Memory (learning and remembering): Cognitive psychology tells us that a critical element of human learning is the extent to which the learner can impose meaning on the new material, by integrating it with what s/he already knows. In contrast to computer learning (and old models of human learning like S-R conditioning) a major determinant of efficiency and effectiveness of learning is meaning.

Transfer (using old concepts to solve new problems), Despite our intuitions that once someone has learned a concept, s/he will be easily able to access it to solve new problems, psychologist shave shown that spontaneous solution rates are typically only about 10-30%, even when the relevant concept is known. However there are now a number of effective strategies to facilitate transfer. Use of multiple examples is a common element to all; two examples are ore effective in learning for transfer than first learning the underlying concept and then e\seeing an example. Second, the learner must actively engage in searching for the "deep structure' of the example, and again, the best way to achieve this is to see the same problem arise in multiple contexts and to actively engage in comparison and contrast to seek out the common elements

Deliberate practice and its critical role in transfer: Multiple examples are critical for transfer. There are also strategies to sequence example optimize their impact. Two strategies are: a) mixed practice, where the examples from different categories are deliberately mixed up, and the learner must sort them out, and distributed practice, where practice sessions are spread out over time.

Experiential knowledge as a component of expertise While the concepts of formal knowledge of signs and symptoms, disease mechanisms, etc. are an important part of initial clinical learning, experience leads to the gradual acquisition of multiple examples, and expert clinicians often use similarity to prior learned examples as a first strategy in reasoning, a process called non-analytic reasoning. Expert clinicians do diagnosis in many ways just as people may recognize an everyday object - it's a chair or a cardiomyopathy because it look like a chair or a patient with cardiomyopathy.

General strategic skills (problem-solving, critical thinking, reflection, etc.). While we used to think that expertise resulted from the acquisition of general skills (problem-solving, reasoning, etc.), a recurrent finding is that successful solution of one problem is almost uncorrelated with solution of another. This finding, and the futile quest for general processes that are acquired with expertise, has led to the abandonment of search for general skills. With one caveat; terms like "reflective practice" and "metacognition" appear to be a new generation of general skills. However to date, these "skills" are underspecified, and it is not yet clear whether they can be measured, can be learned, and can be shown to be an important component of expertise.

Further reading:

Regehr G, Norman GR. Issues in cognitive psychology: Implications for professional education. Academic Medicine, 1996; 71: 988-1001.

Eva KW, Neville AJ, Norman GR. Exploring the etiology of content specificity: Factors influencing analogical transfer and problem solving. Academic Medicine, 1998; 73: S1-S6.