This is an article I wrote for the Jul/Aug 2017 edition of Osteopathy Today.
What is expertise?
NCOR's Austin Plunkett and Dawn Carnes ask - what is expertise?
How do we describe expertise?
Academia offers a hierarchical approach towards recognition of expertise; for example, through Bachelor, Master, then Doctoral level awards, and various posts thereafter until the title Professor is awarded and conferred for outstanding contribution. This makes it straightforward for academics and non-academics to recognise the level of expertise a person has gained. The NHS also has a clear hierarchy where roles, responsibility and, one hopes, experience and skill are easily identified by job titles.
However, in other contexts 'expertise' is notoriously hard to define (Hambrick et al, 2014), and its meaning varies across disciplines (Ericsson ed., 2014). Definitions tend to focus on the possession of extensive knowledge and abilities within a particular area, beyond the capabilities of a novice or the general population (Gobet, 2015) and with validation by an awarding organisation.
Collins online English dictionary defines expertise as 'special skill or knowledge that is acquired by training, study, or practice'. In an osteopathic model of expertise, each of these – training, study, practice – are valuable. None can be isolated as the only necessary component in developing expertise, and none can be wholly excluded. Consequently, how might we describe or recognise an expert in osteopathy? Would we expect an osteopath described as an expert to be able to demonstrate significant levels of training, study, and clinical experience in relation to their area of expertise? If this is the case, the next problem is defining what these 'significant levels' are.
The term 'expert' or 'specialist' can be conferred on an individual by their peers or by the public, or through self-declaration by the individual. Two problems arise here in professional non-NHS healthcare practice; how might an individual seek recognition as an expert or a specialist, and what is there to prevent those without adequate skills from declaring themselves to be experts or specialists, thereby potentially jeopardising patient care and trust.Patients may seek out osteopaths who have experience and skills relating to their specific needs, and who can provide an approach to treatment and management that is aligned to these needs. Yet osteopathy currently lacks a profession-wide means whereby those with a high degree of skill or knowledge can clearly and consistently describe what sets them apart.
One of the core projects of the Osteopathic Development Group (ODG) is to look at advanced clinical practice in osteopathy. You can find out more by visiting: http://www.osteodevelopment.org.uk/advanced-practice
How do we achieve expertise?
It can be appealing to believe that expertise is innate, that experts are simply born that way, and that expertise cannot be learned. This idea blurs with other concepts, for example that of being a connoisseur. The notion of a connoisseur might conjure the image of a gifted enthusiast who gains knowledge through experience. Some might feel that this type of expertise cannot be taught, suggesting that the connoisseur is born with abilities that others cannot attain.
Others have stated while some degree of talent may be a necessary starting point, it is training and effort that enables a capable person to achieve expertise (Bourne et al, 2014; Ericsson 2014). This feels far less romantic than the connoisseurial notion of innate genius, perhaps because we tend to overlook the huge amount of dedicated training, study, and feedback that underpins the abilities of many apparent geniuses. Mozart, for example, played piano for hours every day under the tutelage of his musician-composer father, while Picasso had a similarly intensive childhood introduction to painting. The mythos surrounding such individuals tends to focus on their apparent innate expertise, and glosses over their years of diligent practice.
Focused, purposeful training may be necessary to develop ability into expertise, but is it sufficient? Intensive, goal-directed, feedback-informed practice emphasises declarative knowledge, and accounts for only part of what it means to be an expert. Extensive experience in clinical practice allows the development of procedural knowledge and practical experience, which are valuable in developing well-rounded expertise (Tyreman, 2000).
The definition of expertise in osteopathic research is built around academic, medical and health industry hierarchies and institutions, and public acceptance and knowledge. It embraces training, study, and practice; each is important, and none can supplant the others. As a profession, we have a lot to consider and develop to create our own definitions of experts and specialists.
Bourne L E Jr, Kole J, Healy A. Expertise: defined, described, explained. Frontiers in Psychology. 2014 Mar; 5:186. Available online at http://bit.ly/expertise-defined
McKeown C, ed. 2008. Collins Concise English Dictionary. Glasgow: HarperCollins. Available online at https://www.collinsdictionary.com/
Ericsson K A, ed. 2014. The Road To Excellence: The Acquisition of Expert Performance in the Arts and Sciences, Sports, and Games. New York: Psychology Press.
Fawkes C, Carnes D, Froud R. Collecting patient reported outcome data in clinical practice. European Journal of Integrated Medicine. 2016;8(4):591. doi: 10.1016/j.eujim.2016.07.014. Available online at http://www.sciencedirect.com/science/article/pii/S187638201630138X
Fawkes C, Froud R, Carnes D. Measuring patient outcome using data capture by mobile app. Trials. 2015; 16(Suppl 1): P27. doi: 10.1186/1745-6215-16-S1-P27. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461022/
Gobet F, 2015. Understanding expertise: A multidisciplinary approach. London: Palgrave.
Hambrick D, Oswald F, Altmann E, Meinz E, Gobet F, Campitelli G. Deliberate practice: Is that all it takes to become an expert? Intelligence. 2014 Jul-Aug; 45:34-45. Available online at http://bit.ly/deliberate-practice
Tyreman S. Promoting critical thinking in health care: Phronesis and criticality. Medicine, Health Care and Philosophy. 2000 ; 3:117-124.