The life long challenge of expertise

The development and maintenance of expertise in any domain requires extensi ve, sustained practice of the necessary skills. However, the quantity of ti me spent is not the only factor in achieving expertise; the quality of this time is at least as important. The development and maintenance of expertis e requires extensive time dedicated specifically to the improvement of skil ls, an activity termed deliberate practise. Unfortunately, determining how to engage in this deliberate practise is not obvious for tasks such as diag nosis, which involve high stakes and are predominantly cognitive nature. Re flection on and adaptation of one's cognitive processes is important; this could be supplanted by seeking out the opportunity to engage in trial and e rror in low risk environments such as simulators. Regardless, most individuals tend to favour well-entrenched activities and avoid practise. This may be due to lack of awareness of deficiencies in per formance. However, it may also be due to the individual's conception of the nature of expertise. Although expertise requires experience, experience al one is insufficient. Rather, the development of expertise is critically dep endent on the individual making the most of that experience. As a result, m otivational factors are fundamental to the development of expertise. Overco ming deficiencies in self-monitoring is not a sufficient remedy. It is also necessary is that clinicians form an attitude toward work that includes co ntinual re-investment in improvement.