstration of thoughtful and sensitive clinical work with a client group whose 'emerging-adulthood-in-process' necessitates that therapists do all they can not to get in the way of the complex developmental struggles of the troubled young adults who find their way into therapy. [ABSTRACT FROM AUTHOR]

Clinical excellence is the goal in healthcare delivery, at both the provider and system level. At Johns Hopkins University School of Medicine, The Miller Coulson Academy of Clinical Excellence (MCACE) was established to celebrate and promote clinical excellence in hopes of optimizing the care experienced by patients. The MCACE describes clinical excellence as achieving a level of mastery in several areas including, but not limited to, communication and interpersonal skills, professionalism and humanism, diagnostic acumen, and negotiation of the healthcare system. The Academy's definition also puts an emphasis on teaching others to serve our patients and being a role model for clinical excellence. To have a positive influence on those beyond their immediate reach at Hopkins, the MCACE team launched CLOSLER, a free and open access medical education website (closler.org). With the goal of sharing thoughtful clinical stories and perspectives to stimulate reflection about providing exceptional care to every patient, CLOSLER takes its name from William Osler, the founder of academic medicine in the United States and an early champion of patient-centered care worldwide. CLOSLER offers articles written by healthcare professionals relaying pearls and lessons from practice for all, organized into four sections: Connecting with Patients, Clinical Reasoning, Passion in the Medical Profession, and Lifelong Learning in Clinical Excellence. CLOSLER has ushered in a new era of education that can help to move us closer to Osler and clinical excellence; it pushes the perspectives of outstanding role models to all who are interested in developing in this realm.

The academic promotion process in thoracic surgery can appear nebulous to many young surgeons. However, at most institutions, clear promotion criteria exist for specific academic tracks, and they are based on factors such as clinical excellence, research/investigation, funding, education/teaching, service, health policy, diversity, equity, and inclusion (DEI), ethics, quality and safety, and health care delivery. A thorough understanding of the promotion process is the key to successful advancement in academia., Competing Interests: Disclosure The authors have nothing to disclose., (Published by Elsevier Inc.)

Quality improvement is an essential component of 21st-century medicine. Dr. Shroff's Charity Eye Hospital is National Accreditation Board for Hospitals and Healthcare Providers-accredited organization which firmly believes in amalgamating quality measures with clinical processes and bringing out the most effective clinical environment for best patient care, one of the values of the organization. Clinical excellence is achieved through a stepwise approach.

Introduction: The authors conducted a review of the literature to identify curricula that incorporate the visual arts into undergraduate, graduate, and continuing medical education to facilitate the teaching of clinical excellence. Methods: The authors searched the PubMed and ERIC electronic databases in May 2017, using search terms such as "paintings," "visual arts," and "medical education," along with terms corresponding to previously defined domains of clinical excellence. Search results were reviewed to select articles published in the highest impact general medicine and medical education journals describing the use of visual arts to teach clinical excellence to all levels of medical trainees and practicing physicians. Results: Fifteen articles met inclusion criteria. Each article addressed at least one of the following clinical excellence domains: communication and interpersonal skills, humanism and professionalism, diagnostic acumen, and knowledge. No articles described the use of the visual arts to teach the skillful negotiation of the health care system, a scholarly approach to clinical practice, or a passion for patient care. Conclusions: This review supports the use of visual arts in medical education to facilitate the teaching of clinical excellence. However, research designed specifically to evaluate the impact of the visual arts on clinical excellence outcomes is needed.

Background: Hospitals are the most important and largest institution in each country's health system which health care services are carried out on a large scale. One of the most important processes to improve the quality of health services is accreditation in the country. This study aimed to identify challenges, obstacles and providing solutions in hospital accreditation. Materials and Methods: This research is a qualitative one which conducted using content analysis approach in the north of the country in 2017. Twenty-five people consisted of two heads of hospitals, three hospital managers, three matrons, four supervisors, ten nurses, three people responsible for accreditation selected as contributors to the study using a targeted sampling approach. After the interview with Maxqda software, coding was performed and necessary analysis was carried out. In order to obtain data validity, two methods of reviewing the participants and reviewing experts were used. Results: Analyzed data was categorized in the 98 initial codes, 16 concepts and 5 main categories. The main issues included resource challenges, organizational challenges, technical challenges, negative consequences and solutions. Conclusion: Pathology helps the organization to focus on problems and by collecting and analyzing data and identifying risky spots, managers and planners will find methods to develop and solve the problem. Particularly, the correct implementation of the accreditation process can lead to comprehensive clinical excellence. [ABSTRACT FROM AUTHOR]

Background: With the expansion of palliative care, the concept of clinical excellence is worthy of study and has not been described well in the literature. Objective: To apply the domains of clinical excellence, as proposed and published by the Miller Coulson Academy of Clinical Excellence, to the field of palliative care. Design: Review of the literature to identify episodes of superb palliative care delivered by individuals and teams. Measurement and Main Results: In reviewing 821 publications, we found multiple palliative care case reports to serve as exemplars for each of the distinct domains of clinical excellence. Conclusions: The domains of excellence are relevant and applicable to the field of palliative care. This article aims to inspire clinicians—and advance the field—by promoting thoughtful reflection on what clinical excellence in palliative care entails. [ABSTRACT FROM AUTHOR]

Background: Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school's curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, "clinical excellence" program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the "clinical excellence" of new clerks. Methods: In a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills. Results: Overtime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCEdiag and OSCEreason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCEdiag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCEreason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCEdiag and OSCEreason scores (>400) than those with less cumulative learning hours. Conclusion: Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot "clinical excellence" program have encouraged the formal implementation of this course as part of the clerkship curriculum. [ABSTRACT FROM AUTHOR]

Introduction: There are now more than 50,000 hospitalists working in the United States. Limited empiric research has been performed to characterize clinical excellence in hospital medicine. We conducted a qualitative study to discover elements judged to be most pertinent to excellence in clinical care delivered by hospitalists. Methods: The chiefs of hospital medicine at five hospitals were asked to identify their "clinically best" hospitalists. Data collection, in the form of one-on-one interviews, was directed by an interview guide. Interviews were transcribed verbatim, and the informants' perspectives were analyzed using editing analysis to identify themes. Results: A total of 26 hospitalists were interviewed. The mean age of the physicians was 38 years, 13 (50%) were women, and 16 (62%) were non-white. Seven themes emerged that related to clinical excellence in hospital medicine: communicating effectively, appreciating partnerships and collaboration, having superior clinical judgment, being organized and efficient, connecting with patients, committing to continued growth and development, and being professional and humanistic. Discussion: This qualitative study describes how respected hospitalists think about excellence in clinical care in hospital medicine. Their perspectives can be used to guide continuing medical education, so that offered programs can pay attention to enhancing the skills of learners so they can develop towards excellence, rather than using only competence as the desired target objective. [ABSTRACT FROM AUTHOR]

Clinical excellence is the ultimate goal in patient care. Exactly what the clinically excellent primary care physician (PCP) looks like and her characteristics have not been explicitly described. This manuscript serves to illustrate clinical excellence in primary care, using primarily case reports exemplifying physicians delivering holistic and patient-centred care to their patients. With an ever in creasing demand for accessible and accountable health care, an understanding of the qualities desirable in primary care providers is now especially relevant. A literature review was conducted to identify compelling stories showing how excellent PCPs care for their patients. In the 2397 published works reviewed, we were able to find case reports and studies that exemplified every domain of the description of clinical excellence proposed and published by the Miller Coulson Academy of Clinical Excellence (MCACE). After reviewing these reports, the authors felt that the domains of excellence, as described by the MCACE, are practically applicable and relevant for primary care physicians. It is our hope that this paper prompts readers to reflect on clinical excellence in primary care. [ABSTRACT FROM AUTHOR]

Objectives: Changes in the US healthcare economic system are requiring academic health centers (AHCs) to restructure in pursuit of their traditional tripartite missions; engaging the individuals focused on clinical care is becoming more important. We conducted this study to guide our institution's transformation by identifying ways to formally recognize clinicians who are excelling in patient care and understand which forms of acknowledgment would be acceptable and motivating.Methods: A survey was developed by a large committee with representation spanning the AHC and was sent electronically in spring 2014 to stakeholders across the institution. Items assessed perceptions of the importance and present state of valuing clinical excellence, the utility of 14 potential metrics to assess clinical excellence, and the meaningfulness of seven potential rewards for clinical excellence. Bivariate and multivariate logistic regression models analyzed differences (P < 0.05) by respondent sex, ethnicity, academic rank, primary clinical affiliation, and time spent in patient care and research activities.Results: A total of 1716 of 3168 (54%) stakeholders responded, including 1198 of 2151 (56%) individuals from academic hospitals, 114 of 276 (41%) from the outpatient affiliated practices, and 304 of 741 (54%) from satellite locations. Nearly everyone (96%) agreed that clinical accomplishments should be recognized, although a minority (47%) believed that clinicians were already valued. Most respondents selected 7 or more of 14 metrics as valid and reasonable for assessing clinical excellence. Popular metrics (eg, clinical productivity) were not believed to represent clinical excellence as much as others (eg, professionalism). Multivariate analysis found the least agreement among stakeholders on using published scholarship as evidence for clinical excellence, with the widest differences comparing senior faculty versus nonfaculty (88% vs 27%) and those with >75% of their time spent in patient care versus others (37% vs 73%). Most (six of seven) types of reward were perceived as meaningful by the majority of respondents, with little variation among subgroups across bivariate and multivariate analyses.Conclusions: This system-wide assessment was successful at identifying new strategies for recognizing clinical excellence. Other AHCs seeking institutional transformation may wish to perform a similar assessment. [ABSTRACT FROM AUTHOR]

Clinical excellence should be recognized, particularly in the current climate that appropriately prioritizes relationship-centered care. In order to develop a recognition model, a definition of clinical excellence must be created and agreed upon. A paradigm recently suggested by C. Christmas describes clinical excellence through the following domains: diagnostic acumen, professionalism and humanism, communication and interpersonal skills, skillful negotiation of the healthcare system, knowledge, taking a scholarly approach to clinical practice, and having passion for clinical medicine. This work references examples of infectious disease (ID) clinical excellence across Christmas' domains and, in doing so, both examines how the definition of clinical excellence applies to ID practice and highlights the importance of ID physicians. Emphasizing such aspirational standards may not only inspire trainees and practicing physicians to pursue their own fulfilling clinical ID careers, it may also encourage health systems to fully value outstanding ID physicians who labor tirelessly to provide patients with exceptional care. [ABSTRACT FROM AUTHOR]

Background: Provision of exceptional medical care is a goal for the medical profession because this is what the public needs and deserves. Academic medical centers that value excellent clinicians may have the best chance to recruit and retain these faculty members. When our institution hoped to launch the Miller Coulson Academy of Clinical Excellence to measure and reward master clinicians, a critical first step was to use rigorous methods to develop a definition of clinical excellence. Published papers have illustrated that this general definition of clinical excellence is applicable to fields of psychiatry, cardiology, and pediatrics. Summary: In this manuscript, we apply the definition of clinical excellence to nephrology. Using the same framework, we reviewed the literature to find clinical cases and exemplary nephrologists that highlight the specific domains. This collection of reports in nephrology illustrates that the definition of clinical excellence set forth by the Miller Coulson Academy is highly applicable to physicians caring for individuals with kidney disease. Relating the definition of clinical excellence to renal medicine is worthwhile in that it can help to exemplify the model to which physicians and trainees may seek to aspire. Key message: Many examples of clinical excellence in renal medicine can be found in the published medical literature. The domains of clinical excellence, described by the Miller-Coulson Academy of Clinical Excellence, apply very well to the field of nephrology. [ABSTRACT FROM AUTHOR]

In many professional careers, employees remain in a particular job for many years. They often do not have as structured of a career ladder to follow. It, therefore, becomes a challenge to ensure that such individuals have adequate opportunities to satisfy needs for professional growth. Clinical Career Pathways (CCPs) were introduced to nursing in North America in the 1970s at a time of nursing shortage. Prior to their inception, nurses wishing to develop their careers had to move to administration, management or education. Notably, clinical practice is the core of professional nursing, hence, the Clinical Ladder, or Professional Advancement Program for Nurses, was specifically designed for professional nurses who prefer to pursue their careers in direct patient care. Hence, the Clinical Nurse Advancement Program is a professional promotion system that develops, recognizes, and rewards growth in clinical nursing practice. The need to identify and establish a national framework and guidelines for Nursing Clinical Excellence Program is a priority for nursing profession in Nigeria. This will not only promote excellence in clinical practice but will also achieve the goal of national consistency of structure and process. Again, it will facilitate transferability and transportability of the nurse's level of practice within and across organizations. [ABSTRACT FROM AUTHOR]

Background: Determining what constitutes an excellent allied health care professional (AHCP) is important, since this is what will guide the development of curricula for training future physical therapists, oral hygienists, speech therapists, diagnostic radiographers, and dietitians. This also determines the quality of care. Aim: To describe perspectives of AHCPs on which characteristics are commonly associated with an excellent AHCP. Methods: AHCPs' perspectives were derived from three focus group discussions. Twenty-one health care professionals participated. The final analysis of the focus group discussions produced eight domains, in which content validity was obtained through a Delphi panel survey of 27 contributing experts. Results: According to the survey, a combination of the following characteristics defines an excellent AHCP: (1) cognizance, to obtain and to apply knowledge in a broad multidisciplinary health care field; (2) cooperativity, to effectively work with others in a multidisciplinary context; (3) communicative, to communicate effectively at different levels in complex situations; (4) initiative, to initiate new ideas, to act proactively, and to follow them through; (5) innovative, to devise new ideas and to implement alternatives beyond current practices; (6) introspective, to self-examine and to reflect; (7) broad perspective, to capture the big picture; and (8) evidence-driven, to find and to use scientific evidence to guide one's decisions. Conclusion: The AHCPs perspectives can be used as a reference for personal improvement for supervisors and professionals in clinical practice and for educational purposes. These perspectives may serve as a guide against which talented students can evaluate themselves. [ABSTRACT FROM AUTHOR]

The article presents a study on the professional performance's peer assessment through hospitalist physicians. The study examined the responses of 22 hospitalist physicians in assessing the clinical skills of their peers. The study shows that the correlativity among scale details and the variable that states the chosen doctor of a person for his or her loved one renders validity evidence to the assessment scale. Thus, the study could be used in identifying the top performers in the hospital.

The author emphasizes the need to focus on quality in mental health and addictions treatment. High-quality care means care that is personalized, prevention-oriented, and based on evidence about the benefits, costs, and the desires of each person. Whereas the challenges to improving quality are formidable, four critical issues can and must be addressed: focus on whole health, clinical excellence, workforce, and information technology. With strong leadership, commitment, and persistence, we can have a system that supports recovery and ensures a meaningful life in the community for our sickest and poorest citizens. [ABSTRACT FROM AUTHOR]

Background: The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. Objective: Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR. Methods: The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data. Results: The search identified 606 titles, with the majority (393/606, 64.9%) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6%) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5%) or the specific domains of communication and interpersonal skills (380/578, 65.7%), diagnostic acumen (31/578, 5.4%), skillful negotiation of the health care system (4/578, 0.7%), scholarly approach to clinical practice (41/578, 7.1%), professionalism and humanism (2/578, 0.4%), knowledge (97/578, 16.8%), and passion for clinical medicine (20/578, 3.5%). Conclusions: Results suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all. [ABSTRACT FROM AUTHOR]

This article was migrated. The article was marked as recommended. Introduction: The authors conducted a review of the literature to identify curricula that incorporate the visual arts into undergraduate, graduate, and continuing medical education to facilitate the teaching of clinical excellence. Methods: The authors searched the PubMed and ERIC electronic databases in May 2017, using search terms such as "paintings," "visual arts," and "medical education," along with terms corresponding to previously defined domains of clinical excellence. Search results were reviewed to select articles published in the highest impact general medicine and medical education journals describing the use of visual arts to teach clinical excellence to all levels of medical trainees and practicing physicians. Results: Fifteen articles met inclusion criteria. Each article addressed at least one of the following clinical excellence domains: communication and interpersonal skills, humanism and professionalism, diagnostic acumen, and knowledge. No articles described the use of the visual arts to teach the skillful negotiation of the health care system, a scholarly approach to clinical practice, or a passion for patient care. Conclusions: This review supports the use of visual arts in medical education to facilitate the teaching of clinical excellence. However, research designed specifically to evaluate the impact of the visual arts on clinical excellence outcomes is needed., (Copyright: © 2018 Gelgoot E et al.)