[EXPERTISE IN MEDICINE].

ABSTRACT

INTRODUCTION: The Israeli state accords the status of "specialist", after an authorization by the Israeli Medical Association (IMA) Scientific Council and Ministry of Health (MOH), to physicians who fulfilled the requirements for the title in the 56 recognized specialties in the country. An "expert" and "specialist" are synonyms in Hebrew. However, there is no doubt that these two terms are not identical. The scientific council defines the specialist it approves as the practitioner who can practice independently in the professional domain in which he was authorized. The literature in the domain portrays a more nuanced scale, starting from novice, to advanced novice, competent, proficient, expert and finally master. Research on expertise is associated with Anders Ericsson's name, who coined the "ten thousand hours" as the average time needed to attain expertise. Ericsson also asserts that it is not just about time, but also about the method. i.e. Deliberate Practice, in which the learner has to leave his comfort zone, focus on practice with clear and distinct goals and receive external feedback. The literature describes pedagogies that employ Deliberate Practice that accelerate expertise acquisition. There is also extensive research in which physiological markers including imaging measure the expression of expertise in the brain and other systems. The dangers of expertise are also described, the most extreme being those of rigidity and hubris. While in the surgical professions, performance improves as a function of seniority and volume, in the non-surgical fields there is attrition of skills unless an infrastructure of life-long learning skills that include Deliberate Practice is incorporated. A new evidence-based paradigm is offered the goal of physicians' formation is expertise (adaptive, not just routine expertise) and not competence or proficiency alone. However, in spite of the fact that the paradigm is supported by a multitude of theoretical and empirical data, beyond surgical skills and simulation, it is not yet fully implemented and on a large scale.