Skip to main content

Professional Expertise in Medicine

  • Chapter
  • First Online:
Catheter-Based Cardiovascular Interventions

Abstract

This chapter discusses how the mere accumulation of experience does not necessarily lead to the development of expertise. In order to develop expertise in any domain, learners must engage in the right amount and type of practice in an enriched learning environment. We have introduced the expert-performance approach, which provides a systematic framework for researchers to capture expert performance and its underlying mechanisms using reliable, objective, and representative task simulations. Finally, we have highlighted how it is possible to use the expert-performance framework to capture, assess, and potentially expedite the development of expertise in medicine. The literature presented clearly demonstrates the need to implement evidence-based frameworks for performance enhancement in medicine. By identifying the critical characteristics that are associated with expert performance, training interventions can be designed and implemented to enhance the specific skills and necessary adaptations that are key to expertise in medicine, subsequently improving the quality of patient treatment and reducing the costs associated with health care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Williams AM, Ford PR, Eccles DW, Ward P (2010) Perceptual-cognitive expertise in sport and its acquisition: implications for applied cognitive psychology. Appl Cognit Psychol 25(3):432–442

    Article  Google Scholar 

  2. Chi MTH (2006) Laboratory methods for assessing experts’ and novices’ knowledge. In: Ericsson KA, Charness N, Feltovich P, Hoffman RR (eds) The Cambridge handbook of expertise and expert performance. Cambridge University Press, New York, pp 223–241

    Google Scholar 

  3. Simon HA, Chase WG (1973) Skill in chess. Am Sci 61:394–403

    Google Scholar 

  4. Ericsson KA, Smith J (1991) Prospects and limits of the empirical study of expertise: an introduction. In: Ericsson KA, Smith J (eds) Toward a general theory of expertise: prospects and limits. Cambridge University Press, New York

    Google Scholar 

  5. JAMA (2000) Your doctor’s education. J Am Med Assoc 284(9):1198

    Article  Google Scholar 

  6. NHS Careers (2010) Careers in medicine. Crown, Bristol

    Google Scholar 

  7. Shanteau J, Stewart TR (1992) Why study expert decision making? Some historical perspectives and comments. Organ Behav Hum Decis Process 53:95–106

    Article  Google Scholar 

  8. Ericsson KA, Krampe RT, Tesch-Römer C (1993) The role of deliberate practice in the acquisition of expert performance. Psychol Rev 100(3):363–406

    Article  Google Scholar 

  9. Ericsson KA, Nandagopal K, Roring RW (2009) Toward a science of exceptional achievement: attaining superior performance through deliberate practice. Ann N Y Acad Sci 1172:199–217

    Article  PubMed  Google Scholar 

  10. Ericsson KA (2008) Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med 15:988–994

    Article  PubMed  Google Scholar 

  11. Choudhry NK, Fletcher RH, Soumeral SB (2005) Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 142(4):260–273

    PubMed  Google Scholar 

  12. Ericsson KA, Whyte J, Ward P (2007) Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach. Adv Nurs Sci 30(1):E58–E71

    Google Scholar 

  13. Ericsson KA, Lehmann AC (1996) Expert and exceptional performance: evidence of maximal adaptation to task constraints. Annu Rev Psychol 47:273–305

    Article  PubMed  CAS  Google Scholar 

  14. Camerer CF, Johnson EJ (1991) The process-performance paradox in expert judgement: how can the experts know so much and predict so badly? In: Ericsson KA, Smith J (eds) Toward a general theory of expertise: prospects and limits. Cambridge University Press, New York, pp 195–217

    Google Scholar 

  15. Doane SM, Pellegrino JW, Klatzky RL (1990) Expertise in a computer operating system: conceptualization and performance. Hum-Comput Interact 5:267–304

    Article  Google Scholar 

  16. Reif F, Allen S (1992) Cognition for interpreting scientific concepts: a study of acceleration. Cognit Emotion 9(1):1–44

    Google Scholar 

  17. Lewis C (1981) Skill in algebra. In: Anderson JR (ed) Cognitive skills and their acquisition. Lawrence Erbaum Associates, Hillsdale, pp 85–110

    Google Scholar 

  18. Ericsson KA (2004) Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 79(10):S70–S81

    Article  PubMed  Google Scholar 

  19. Ericsson KA (2006) The influence of experience and deliberate practice on the development of superior expert performance. In: Ericsson KA, Charness N, Feltovich P, Hoffman RR (eds) The Cambridge handbook of expertise and expert performance. Cambridge University Press, Cambridge, pp 685–706

    Chapter  Google Scholar 

  20. Simonton DK (2004) Creativity in science: chance, logic, genius, and zeitgeist. Cambridge University Press, Cambridge

    Book  Google Scholar 

  21. Williams AM, Hodges NJ (2012) Skill acquisition in sport: research, theory and practice. Routledge, London

    Google Scholar 

  22. Ericsson KA, Williams AM (2007) Capturing naturally occurring superior performance in the laboratory: translational research on expert performance. J Exp Psychol Appl 13(3):115–123

    Article  PubMed  Google Scholar 

  23. Williams AM, Ericsson KA (2007) Introduction to the theme issue: perception, cognition, action, and skilled performance. J Mot Behav 39:338–340

    Article  Google Scholar 

  24. Williams AM, Ericsson KA (2005) Perceptual-cognitive expertise in sport: some considerations when applying the expert performance approach. Hum Mov Sci 24:283–307

    Article  PubMed  Google Scholar 

  25. Ericsson KA, Simon HA (1993) Protocol analysis: verbal reports as data. Bradford Books/MIT Press, Cambridge

    Google Scholar 

  26. Ericsson KA, Kintsch W (1995) Long-term working memory. Psychol Rev 102(2):211–245

    Article  PubMed  CAS  Google Scholar 

  27. Ericsson KA, Patel V, Kintsch W (2000) How experts’ adaptations to representative task demands account for the expertise effect in memory recall: comment on Vicente and Wang (1998). Psychol Rev 107:578–592

    Article  PubMed  CAS  Google Scholar 

  28. Bryan WL, Harter N (1897) Studies in the physiology and psychology of the telegraphic language. Psychol Rev 4(1):27–53

    Article  Google Scholar 

  29. Bryan WL, Harter N (1899) Studies on the telegraphic language: the acquisition of a hierarchy of habits. Psychol Rev 6:345–375

    Article  Google Scholar 

  30. Ward P, Williams AM, Hancock PA (2006) Simulation for performance and training. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR (eds) The Cambridge handbook of expertise and expert performance. Cambridge University Press, Cambridge, pp 243–262

    Chapter  Google Scholar 

  31. Walls J, Bertrand L, Gale T, Saunders N (1998) Assessment of upwind dinghy sailing performance using a virtual reality dinghy sailing simulator. J Sci Med Sport 1:61–71

    Article  PubMed  CAS  Google Scholar 

  32. Bellenkes AH, Wickens CD, Kramer AF (1997) Visual scanning and pilot expertise: the role of attentional flexibility and mental model development. Aviat Space Environ Med 68:569–579

    PubMed  CAS  Google Scholar 

  33. Russo MB, Kendall AP, Johnson DE, Sing HC, Thorne DR, Escolas SM et al (2005) Visual perception, psychomotor performance, and complex motor performance during an overnight air refueling simulated flight. Aviat Space Environ Med 76(7 Suppl):92–103

    Google Scholar 

  34. Verner L, Oleynikov D, Holtmann S, Haider H, Zhukov L (2003) Measurements of the level of surgical expertise using flight path analysis from da Vinci Robotic Surgical System. Med Meets Virtual Real 11:373–378

    Google Scholar 

  35. Haluck RS, Webster RW, Snyder AJ, Melkonian MG, Mohler BJ, Dise ML et al (2001) A virtual reality surgical simulator trainer for navigation in laparoscopic surgery. In: Westwood JD, Hoffman HM, Mogel GT, Stredney D, Robb RA (eds) Medicine meets virtual reality 2001: outer space, inner space, virtual space. Ios Press, Amsterdam, pp 171–177

    Google Scholar 

  36. Janelle CM, Singer RN, Williams AM (1999) External distraction and attentional narrowing: visual search evidence. J Sport Exerc Psychol 21:70–91

    Google Scholar 

  37. Causer J, Holmes PS, Smith NC, Williams AM (2011) Anxiety, movement kinematics, and visual attention in elite-level performers. Emotion 11(3):595–602

    Article  PubMed  Google Scholar 

  38. Nieuwenhuys A, Pijpers JR, Oudejans RRD, Bakker FC (2008) The influence of anxiety on visual attention in climbing. J Sport Exerc Psychol 30: 171–185

    PubMed  Google Scholar 

  39. Miller NL, Matsangas P, Shattuck LG (2007) Fatigue and its effect on performance in military environments. In: Hancock PA, Szalma JL (eds) Performance under stress. Ashgate Publishing Limited, Hampshire, pp 231–250

    Google Scholar 

  40. Vesterinen V, Mikkola J, Nummela A, Hynynen E, Hakkinen K (2009) Fatigue in a simulated cross-country skiing sprint competition. J Sports Sci 27(10):1069–1077

    Article  PubMed  Google Scholar 

  41. Gaba DM (2002) Two examples of how to evaluate the impact of new approaches to teaching. Anesthesiology 96:1–2

    Article  PubMed  Google Scholar 

  42. Gaba DM (2004) What makes a “good” anesthesiologist? Anesthesiology 101:1061–1063

    Article  PubMed  Google Scholar 

  43. Schwid HA, Rooke GA, Carline J, Steadman RH, Murray WB, Olympio M et al (2002) Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study. Anesthesiology 97:1434–1444

    Article  PubMed  Google Scholar 

  44. Schijven M, Jakimowicz J (2003) Construct validity: experts and residents performing on the Xitact LS500 laparoscopy simulator. Surg Endosc 17:803–810

    Article  PubMed  CAS  Google Scholar 

  45. Causer J, Bennett SJ, Holmes PS, Janelle CM, Williams AM (2010) Quiet eye duration and gun motion in elite shotgun shooting. Med Sci Sports Exerc 42(8):1599–1608

    Article  PubMed  Google Scholar 

  46. McRobert AP, Williams AM, Ward P, Eccles DW (2009) Tracing the process of expertise in a simulated anticipation task. Ergonomics 52(4):474–483

    Article  PubMed  Google Scholar 

  47. Vaeyens R, Lenoir M, Williams AM, Mazyn L, Philippaerts RM (2007) The effects of task constraints on visual search behavior and decision-making skill in youth soccer players. J Sport Exerc Psychol 29:147–169

    PubMed  Google Scholar 

  48. Janelle CM, Hillman CH, Apparies RJ, Murray NP, Meili L, Fallon EA et al (2000) Expertise differences in cortical activation and gaze behavior during rifle shooting. J Sport Exerc Psychol 22:167–182

    Google Scholar 

  49. Posner MI, Nissen MJ, Klein RM (1976) Visual dominance: an information processing account of its origins and significance. Psychol Rev 83:157–171

    Article  PubMed  CAS  Google Scholar 

  50. Williams AM, Davids K, Williams JG (1999) Visual perception and action in sport. E & FN Spon, London

    Google Scholar 

  51. Mann DTY, Williams AM, Ward P, Janelle CM (2007) Perceptual-cognitive expertise in sport: a meta-analysis. J Sport Exerc Psychol 29:457–478

    PubMed  Google Scholar 

  52. Law B, Atkins MS, Kirkpatrick AE, Lomax AJ, Mackenzie CL (2004) Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment. In: Eye tracking research & applications symposium on eye tracking research & applications, San Antonio, 2004, ACM Press, New York, pp 41–48

    Google Scholar 

  53. Hoffman RR, Shadbolt NR, Burton AM, Klein G (1995) Eliciting knowledge from experts: a methodological analysis. Organ Behav Hum Decis Process 62(2):129–158

    Article  Google Scholar 

  54. Fox MC, Ericsson KA, Best R (2010) Do procedures for verbal reporting of thinking have to be reactive? A meta-analysis and recommendations for best reporting methods. Psychol Bull 137(2):316–344

    Article  Google Scholar 

  55. McRobert AP, Ward P, Eccles DW, Williams AM (2011) The effect of manipulating context-specific information on perceptual-cognitive processes during a simulated anticipation task. Br J Psychol 102(3):519–534

    Article  PubMed  Google Scholar 

  56. McPherson SL, Vickers JN (2004) Cognitive control in motor expertise. Int J Sport Exerc Psychol 2:274–300

    Article  Google Scholar 

  57. Joseph GM, Patel VL (1990) Domain knowledge and hypothesis generation in diagnostic reasoning. Med Decis Making 10:31–46

    Article  PubMed  CAS  Google Scholar 

  58. Lesgold A, Rubinson H, Feltovich P, Glaser R, Klopfer D, Wang Y (1988) Expertise in a complex skill: diagnosing X-ray pictures. In: Chi M, Glaser R, Farr MJ (eds) The nature of expertise. Erlbaum, Hillsdale, pp 311–342

    Google Scholar 

  59. Patel VL, Arocha JF, Kaufmann DR (1994) Diagnostic reasoning and medical expertise. In: Medin D (ed) The psychology of learning and motivation. Academic Press, New York, pp 187–251

    Google Scholar 

  60. Patel VL, Groen GJ (1991) The general and specific nature of medical expertise. In: Smith KAE (ed) Toward a general theory of expertise. Cambridge University Press, Cambridge, pp 93–125

    Google Scholar 

  61. Mazhindu D, McRobert AP, Jones N, Raw D, Whyte J, Williams AM (2009) Expert performance and professional judgement: what is it and how do we know it? Paper presented at Royal College of Nursing, Liverpool

    Google Scholar 

  62. Richards C, Rosen J, Hannaford B, Pellegrini C, Sinanan M (2000) Skills evaluation in minimally invasive surgery using force/torque signatures. Surg Endosc 14:791–798

    Article  PubMed  CAS  Google Scholar 

  63. Wayne DB, Barsuk JH, O’Leary KJ, Fudala MJ, McGaghie WC (2008) Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J Hosp Med 3(1):48–54

    Article  PubMed  Google Scholar 

  64. Kramer AWM, Jansen KJJM, Düsman H, Tan LHC, van der Vleuten CPM, Grol RPTM (2003) Acquisition of clinical skills in postgraduate training for general practice. Br J Gen Pract 53:677–682

    PubMed  Google Scholar 

  65. Moulaert V, Verwijnen MGM, Rikers R, Scherpbier AJJA (2004) The effects of deliberate practice in undergraduate medical education. Med Educ 38:1044–1052

    Article  PubMed  Google Scholar 

  66. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ (2006) Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 40:792–797

    Article  PubMed  Google Scholar 

  67. Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 27(1):10–28

    Article  PubMed  Google Scholar 

  68. Smeeton NJ, Williams AM, Hodges NJ, Ward P (2005) The relative effectiveness of various instructional approaches in developing anticipation skill. J Exp Psychol Appl 11(2):98–110

    Article  PubMed  Google Scholar 

  69. Hagemann N, Strauss B, Cañal-Bruland R (2006) Training perceptual skill by orienting visual attention. J Sport Exerc Psychol 28:143–158

    Google Scholar 

  70. Causer J, Holmes PS, Williams AM (2011) Quiet eye training in a visuomotor control task. Med Sci Sports Exerc 43(6):1042–1049

    Article  PubMed  Google Scholar 

  71. Porte MC, Xeroulis G, Reznick RK, Dubrowski A (2007) Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Am J Surg 193:105–110

    Article  PubMed  Google Scholar 

  72. Cross ES, Schmitt PJ, Grafton ST (2007) Neural ­substrates of contextual interference during motor learning support a model of active preparation. J Cogn Neurosci 19(11):1854–1871

    Article  PubMed  Google Scholar 

  73. Schmidt RA, Lee TD (2005) Motor control and learning: a behavioral emphasis. Human Kinetics, Champaign

    Google Scholar 

  74. Lee TD, Magill RA (1983) The locus of contextual interference in motor-skill acquisition. J Exp Psychol Learn Mem Cogn 9:730–746

    Article  Google Scholar 

  75. Shea JB, Morgan RL (1979) Contextual interference effects on the acquisition, retention, and transfer of a motor skill. J Exp Psychol Learn Mem Cogn 5:179–187

    Article  Google Scholar 

  76. Battig WF (1972) Intratask interference as a source of facilitation in transfer and retention. In: Thompson RF, Voss JF (eds) Topics in learning and performance. Academic, New York, pp 131–159

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joe Causer Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Causer, J., Williams, A.M. (2013). Professional Expertise in Medicine. In: Lanzer, P. (eds) Catheter-Based Cardiovascular Interventions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27676-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-27676-7_9

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-27675-0

  • Online ISBN: 978-3-642-27676-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics