On acquiring expertise in medicine

Abstract

This article presents a new theory of expertise development in medicine and the empirical evidence available. This theory describes expertise development as the progression through a series of consecutive phases, each of which is characterized by functionally different knowledge structures underlying performance. The first phase is characterized by the accumulation of causal knowledge about disease and its consequences. Through experience with real cases, this knowledge transforms into narrative structures called illness scripts. The cognitive mechanisms responsible for this transition are: Encapsulation of elaborated knowledge into high level but simplified causal models or even diagnostic categories and tuning through the inclusion of contextual information. The third phase is characterized by the use of episodic memories of actual patients in the diagnosis of new cases. It is assumed that knowledge acquired in different phases form layers in memory through a sedimentation process. These knowledge sediments, although usually not applied any more in subsequent phases in the development of expertise, remain available for use when ontologically more recently acquired structures fail to produce an adequate representation of a clinical problem.

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Schmidt, H.G., Boshuizen, H.P.A. On acquiring expertise in medicine. Educ Psychol Rev 5, 205–221 (1993). https://doi.org/10.1007/BF01323044

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Key words

  • expertise development
  • encapsulation
  • contextual knowledge
  • illness scripts