Connecting the dots: like watching a movie…critically

Acquisition of expertise in the diagnosis and management of patients requires years of practice; exposure to diverse clinical entities is critical as well as the myriad ways in which the same disease can present in a given patient. However, this repeated exposure has to be accompanied by two critical elements; first, the novice needs the guidance of an expert or master to appreciate the nuances and subtleties in making a diagnosis or taking a course of action. Second, and perhaps most importantly, the physician needs to acquire the habit of reflecting on and in actions during the clinical encounter. Unguided repetition during formative years or lack of critical introspection during practice hinders the progression to expertise. In a way, a complex clinical encounter is akin to watching a complex movie; it takes repeated exposure to the movie to understand the subtleties the director is utilizing to understand the plot in its entirety.