Modern Conceptions of Elite Medical Practice Among Internal Medicine Faculty Members

BACKGROUND: To understand the modern conceptions of elite practice informing the hidden curriculum through use of peer nominations asking clinicians to identify exceptional practitioners. METHOD: We distributed a Web-based survey to Department of Medicine faculty at five universities in North America. Participants were asked to nominate individuals they deemed to be "outstanding practitioners" and to provide reasons. They were then asked to nominate "exceptional diagnosticians" and "exceptional professionals." RESULTS: Two hundred eighty-two physicians nominated 558 unique peers as "outstanding practitioners." Justifications included knowledge (45.1%), patient-related interpersonal skill (18.7%), teaching skill (10.8%), and research success (6.8%). More "exceptional diagnostician" nominees were nominated as "outstanding practitioners" (65.2%) relative to "exceptional professional" nominees (56.1%), although the effect size was small (phi = 0.09). CONCLUSIONS: Knowledge-based competencies maintain a central role in modern conceptions of elite medical practice, although, contrary to the historical dominance of biomedical abilities, a diverse set of skills and professional aptitudes are also well represented.