Medical expertise as hybrid expertise: a proposal for the articulation of medical knowledge

Abstract

Medical expertise is traditionally understood through two main epistemic perspectives: propositional-cognitive knowledge, which emphasizes scientific and theoretical understanding, and practical-experiential knowledge, which is rooted in experience and tacit skills. Existing models often focus on one of these dimensions, failing to capture the full complexity of medical expertise. This study proposes a hybrid expertise (HE) framework that integrates both forms of knowledge, offering a more comprehensive characterization of how expertise is acquired and applied in medical practice. This study employs a theoretical-analytical approach, drawing from established distinctions in epistemology, such as know-how vs. know-that, tacit vs. explicit knowledge, and declarative vs. procedural knowledge. This perspective aligns with related concepts such as adaptive expertise (AE) and interdisciplinary expertise (IE). Additionally, we challenge the assumption that all medical students can become experts with proper training, arguing that expertise requires exceptional performance beyond mere competence. This perspective has important implications for medical education, emphasizing the need for curricula that balance theoretical instruction with experiential learning. These insights contribute to a more nuanced understanding of expertise, with potential applications in medical training, policy-making, and healthcare practice.