Advanced Clinician - At this level the clinician experience allows them to "read" the situation and respond appropriately. The clinician intuitively understands the situation but at this stage still needs to think analytically about what to do.

Case Study - An analysis of a clinical situation where the focus is on the clinician’s decision-making regarding a diagnosis and/or set of symptoms.

Clinical Narrative - A detailed description of a clinical situation including intentions and interpretations of events, chronology of action and outcomes (Benner, 1987).

Clinical Scholar - At this level the clinician’s practice is fluid. The clinician intuitively understands the situation and the action to take. The manner and degree of engagement and involvement with patients and families is finely tuned. They skillfully work with and through others.

Clinician Level - At this level clinician’s have a broad range of experience in caring for patients, develop therapeutic relationships with patients and families and works effectively with all members of the team. When the clinician has consistently demonstrated Clinician Level behavior the manager/director will recognize them as practicing at the Clinician Level. This level must be achieved within two years of hire.

Colleague: - A colleague "from outside of your discipline" should be someone who knows your practice and can speak to your work in any or all of the themes of practice.  Therefore, a colleague for this purpose is defined as someone with formal clinical training who is "a member of the care team" or a "direct care provider". Examples are pharmacists, chaplains, clinical dieticians, physicians, child-life specialists or any of the six disciplines involved in this program. They are nursing, occupational therapists, physical therapists, respiratory therapists, social workers and speech-language pathologists.

Consensus - A decision by consensus is a decision in which all the group members find a common ground. It means that everyone understands the decision and can explain why it is best. It means that everyone can live with the decision.

Domain - see theme.

Dreyfus Model of Skill Acquisition - Based on the work of Drs. Hubert and Stuart Dreyfus, both professors at the University of California at Berkeley. This is a situational model of skill acquisition. It is the development of skilled know how. The model states that a person passes through five stages of qualitatively different perceptions of his/her task and/or mode of decision-making as his/her skill improves. It is neither expected nor possible for all individuals to proceed in a linear fashion. Skill according to this model is based on innate ability, experience and environment.

Endorsement - Acknowledgement that the clinicians practice meets the criteria for the level of practice being applied for in the opinion of the endorser.

Entry level - Following the completion of orientation, including all competencies, clinicians will begin their practice becoming comfortable with patient care management, systems and resources. When the clinician has consistently demonstrated entry level behavior the manager/director will recognize them as practicing at the Entry level. This level must be achieved within three to twelve months of hire.

Experience - The transformation of preconceived notions, expectations and/or theory by means of encounters with actual clinical situations (Benner & Wrubel, 1982).

Level of Practice - Four distinct stages that are characterized by a particular perspective, type of decision making and level of involvement with patients, families and colleagues.

Live at - Level of practice that the clinician consistently practices at. There will always be times when a clinical situation can be described at another level (visiting) but it is not representative of practice. To live at a level is to be consistent with that level of practice. There are four levels of practice: Entry, Clinician, Advanced Clinician and Clinical Scholar.

Portfolio - A series of professional documents, which will contain- a cover letter, clinical narrative, letters of support, letter of endorsement and a resume.

Recognition - Acknowledgement that a clinician has achieved and consistently demonstrates the identified level of practice for a minimum of the previous six months.

Review Board - A multi-disciplinary group of clinicians who will review all portfolios submitted by clinician’s seeking to be recognized at the Advanced Clinician and Clinical Scholar level. Three Board members, including a representative from the clinician’s discipline, interview the clinician and make a recommendation to the larger Board. The full Board will decide to recognize or not recognize the clinician at the applied for level.

Review Team - Three members of the Review Board who interview a clinician applying for either the Advanced Clinician or Clinical Scholar level. One member of the review team will be a member of the applicant’s discipline.

Salience - The condition where certain aspects stand out as more or less important in a situation. Salience is a perceptual stance or embodied knowledge whereby a person does not deliberately have to calculate which aspects of the situation are more or less important; they just appear as more or less important.

Self-reflection - Process by which a clinician reviews each theme and the behaviors noted in the levels of practice and identifies examples of their own practice that fit with the behaviors at that level. Through this thoughtful process the clinician determines at what practice they live at.

Theme - Is a cluster of competencies or recurring aspects or elements found in the practice. Themes identified at the Massachusetts General Hospital are clinician-patient relationship, clinical knowledge and decision making and teamwork and collaboration. Physical Therapy and Occupational Therapy identified a fourth theme, movement.

Transition Board - Clinicians and leadership who will be appointed by the Senior Vice President for PCS and Chief Nurse to review and decide on recognition of clinicians at the Advanced Clinician and Clinical Scholar levels of practice. As this occurs there is a transition plan to eventually have a Board comprised on Advanced Clinicians and Clinical Scholars.

Visiting a Level - Occurs when the clinician demonstrates certain behaviors at certain times at one level but does not demonstrate those behaviors consistently at that level.