| Abstract: | It has been hypothesized that the development of medical expertise may be characterized by structural changes in the knowledge base, a process termed “knowledge encapsulation” (Schmidt, Norman, & Boshuizen, Academic Medicine, 65, 611–621, 1990). Until now this process has been investigated using a cross-sectional paradigm, comparing levels of expertise often far apart. The present study applies a follow-up approach, covering the first two years of apprenticeship of medical students (the clerkships) and includes a comparison between high- and low-achieving students. Experience level appears to be correlated with structural changes in the knowledge base and with the quality of the diagnosis. Achievement level has a weak correlation with the quality, but not with the structure of the knowledge. It is concluded that high and low achievers do not differ in the way their knowledge structures change as a consequence of practical experience. Implications for teaching and learning in practical settings are discussed. |
