Table 1

Domains of clinical excellence applied to COVID-19 care despite notable challenges

DomainCOVID-19 challengesExamples of clinical excellence
Communication and interpersonal skills
  • Fear and anxiety from COVID-19.

  • Personal protective equipment (PPE) limits in-person communication.

  • Limited access to broadband internet to access telemedicine visits.

Telemedicine allows providers to conduct a history and engage in shared decision making without wearing a mask.
Healthcare systems are exploring alternative ways for patients to access telemedicine visits.
Use of the CALMER acronym can help patients deal with apprehension and uncertainty.
Professionalism and humanism
  • Difficulty maintaining humanity through the impersonal nature of encounters while wearing PPE.

  • Physicians have taken on personal risk to care for their patients.

Use of the ABC pneumonic helps providers to Attend mindfully, Behave calmly, Communicate clearly.
Intense clinical experiences, including witnessing the death of patients, can contribute to professional growth and identity formation.
Diagnostic acumen
  • Physicians spend less time with patients due to PPE constraints and need to limit in-person contact due to infectious risks.

Attention to detail and careful observation can uncover life-threatening complications from COVID-19 or help to identify unique features of the clinical syndrome.
Skillful negotiation of the healthcare system
  • Need to rapidly expand capacity to care for surges of patients with COVID-19.

  • Inequities in healthcare access.

Redesign of clinical systems with an eye on efficiency and education were key to adapting to COVID-19 surges.
Engaging with patients in their own language and meeting with healthcare advocates to understand specific issues and concerns of different communities is critical.
Scholarly approach to clinical practice
  • Difficulty navigating the uncertainties of COVID-19 clinical care, particularly early on in the pandemic.

Sharing clinical experience through consensus guidelines (eg, on the timing and appropriate use of tracheostomy in patients with COVID-19) has improved the quality of care and the lived experience of patients.
Exhibiting a passion for patient care and modelling clinical excellence
  • Keeping up with the pace of knowledge generation about COVID-19.

  • Healthcare workers and their families were at higher risk of contracting COVID-19 and requiring. hospitalisation.

Dedication (reading, listening to podcasts and attending teaching sessions) has enabled clinicians to keep abreast of the enormous amount of information that comes out regularly related to COVID-19 care.
A committed workforce showed up to serve despite significant risk and safety concerns.
Interface with researchers to advance discovery
  • Research on COVID-19 requires the collaboration of bedside clinicians with researchers to maximise relevance and impact.

Innumerable partnerships have led to important discoveries about COVID-19 including the potential role of proning in hypoxic patients, and the possibility that some cases of severe COVID-19 are due to autoantibodies against the ACE-2 receptor.