What Makes a Clinical Expert? A Scoping Review in Medical Education

Abstract Background The Evidence-Based Medicine paradigm has dominated modern medicine since its inception in the 1990s. Despite occupying the lowest position in the methodological hierarchy, clinical expertise is fundamental for evidence-based practice and a crucial component of effective medical education. However, little attention has been paid to the concept of clinical expertise. To fill this gap, this study addresses how clinical expertise is conceptualized in medical education literature. Methods We systematically conducted a scoping review to map how medical education literature conceptually addresses clinical expertise. We queried PubMed, Web of Science, and Scopus databases with a search string of terms related to clinical expertise. Results In total, 69 articles spanning 49 years were included for full text review. Upon thematic analysis, we discovered three main interconnected trends across the literature. First, we identified a polyphony of terminologies used to define or allude to clinical expertise, with most of the literature tending to use ‘clinical reasoning’ as a stand-in or proxy. Second, this use of clinical reasoning as a proxy for clinical expertise appears to downplay non-cognitive aspects such as communication skills, teamwork, and ethical deliberation. Lastly, this bias appears in medical education through a notable heterogeneity of approaches to teaching, manifesting as disjunctions between how clinical expertise is taught and how it is developed and recognized in real-world settings. Conclusions Our findings highlight the relative conceptual neglect of clinical expertise, as seen in the often-vague approaches in definition and subsequent dominance of clinical reasoning as a proxy. In turn, cognitive elements of clinical practice are given more priority while important non-cognitive elements receive considerably less attention/run the risk of being neglected. Future research should focus on clearly conceptualizing clinical expertise to foster the cultivation of a fuller spectrum of capacities enabling integrated, patient-centered, and contextually attuned clinical practice and healthcare delivery. Furthermore, a shared conceptual foundation of clinical expertise may help reduce divergence between medical education and the realities of clinical practice.