The study of expertise in medical education has tended to follow a tradition of trying to describe the analytic processes and/or nonanalytic resources that experts acquire with experience. However, the authors argue that a critical function of expertise is the judgment required to coordinate these resources, using efficient nonanalytic processes for many tasks, but transitioning to more effortful analytic processing when necessary. Attempts to appreciate the nature of this transition, when it happens, and how it happens, can be informed by the evaluation of other literatures that are addressing these and related problems. The authors review the literatures on educational expertise, attention and effort, situational awareness, and human factors to examine the conceptual frameworks of expertise arising from these domains and the research methodologies that inform their practice. The authors propose a new model of expert judgment that we describe as a process of slowing down when you should.

In this era of increasing complexity, there is a growing gap between what we need our medical experts to do and the training we provide them. While medical education has a long history of being guided by theories of expertise to inform curriculum design and implementation, the theories that currently underpin our educational programs do not account for the expertise necessary for excellence in the changing health care context. The more comprehensive view of expertise gained by research on both clinical reasoning and adaptive expertise provides a useful framing for re-shaping physician education, placing emphasis on the training of clinicians who will be adaptive experts. That is, have both the ability to apply their extensive knowledge base as well as create new knowledge as dictated by patient needs and context. Three key educational approaches have been shown to foster the development of adaptive expertise: learning that emphasizes understanding, providing students with opportunities to embrace struggle and discovery in their learning, and maximizing variation in the teaching of clinical concepts. There is solid evidence that a commitment to these educational approaches can help medical educators to set trainees on the path towards adaptive expertise.

We hope that, by highlighting these issues, we may begin to marry the strengths of the traditional cognitive paradigm with the strengths of these other paradigms and expand the scope of cognitive research in medical expertise.

Our results show that the inclusion of basic science instruction enhanced the learning of novel related content. We discuss this finding within the broader context of research on basic science instruction, development of adaptive expertise and assessment in medical education.