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Hallmarks of Excellence: What is the path to Clinical Mastery?

Posted 12/13/2013

Hint: It is not CE


Continuing education may be replaced with a new model of life long growth: Continuing Development.

There is certainly a need to ensure that doctors remain competent and their knowledge current after graduation.  But what is the best way to do this?  In an attempt to ensure that doctors remain competent, and that they stay abreast of current trends and advancements, licensing boards began several decades ago to dictate a prescribed number of approved continuing education (CE) class hours. But the required CE, in the form of formal didactics, is often disjointed from clinical practice.  CE is often a class taken by a doctor over the weekend with the hope that some of the new knowledge may be implemented into practice on Monday morning.

Built In, Not Bolted On

Continuing development (CD) or continuing professional development (CPD) by contrast is a system intent on developing several core competencies and engraining them into the practice of the physician.  CD has a goal of changing behavior and improving clinical outcomes.  CD is a journey that, if done correctly, will last a lifetime and will engage the physician to learn and grow on a daily basis.  

You Can Lead a Horse to Water, but…

Regardless of the intent and implementation of a continuing development program, it will fall short of its goals if the individual doctors are not invested in the process.  The motivation for professional development must come from within the individual doctor.  We can encourage doctors to pursue CD and to honor its concepts, but ultimately the responsibility rests squarely on the shoulders of the physician.  Rules and regulations will provoke a physician to obey the letter of the law, but cannot ensure total compliance.


Characteristics of successful lifelong learners in clinical practice include:

  • The drive to be a master clinician and to provide excellent patient care
  • The pride in the enduring value of professional competencies and scholarly growth
  • The need to expand and grow in knowledge and clinical application


Continuing development requires the heartfelt desire to grow and blossom throughout a career. Doctors must embrace the concept of lifelong learning and be knowledge seekers.

This stands in contrast to passive learning.  Passive learners sit in a classroom and are taught, they are directed what to read and what to study.  They do what is required of them without seeking to learn more.  Passive learners can be straight A students and may be difficult to differentiate from active knowledge seekers in the classroom setting.  How can we inspire passive learners to become active knowledge seekers?

Master CliniciansMaster Clinicians

The Role of Chiropractic Colleges

Chiropractic colleges should use criteria to identify lifelong learners and actively attract and recruit these knowledge seekers.  Colleges should also inspire students to continually seek knowledge rather than regurgitate lectures or board review material.  They should introduce students to the tools that they will need to continue to learn and develop throughout their career.  As students approach graduation, classroom-based didactics should be replaced with active clinical rotations which require students to seek knowledge while clinically active.  This should translate to doctors in the field who continue to grow and learn daily through clinical encounters.  Daily learning in the student clinic should be a model for daily learning throughout a chiropractor’s career.

Continuing development has many benefits for the doctor, the patients, and society.  The doctor benefits from career satisfaction, and patients benefit from superior healthcare.  A doctor who is continually being challenged is less likely to suffer from burnout.


Clinical MasteryClinical Mastery

The Role of Chiropractic Licensing Boards

Chiropractic licensing boards should embrace the new model of lifelong learning while modifying their policies to enhance it.  However, these agencies cannot leave chiropractors to their own devices to maintain clinical competencies.  The agencies and boards still need to maintain structure and accountability in their regulation of professional education and competencies.  But there are ways that the boards can encourage larger goals and enhanced continuing professional development.

Many state boards are increasing the number of CE hours, but allowing more time to acquire those hours.  This rewards those who seek diplomate status and certification programs.  Instead of having twenty hours per year a state may require forty hours of CE every two years.  This encourages doctors to pursue certifications or diplomates that may take multiple years to complete.  Innovations like these reward doctors working toward larger professional goals. I should note that CE should be part of a larger plan of continual lifelong grow and development.


The Master Clinician

Those who know me well recognize that I value the pursuit of clinical mastery and that I often refer to the goal of becoming a Master Clinician, someone who is grounded in a variety of relevant core competencies.  Continuing professional development is a conduit that can aid those seeking the life goal of growing into a Master Clinician.


Suggested Reading

Continuing Professional Development (CPD) of Medical Doctors


The Effectiveness of Continuing Professional Development - Final