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Defining an Expert Clinician

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We surveyed over 540 physicians and nurses to understand more about what they perceive confers upon a colleague the reputation of "expert."

Publicado en: Salud y medicina
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Defining an Expert Clinician

  2. 2. Working with leading experts to create our roundtable discussions, we are often asked: “What criteria do you consider when choosing an expert?” We reached out to our readership and surveyed over 5,000 healthcare professionals 
 with over 540 answering our online survey. Here are the results from doctors and nurses:
  3. 3. WHAT ISTHEVALUE OF AN EXPERT? To find out we asked: “An expert clinician is someone…” Physicians and nurses seek expert opinion to guide them in their professional healthcare missions. Almost 50% disagreed with the notion that working with pharma would disqualify expertise. Comment sentiments revealed: “who is approachable and loves to share their knowledge base in patient care” “who makes me think beyond my bounds and opens my own insight while challenging me” “who I would turn to for advice for my own care or that of a family member”
  4. 4. GENERAL CRITERIA OF EXPERTISE PHYSICIANS’ PERSPECTIVE MDs ranked the following elements #1 in determining expert reputation: Clinically Active - Touching Patients (28%) Recognized by Peers (24%) Publishes Relevant Materials (10.5%) Board Certifications (8.5%) Other choices garnered 5% or less of the #1 ranking (in descending order): Participates in Educational Scientific Programs Clinical Research Principal Investigator AcademicTraining Clinical Research Available for Discourse and Debate Institutions Worked In Teaches Students Regularly Awards & Funding Received Active in Society Leadership
  5. 5. GENERAL CRITERIA OF EXPERTISE NURSES’ PERSPECTIVE RNs & NPs ranked the following elements #1 in determining expert reputation: Clinically Active - Touching Patients (35%) Board Certifications (12%) Recognized by Peers (10%) Clinical Research - Principal Investigator (9%) Clinical Research - Involved in Studies (9%) Publishes Relevant Materials (6%) ! Other choices garnered 5% or less of the #1 ranking (in descending order): Institutions Worked In AcademicTraining Teaches Students Regularly Participates in Educational Scientific Programs Awards & Funding Received Clinical Research Principal Investigator Available for Discourse and Debate Active in Society Leadership
  6. 6. PUBLISHING CRITERIA Not surprisingly, physicians considered “traditional” authorship and editorial roles in journals and textbooks as highly or moderately indicative of expertise. More “contemporary” media such as blogging, podcasting and online video did not seem to indicate expertise. Nurses followed suit on “traditional” and “contemporary” modes. Notably there was a fall off in the perceived value of peer reviewing to journal editing - the opposite of the physicians’ perspective on these roles contributing to expertise.
  7. 7. INSTITUTION CRITERIA Physicians reserved their top 3 rankings mostly for University Hospitals and Multispecialty Academic Centers (MACs), whileVAs and Community Hospitals were not considered for the top slots. Even though MCOs finished in the second lowest position, this category garnered the most combined #1 and #2 rankings. Physicians were mostly interested in the “reputation of the institution” rather than what type. Nurses agreed with physicians regarding “reputation of the institution” over the type as indicia of expertise. However, they spent their top 3 picks mostly on MACs, equating them with MCOs from a physician’s perspective. Surprisingly, nurses considered Individual Practice on par with MACs.
  8. 8. PATIENT PANEL SIZE Physicians (47%) and Nurses (48%) overwhelmingly agreed that patient panel size would not be considered as indicating “expertise.” When contrasted with their responses which consider “Clinically Active -Touching Patients” as the #1 general criteria, there seems to be a disconnect. ! The respondents’ comments could resolve the disconnect which emphasized: ! Expertise is not dependent upon the absolute quantity of patients, but rather the # of patients relative to the specialty of expertise. 26% of Physicians and Nurses agreed that a patient panel size of 1,500-2,000 would indicate expertise for a physician running an internist or family practice.
  9. 9. YEARS IN PRACTICE Nurses Physicians Physicians and Nurses agreed expertise can be attained within a range of 6-15 years of clinical practice, leaning more toward 6-10 years than 11-15 years. Some commentary suggested as little as 5 years could confer expertise. Comment sentiments revealed: “at least 5 years” “more than 5 years” “minimum of 5 consecutive years in one area to approach an expert status” “one needs at least 5 years experience to have well-rounded background”
  10. 10. # OF SCIENTIFIC PAPERS PUBLISHED Nurses Physicians Physicians (53%) and Nurses (51%) responded the number of papers does not indicate expertise, however, 34% indicated that up to 50 papers would be a suitable marker of expertise. Comment sentiments revealed: “authoring only indicates you write about what you do, not that you do it well” “publish or perish mentality undermines clinical expertise” “I don’t really care about the papers” “does not indicate expertise, only a willingness to do research”
  11. 11. TYPES OF SPEAKING ENGAGEMENTS Nurses Physicians Physicians and Nurses overwhelmingly agreed that speaking at a National Conference (average 75%) or a Specialty Conference (average 62%) would indicate expertise. Comment sentiments revealed: “conference speakers, particularly nationally, are heavily influenced by the industry sponsors of the conference” “some true experts are not ubiquitous on speaker panels, but other not-so- expert physicians turn up all the time” respondents were permitted to choose more than one answer
  12. 12. CHOOSING CONFERENCE SESSIONS Nurses Physicians When asked to rank the criteria used to select which sessions they would attend at a national conference, predictably Physicians and Nurses overwhelmingly ranked “topic” #1 (88%) while the identity of the speaker only garnered 11% of the #1 picks. Comment sentiments revealed: “while I generally choose a topic in my field, the speaker can sometime sway my choice if the topic could also be relevant” “the identity of the speaker is very important, but it does not override my desire to learn within my discipline” “could attend for the speaker if its an important late-breaking trial result” respondents were permitted to choose more than one answer
  13. 13. INSIGHTS INTO CLINICAL EXPERTISE • Physicians and nurses agree on the overwhelming value of touching patients conferring clinical expertise. • Peer recognition is almost as greatly valued by physicians as touching patients. • Board certifications and traditional publishing are considered valuable indicators of expertise. • Academic training, institutional employment, clinical research, society leadership and teaching are not strong indicators of expertise. • Traditional authorship of journal articles and textbooks indicates expertise, while more contemporary media such as blogging, podcasts and video series are not. • Institutions of employment seem to be regarded on a case by case basis more significantly than other criteria. • Absolute patient panel sizes are not indicative; number of patients relevant to the type and complexity of the practice can contribute to expertise if the practice is “active” for that type. • A minimum of 5 continuous years of practice in an area indicates expertise, with a range of 6-10 years being an accepted norm. • The quantity of scientific papers is not indicative of expertise - although between 1-50 may show expertise. • Speaking at a national conference can confer expertise. • Conference attendees are generally not persuaded to attend a session by “who” is speaking so much as “what” topic they are speaking about.
  14. 14. WHAT DOES A CLINICAL EXPERT LOOK LIKE? • This individual is board certified and has at least 5 - 10 years in an active “patient-touching practice” in a singular area of medicine. • In addition, this individual is has been recognized by their peers in the field, is sought after, spoken at a national, specialty or regional conference and has published in traditional journals or textbooks. • Additional expertise may be conferred if the institution in which the professional works is considered excellent relative to their specialty. • Clinical research, publishing more than 50 papers, or academic training are dubious indicators of clinical expertise.
  15. 15. • We submit that gauging expertise is open to vigorous debate, individual perspective, and specific combinations of circumstances. Our goal here is to provide generalized insights from the perspectives of readers of The Medical Roundtable. • Our attempt to normalize various disparate and conflicting criteria is not intended to otherwise critique any particular individual or institution. • The Medical Roundtable continues to provide surveys and insights as we execute our mission to “Add Experience to the Evidence” What are your thoughts? Comment on slideshare or email us at
  16. 16. For more information: T.Anthony Howell | Publisher (203) 253-5906