Theories of expertise have profoundly shaped modern medical education. Most notably, theories of the stages of skill acquisition to become an expert, developed by Dreyfus and Dreyfus, were used to inform the Accreditation Council for Graduate Medical Education's six core competencies. Becoming an expert takes time, and Ericsson has argued that, across a variety of activities, it takes 10 000 hours of deliberate practice to achieve expertise. But most people, even those that have spent that much time in one type of activity, do not become experts. This Led my colleagues and I to become interested in the work of Bereiter and Scardamalia, who have considered why, with the same level of exposure to a field or activity, some individuals become 'experienced non-experts', whereas others become experts.4 Bereiter and Scardamalia have studied situations in which individuals are faced with a combination of routine and challenging problems. This certainly applies to clinical medicine.
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