Table 1

Dreyfus stages applied to clinical medicine5

Dreyfus stages
Stage 1—novice (medical student)Learns basics of history taking and examination
Stage 2—advanced beginner (house officer or SHO)Learns to apply skills in selected clinical situations which become increasingly dependent on the context of the situations—that is, hospital admissions, rounds, etc, which enables learning through experience
Stage 3—competent (registrar)Learns to plan the approach to each patient’s situations in a supervised fashion. Learns consequences of actions and pattern recognition
Stage 4—proficient (newly appointed consultant)Develops routines to streamline patient care. Manages multiple stimuli in a thoughtful way which is intellectually and emotionally absorbing. Integrates mastered skills with personal style
Stage 5—expert (mid career physician)Recognises patterns, has intuition for the work, attuned to distortions in patterns and to slow down when things don’t fit the expected pattern