Medical Expertise: The Power of Knowing

“How expertisedevelops in medicine: knowledge encapsulation and illness script formation” is a 2007 publication by Schmidt and Rickers in Medical Education. The development of expertise is described as going through phases: 1) understanding disease in term of pathophysiology, 2) encapsulation into diagnostic labels/models, 3) transition into illness scripts (narrative with pertinent contextual details or enabling conditions), and 4) possessing interpreted scripts for each disease. This process of attaining expertise is facilitated by integrating the teaching of basic science and clinical cases, increasing students’ exposure to variety of patients and diseases, and supporting reflection in the context of mentors and peers. 

Although these phases make intuitive sense, there are certainly elements that I did not fully appreciate before, such as the critical importance of acquiring contextual information to create patient and disease narratives. I wish I have sought out sooner this concept of how medical expertise is acquired. Without this concept of what our goal ultimately is, how the progression from medical novice to expert occurs, it may be akin to trying to put together a puzzle without having seen the final picture. I wonder if I had known this earlier, whether I would have changed the way in which I learned?

 It would perhaps be useful to give students an earlier introduction to the basic concepts of medical education. We can teach students about what expertise means, what the journey towards it entails, and the rationale behind the different teaching methods. This could help students become more active and focused learners. Otherwise, we may be trapped into thinking that PowerPoint lectures are the best way to learn, when they are but a component of the process. It may help students appreciated the value of different teaching methods and ameliorate antagonism with what may otherwise be perceived to be unconventional techniques. Perhaps this is also a way for us to encourage conversation about medical education and inspire a new generation of medical educators.

- Jenny

1. Schmidt HG, Rikers RMJP. How expertise develops in medicine: knowledge encapsulation and illness script formation. [Internet]. Medical education 2007 Dec;41(12):1133-9.[cited 2011 Aug 11] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18004989