• C B Guest, G Regehr, and R G Tiberius.
• Department of Anaesthesia, Sunnybrook And Women's College Health Sciences Centre, Toronto, Canada.
• Med Educ. 2001 Jan 1;35(1):78-81.

AbstractThe development and maintenance of expertise in any domain requires extensive, sustained practice of the necessary skills. However, the quantity of time spent is not the only factor in achieving expertise; the quality of this time is at least as important. The development and maintenance of expertise requires extensive time dedicated specifically to the improvement of skills, an activity termed deliberate practise. Unfortunately, determining how to engage in this deliberate practise is not obvious for tasks such as diagnosis, which involve high stakes and are predominantly cognitive nature. Reflection on and adaptation of one's cognitive processes is important; this could be supplanted by seeking out the opportunity to engage in trial and error 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 performance. However, it may also be due to the individual's conception of the nature of expertise. Although expertise requires experience, experience alone is insufficient. Rather, the development of expertise is critically dependent on the individual making the most of that experience. As a result, motivational factors are fundamental to the development of expertise. Overcoming deficiencies in self-monitoring is not a sufficient remedy. It is also necessary is that clinicians form an attitude toward work that includes continual re-investment in improvement.

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