Cognitive metaphors of expertise and knowledge: prospects and limitations for medical education

CONTEXT: Many approaches to the study of expertise in medical education have their roots most strongly established in the traditional cognitive psychology literature. As such, they take a common approach to the construction of expertise and frame their questions in a common way. This paper reflects on a few of the paradigmatic assumptions that have 'come along for the ride' with the traditional cognitive approach, and explores what might have been left out as a consequence. METHODS: We examine the operational definition of 'expert' as it has evolved using the traditional cognitive paradigm and we explore some alternative definitions and constructions of expert performance that have arisen in parallel education research paradigms. We address 3 inter-related aspects of expertise as manifested in the traditional cognitive approach: the construction of the expert as a (routine) diagnostician; the construction of the developmental process as the (automatic and un-reflective) accrual of resources through experience, and the construction of accrued knowledge as a relatively static resource that is subsequently used and built upon with further experience. CONCLUSIONS: 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.