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Having our cake and eating it too: seeking the best of both worlds in expertise research


Maria Mylopoulos, SickKids Learning Institute and Department of Paediatrics, University of Toronto, 525 University Avenue, Unit 600 Room 6020, Toronto, Ontario M5G 2L3, Canada. Tel: 00 1 416 813 7654 (ext 3126); Fax: 00 1 416 813 6924; E-mail:


Context  Education researchers in a variety of disciplines have attempted to use their understanding of expert processes to inform learning across the continuum from school learning to lifelong learning. In medical education, this has led to models of expertise that aim to understand accurate and efficient clinical reasoning. More recently, researchers outside medicine have begun to develop models of ‘adaptive expertise’. As these additional constructions of expertise are introduced into health professions education, there is considerable potential to enhance research in medical expertise by providing opportunities for us to identify our implicit assumptions and reflect on the ways in which our theoretical lenses bias our perceptions of what it means to be an expert.

Methods  Firstly, we critically examine these two broad categories of research on expertise and their underlying assumptions and implications. Our exploration is organised around four main questions: (i) How is expertise defined? (ii) How does it develop? (iii) What is investigated? (iv) Based on what is known, what does an expert look like? Secondly, we discuss some implications and topics of future inquiry for research programmes informed by an inclusive understanding of expert practice and development.

Conclusions  In articulating two paradigms of expertise, our goal is to explore the research questions, methods and findings that underpin them and to make explicit the resulting emphases on specific aspects of expert performance. Our resulting collaborative understanding of expertise yields a richer, more complex and ultimately more accurate view of expert performance, with important implications for future research in medical education.