Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Master Clinicians – The Early Years

The author, far right, with colleagues.


It’s no surprise that it takes hard work to become a great clinician. This is a glimpse of what the first steps on that road might look like.

Many of us remember learning from master clinicians with aspirational diagnostic, communication, and teaching skills during our training years.


Have you ever wondered what these great clinicians were doing during their early careers? How did they structure their learning? What did they read, and how often? What were their jobs like? Who did they learn from? And what were their key clinical behaviors?


To find out, I interviewed 17 members of the University of California, San Francisco, Department of Medicine Council of Master Clinicians. I asked them about their first clinical jobs after training, their reading and learning routines, their patient care activities, and their clinical habits.


My colleagues on this project were Gurpreet Dhaliwal, MD and Bridget O’Brien, PhD. We hoped that understanding the early career habits and behaviors of these master clinicians could guide today’s medical trainees and junior faculty who set clinical excellence as a career goal.


Structured Reading Programs

We learned that many of these clinicians had structured reading programs during their early careers. One said, “I would jot clinical questions down on an index card, and I wouldn’t go to bed until I had looked up those four or five things… I was probably looking up something every day.” Another said, “I learned to read [case reports] and then write down what I thought was going on. I was actually trying to figure it out.”


High Patient Volumes

Many of these clinicians started with jobs that involved high patient volumes: “I was a full-time clinician-educator. I spent seven months on the inpatient medicine teaching service [and] two months on medicine consult.” They also found ways to increase the number of patients they saw and to venture outside their comfort zones, including moonlighting in emergency departments, volunteering in understaffed clinics, and working as visiting physicians for homebound patients.


Hard Work

One particularly inspiring insight was that these clinicians, often thought of as naturally gifted, instead credited their hard work. One said, “I wasn’t the brightest bulb in the chandelier… I read constantly… I had to repeat it and repeat it and drum it into myself. I always felt I had to work a little harder than everybody else.”


Strong Peer Networks

These master clinicians also described building peer networks to discuss clinical cases. One said, “I had colleagues who were all like-minded… we were lucky enough to be able to reflect [with] each other and… ask for each other’s opinions – that helped build the database.” Another reflected, “We had groups that would meet and hash out clinical problems… We shared a lot of experiences amongst ourselves in that way.” This on-the-job exchange of knowledge contributed to a workplace culture of shared learning.


It was inspiring to see that every action these master clinicians adopted during their early careers can be enacted by trainees and junior faculty today. If you’d like to learn more, see the table of proposed action steps in our article.