Perceptions of expertise and its development among critical care trainees and staff physicians: A qualitative interview study

BACKGROUND: In highly specialized fields such as critical care medicine (CCM), understanding how expertise is defined and developed is essential for both clinical practice and education. While expertise has been widely studied, its characteristics and developmental trajectory among critical care physicians remain incompletely understood. METHODS: The qualitative interview study involved purposively sampled CCM trainees and experienced staff physicians. Two systems-design researchers interviewed, recorded and transcribed the interviews verbatim. One researcher inductively coded all transcripts, while another researcher reviewed the codes and representative quotations. A CCM physician contributed to theme development, and interpretations were refined through team discussion. RESULTS: 36 participants were interviewed (18 trainees and 18 staff physicians). Expertise in CCM was described as multifaceted, encompassing knowledge, experience, technical and non-technical skills, communication, performance, and personal attributes. Mental model development emerged as a central indicator of progression toward expertise. Trainees and staff physicians largely shared similar views; however, trainees emphasized confidence in decision-making and the role of experts as mentors and leaders. DISCUSSION: Expertise in CCM extends beyond technical competence to include cognitive and interpersonal dimensions. The importance of mental models and decision-making under uncertainty highlights the role of experiential learning and reflective practice. Differences in perception between trainees and staff physicians suggest that confidence and teaching ability may serve as key markers of expertise from a learner perspective. CONCLUSION: Expertise in CCM is complex and evolving, shaped by experience, reflection, and cognitive development. These findings provide a foundation for optimizing ICU training strategies and supporting clinicians' progression toward expert performance in high-stakes environments.