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LEARNING OBJECTIVES

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  1. To describe the challenges that physicians face in maintaining excellence over the life of their professional career.

  2. To identify best practices that physicians should follow to successfully engage in lifelong learning.

  3. To communicate the role of physicians in leading and working within teams to achieve excellent patient outcomes.

  4. To explain the roles that different organizations and accrediting bodies take to help ensure that physicians are achieving excellence in their practice.

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INTRODUCTION

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Dr. Amineh finished a busy day in her primary care office. Although most of her patients had routine concerns, several patients raised questions that she needed to look up in the literature. There was a dermatologic problem she couldn’t identify. One of her patients had been started on a new insulin regimen by her endocrinologist; Dr. Amineh had been to a continuing medical education (CME) program that mentioned this approach but couldn’t remember the details of how to adjust it or potential drug interactions. She hoped to get a few minutes at the end of the day after completing her chart notes to address these questions.

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Despite widespread access to medical information on the Internet, people who fear that they are ill still turn to their trusted physicians for knowledge and wisdom as well as compassion. The trust they place in us is based on an assumption that all physicians live up to their professional commitment to excellence: a commitment to maintain the up-to-date knowledge and skills needed to treat their patients. The public believes that the highly selective and rigorous educational journey that physicians undertake to earn their MD degree has imbued them with the ability and the drive to maintain excellence over the life of their career. Every physician aspires to live up to this commitment. No one wants to be a good enough physician—we all want to be the best physician possible for our patients.

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A commitment to strive for excellence is a key component of professionalism. As discussed in Chapter 3, A Brief History of Medicine's Modern-Day Professionalism Movement, expertise in a body of knowledge is the core of a profession, and the social contract between the public and the profession requires that physicians maintain this competency. Fulfilling this obligation begins in medical school with the mastery of foundational social, biomedical, and behavioral science principles. It continues in practice with a commitment to continuously seek out, analyze, and apply the best available science and evidence to make patient care decisions, to continuously update procedural and clinical skills, and to acknowledge personal limitations. It is important to note that excellence today means demonstrating accountability by willingly participating in formal competency assessments as well as measurement of patient care process and outcome measurements throughout, not just at the start of, your career as a physician (Cassel & Holmboe, 2006; Weiss, 2010).

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A commitment to excellence also means working with others to ...

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