Introduction

Expertise in medicine requires mastery of a diversity of knowledge and skills – motor, cognitive, and interpersonal – which makes it unlike many other fields of expertise, such as chess, bridge, computer programming, or gymnastics. Although some specialties such as pathology or surgery may emphasize one kind of skill or another, most clinicians must be skilled in all domains and must also master an enormous knowledge base drawn from areas as diverse as molecular biology, ethics, and psychology.

Perhaps paradoxically, despite the considerable effort required to achieve mastery, there is no formal equivalent of elite performance, which has been a topic of many other chapters in this book. Though there is stiff competition to enter medical school and only about 15% of Canadian applicants get a position, once in, better than 95% will graduate, get placement in a specialty (residency) program, and enter practice. Once certified competent, competition in practice is absent. Medicine has its legendary clinicians, but these are as rare as Olympic gold medalists and have not been systematically studied.

That is not to say that there are no measures of relative expertise. In some domains, particularly surgery, treatment success can be measured with indicators such as death, complications, or blood loss, and has been linked to physician characteristics like specialty certification (Ericsson, 2004; Norcini et al., 2002) and undergraduate training (Tamblyn et al., 2002).