Defining Expertise in Gynecologic Surgery: Perspectives of Expert Gynecologic Surgeons.

OBJECTIVE: The aim of this study was to describe how professional expertise is defined and understood among gynecologic surgeons and what experiential factors contribute to that understanding.

METHODS: Semistructured interviews with 16 experts in Female Pelvic Medicine and Reconstructive Surgery were conducted to identify how expertise in their field is defined, recognized, and assessed. Independent thematic analysis of the interview transcripts was performed by each member of the research team and then distilled and synthesized into convergent themes.

RESULTS: Experts described surgical expertise as difficult to define but with several dominant themes including knowledge, technical skills, clinical experience, adaptability, continuous learning, communication, and professional recognition. Expertise requires judgment in applying technical skills to meet each patient's specific needs. Experts described unique ways of seeing and thinking during surgery, characterized by spatial awareness of relevant anatomy, temporal awareness of future changes, and rapidly adaptive application of their skills enabling them to do difficult tasks with fluidity, making the tasks seem easy to observers. These expert surgeons acknowledged that achieving expertise requires hard work and maintaining expertise requires continuous learning, highlighted by challenge seeking to do the most difficult tasks in their field. They also noted the importance of effective communication of their knowledge to others, which contributes to their perception as experts by colleagues in the field.

CONCLUSIONS: Surgical expertise is a complex phenomenon with several meaningful themes. Understanding the authentic nature of surgical expertise can be used to support the development of competencies and the effective mentoring of promising surgical trainees to achieve surgical expertise.