Acquiring and maintaining lifelong expertise in surgery.

Expertise in surgery is essential to ensure the best outcomes across various phases of surgical care. Expertise is multidimensional and is both domain- and context-specific. It encompasses a broad range of knowledge, skills, and professional attributes. General expertise is characterized by pattern recognition, rapid and effective decision-making, fluency of actions, and efficiency in performance. Adaptive expertise involves complex decision-making and exceptional performance within the context of unexpected findings, unusual circumstances, complex systems, and the rapidly changing surgical environment. Traditionally, surgeons have acquired expertise through extensive experiences in a variety of difficult and demanding situations. Over the past few decades, considerable emphasis has been placed on a more planned and efficient approach to the development of surgical expertise through extended periods of deliberate practice coupled with specific feedback, and through establishment of progressively higher goals and benchmarks for the surgeon. Reflection and metacognition have been recognized as playing key roles in achieving expertise. More recently, an expert performance approach to training has been described that involves defining expert performance, focusing efforts on achieving expertise, and monitoring the outcomes of such efforts. The cycle of practice-based learning and improvement should serve as the essential framework for implementation of the expert performance approach. Simulation-based education and training, coaching, and communities of practice can be very helpful in achieving and maintaining expertise. Professional organizations, such as the American College of Surgeons, need to continue playing pivotal roles in supporting surgeons in their quest to achieve and maintain expertise.