Guide for Self Reflection: Speech-Language Pathology - Clinical Recognition Program - The Knight Nursing Center for Clinical & Professional Development - Patient Care Services

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One of the questions most frequently asked by clinicians when they hear about the Clinical Recognition Program is, "How will I know my practice level?" This question cannot be answered by completing a checklist or counting up the years of employment. It requires that you think about your practice and the impact you have had on patients, families, and colleagues.

To help you assess your level of practice, we recommend the following steps.

Read through the attached descriptions of each level of practice. You’ll find that the descriptions refer to "themes" or aspects of clinical practice: clinician/patient relationship, clinical knowledge and decision-making, and teamwork/collaboration. Within each theme, four levels of practice are described:

Entry

Clinician

Advanced Clinician

Clinical Scholar

As you read through the descriptions, make note of the differences between each level. Think of specific examples of clinical practice that would "fit" with the criteria being described.

Once you have a sense of the levels, reflect on your own experiences with patients. The more specific you can be in your reflection, the better. For example, as you review the theme of clinician-patient relationship, think about experiences you have had working with specific patients and families. Look at the criteria for the various levels of practice within this theme. What level of practice best characterizes your experiences with regard to the clinician/patient relationship? You might find it helpful to think about someone who represents your "ideal" in the way he/she relates to patients. How does this person’s practice fit the criteria described in the levels? How does it compare to your practice?

Similarly, as you think about your clinical knowledge and decision making, ask yourself which level best describes how you use your knowledge to make decisions about patient care, how you organize and prioritize your patient care responsibilities, or how you seek out and use resources.

In considering the collaboration/teamwork theme, think about how you work with your colleagues in clinical practice and how these interactions have evolved over time. Consider the nature of

your professional relationships with colleagues within and outside of your discipline, how you contribute to an interdisciplinary approach to care, and how you help create an environment that supports excellence in patient care.

Having analyzed your own practice in light of the descriptions of the levels, ask yourself, "At which level do I practice most consistently?" You may well find that there is a range to your practice – that you generally practice at one level but, depending on the situation, may "visit" a different level. Ask yourself, "Where do I live in my clinical practice? Do I practice mostly at the Advanced Clinician level, or do I visit the Advanced level from time to time, with most of my practice being that of the Clinician?" You will likely find that your practice matches a particular level most consistently.

Look at the level where you think you practice most of the time. Challenge your findings. For example, closely examine the criteria at the next level. Can you think of examples from your own experience that fit this description? If so, how often do they occur?

Take your time in completing this reflection. It will give you an important starting point in thinking about where your clinical practice lies.

Once you have given some thought to your own practice, make an appointment to talk to your manager/director. Use the meeting to talk about your practice. Discuss specific examples.
Through your manager/director, you will be recognized at the Entry or Clinician level. If you and your manager/director agree that your practice is at the Advanced Clinician or Clinical Scholar level, decide if you would like to move forward and submit a portfolio to the Clinical Recognition Program’s peer review committee. The committee will review your portfolio, interview you about your practice, and determine whether you meet the criteria for the level you have identified.

To complete a portfolio for recognition at the Advanced Clinician or Clinical Scholar level, ask your manager/director for an application packet or click here to view the Application Packet.

Clinical Recognition Program

Patient Care Services

Massachusetts General Hospital

Levels of Practice

Speech-Language Pathology

	Entry	Clinician	Advanced Clinician	Clinical Scholar
Clinician/Patient Relationship The interpersonal engagement or relational connection between the clinician and the patient and/or family	Considers knowledge of patient and family when implementing standards of care Recognizes needs and advocates for patient based on knowledge of condition. May be disease driven. Has self-awareness of one's own values and how one's own values affects interactions and relationships. Recognizes the uniqueness of each patient and family and acknowledges cultural differences Understands the role of the patient and family in developing realistic goals and expectations based on patient's needs and circumstances Provides informational materials to patients and families	Individualizes care based upon knowledge of patient and family attained through the therapeutic relationship Advocates based on individual patient and family needs Is open to others’ values Selects relevant information to share differently among patients, caregivers, and professionals and assures their understanding Provides informational materials and support to patients and families Identifies patient's readiness to learn and evaluates patient's response to educational exchange Advocates for individual patients and families and utilizes knowledge of institutional patterns during advocacy	Identifies and incorporates patient and family's best mode of learning Captures a patient's readiness to learn and responds accordingly Provides informational materials and emotional support to patients and families Alters interpersonal exchanges to meet cultural differences Shares relevant information with caregivers, professionals, patients, and family members. Subsequent discussion may be altered based on verbal and non-verbal responses to the information presented. Advocates for individuals and families and tries to identify institutional trends that require higher level advocacy	Intuitively uses self in the therapeutic relationship as a means to enhance care Actively mobilizes and empowers patients and families Respects values and suspends judgment Plans constructive interventions based on patient's values Works to build and maintain a relationship with patient and family that encourages self-reliance and independence Advocates for patients at various levels: individual, institutional, state and federal Provides emotional and informational support to patients and families, and modifies subsequent discussion based on where the patient and the family are along the stages of coping and acceptance
Notes:

Entry

Clinician

Advanced Clinician

Clinical Scholar

Clinical Knowledge and Decision Making

Understanding through formal and experiential learning

Utilizes resources and validates information to maintain standards of care and practice
Recognizes the need to prioritize and organize care
Recognizes research as the basis of clinical practice
Recognizes the responsibility and accountability for his/her own clinical practice
Utilizes a conscious, deliberate process to attain clinical decisions
Is primarily guided by scientific and professional knowledge acquired through theory and research-based principles
Recognizes clinical patterns and analyzes and interprets patient's performance to determine differential diagnosis and recommendations
With guidance, incorporates acquired theoretical knowledge and research findings to achieve individualized intervention

Demonstrates a solid knowledge base
Demonstrates a mastery of skills
Initiates independent learning based on his/her needs
Demonstrates clinically sound risk-taking
Is guided by scientific and professional knowledge acquired through theory and research-based principles but altered based on salient aspects of the clinical presentation of the specific patient in light of past clinical experiences
With guidance, able to determine patient's maximum potential and gains from treatment
Utilizes available community and professional resources to ensure proper intervention throughout the continuum of care
Considers the relationship between medical diagnosis, symptoms, and reason for referral

Anticipates needs and sets priorities
Demonstrates spirit of inquiry as it relates to clinical practice
Considers individual differences in normal and disordered communication and swallowing functions across the age span, as well as the role of sociocultural differences relevant to these functions
Integrates relationships between medical diagnosis, symptoms, and reason for referral
Discerns when maximum potential and gains from treatment are reached and discharge is appropriate
Skillfully analyzes and utilizes available community and professional resources to ensure proper intervention throughout the continuum of care
Is beginning to take clinical risks not only based on previous clinical experiences but also intuition
Conducts independent learning based on his/her needs and integrates information into clinical care

Is recognized as an expert in an area of interest and/or specialization
Understands the meaning of illness to patient and family
Synthesizes knowledge and experience in anticipating and planning to meet patient and family needs
Applies relevant research findings to practice
Demonstrates exquisite foresight in anticipating developmental needs of patients and self
Critically evaluates own decision-making and judgments
Develops innovative approaches to care
Utilizes a framework for the analysis and interpretation of clinical findings that incorporates the description of human functioning and disability as predictors of outcome

	Entry	Clinician	Advanced Clinician	Clinical Scholar
Clinical Knowledge and Decision-Making (cont.)				Utilizes a systematic approach to evaluation and management of patients that is intuitive in their practice, but based on sound theoretical knowledge and clinical experiences Utilizes time effectively, fluidly shifting activities and tasks based on patient's performance and reactions to intervention. Anticipates problems that may arise and implements preventive measures
Notes:

Entry

Clinician

Advanced Clinician

Clinical Scholar

Collaboration/

Teamwork

Collective work for the good of the patient and family; built on communication of clinical and ethical understandings between healthcare providers

Seeks and values collaborative relationships between support departments
Peer development focuses on learning needs of individual peers.
Contributes to the effective operation of his/her department
Identifies the value of operations improvement activities
Understands his/her role as an equal member of the healthcare team
Seeks and values collaborative relationships with other disciplines to enhance patient management
Recognizes the value of working in tandem with others to reach mutual goals
Recognizes and utilizes resources available to enhance self-professional growth

Provides guidance to less experienced staff
Identifies improvement related to practice and/or systems
Actively participates in operations improvement activities
Identifies and values experienced colleagues as an enriching resource to their own practice
Acknowledges contributions made by colleagues and uses information during own clinical decision making
Supports colleagues and embraces collaboration by offering and welcoming assistance
Utilizes resources and systems available to enhance patient care and self- professional growth

Acts as a resource to colleagues
Recognizes the need for consultation and institutes referrals that will result in mobilization of resources to meet patient and family needs
Promotes the development of collaborative relationships with colleagues by communicating in a constructive manner
Respects and values contributions of colleagues and acknowledges their work
Incorporates joint decision making into practice
Utilizes conflict resolution skills in response to difficult situations and conflicts with colleagues
Participates in operations improvement initiatives and evaluates outcomes to determine future goals and activities

Skillfully negotiates conflict to promote collaboration
Peer development focuses on elevating the standard of practice as a whole. Implements unique and innovative approaches to meeting development needs of self and others.
Challenges and shapes the system to maximize the benefits for patient care
Leads/coordinates operations improvement activities impacting his/her work area and/or patient population
Achieves credibility; consultation is sought by peers and members of the healthcare team in planning patient care
Assimilates pertinent data, communicates to selected team members, and delegates appropriately to achieve desired outcomes
Identifies and utilizes appropriate resources to provide outcome-focused consultation
Promotes growth and creativity of peers and other team members

Notes: