The role of patient management in medical expertise development: Extending the contemporary theory

Abstract

Medical expertise research has focused on why experienced physicians display remarkable performance in solving clinical problems and how this competency develops over many years of education and practice. The contemporary theory on the development of expertise in medicine proposes that students progress through different stages of knowledge restructuring (i.e., encapsulation and illness script) in which their knowledge is finely tuned towards practical situations. Although research in clinical case paradigm has provided us with a better understanding of the differences between students and doctors, it has almost exclusively focused on diagnostic performance, and patient management has received substantially less attention. This reflects an incomplete picture of a medical expert, as management is not only a crucial step in patient workup, but it is also highly connected to experience with patients. In their daily practice, doctors always diagnose and manage patients concurrently; hence, after a large number of patient encounters in practical settings, these two types of knowledge become integrated into one another. In order to incorporate management into contemporary theory, it is proposed that it should be considered as a part of the illness script structure. In the way towards expertise, knowledge about patient management becomes more prominent, and so an investigation of management knowledge could ultimately enable us to broaden our understanding of medical expertise.