As a concept widely accepted but poorly defined

“non-analytical reasoning plays a key role in decision making at expert levels of practice”

1. OED: expertise as authority vs expertise as experience
2. Expertise as authority
   1. vs lay
3. Expertise as mindset rather than status (Bereiter & Scardamalia 1993) - a journey rather than a destination
4. True expert (Bereiter and Scardamalia 1993)
   1. adaptive - can deal with unusual situations and manage uncertainty
   2. “some practitioners are constantly pushing themselves to reinvest the cognitive space freed by automatisation and pattern learing: they have a desir e to focus on the 'growing edge'”
      1. this impulse can be a problem also

Relative - Howell's model/matrix of cognisance and competence ==

Dreyfus vs Schon - role of reflection

Dreyfus (driving and flying) vs Hoffman's model (based on guilds)

1. domain, time, and context expertise
2. expertise NOT == subspecialization
3. maintain it by “awareness of 'disjuncture' between domains (Jarvis 2006).

1. see definition

How do we quantify it?

“Trainees must develop both independent and interdependent expertise, and an appreciation of the essentially constructivist and uncertain nature of medical knowledge.”

Consider Lave and Wenger (1991) model of “legitimate peripheral participation”

How much is internal and external? “approach may be more important than innate talent” “flow” “deliberate practice” “adaptive expertise”

Practice Points:

1. Different models of expertise provide important insights into the education of surgeons.
2. Both independent and interdependent expertise should by developed.
3. Surgical educators should nurture expert approaches to learning.
4. The development of expertise is dependent on becoming part of a community of practice.

Source: Alderson, D. (2010). Developing expertise in surgery. Medical Teacher, 32(10), 830–836. https://doi.org/10.3109/01421591003695329