Discipline	First Author, Year	Title	Study Design	Themes Discussed
Chiropractic	Ivanova, 2024³²	The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic	Qualitative Interview	Clinical Expertise Operating within EBP: – Patients needed to feel confident in their chiropractor’s expertise before developing a bond or agreeing on treatment goals. This confidence was influenced by the clinic’s reputation and thorough initial assessments which reassured patients. This showcases how expertise facilitates the patient-clinician relationship, and as a result, integration of patient preferences. – Patients highlighted self-confidence in the trainee chiropractors as crucial to building their trust. Overconfidence was viewed negatively, but balanced confidence reassured patients. – Clear explanations fostered collaboration on treatment plans and agreement on care goals. Patients valued explanations that helped them understand the causes of their issues and what they needed to do to improve their condition.
Medicine	Issel, 2018¹⁸	Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle	Commentary	Defining Clinical Expertise: – EBP guidelines have shaped healthcare, forming what the authors call the “Medical Care Triangle.” This triangle represents the interplay between clinician expertise, patient-centredness, and institutionalized guidelines. – Clinician expertise is the result of extensive education, and is proven through licensure and certifications – Clinical expertise is characterized as independent of organizational structures and is heavily emphasized as a core feature in primary care delivery. – Paradox of Expertise: the tension between the clinician’s autonomy (based on expertise) and the standardization imposed by evidence-based guidelines. This paradox acknowledges that expertise must be balanced with the use of guidelines and patient preferences, illustrating a complex decision-making process.
	Paez A, 2018⁷	The “architect analogy” of evidence-based practice: Reconsidering the role of clinical expertise and clinician experience in evidence-based healthcare	Commentary	Defining Clinical Expertise: – The “Architect Analogy of EBP” describes clinical expertise as consisting of three overlapping skill sets: clinical, technical, and organizational. The clinical component involves clinical and communication skills, and knowledge and experience with patient engagement. The technical component involves skills in forming questions and appraising and implementing evidence in clinical practice. Organizational skills cover interdisciplinary teamwork. Clinical Expertise Operating within EBP: – Clinical expertise is essential for filtering and applying evidence in practice, integrating scientific knowledge, critical thinking, and patient assessment. Clinicians must evaluate evidence for its relevance and quality. Expertise is crucial for navigating large volumes of evidence, assessing its applicability, and addressing clinical “gray zones” where evidence is lacking or unclear. Expertise also supports ethical decision-making, patient education, and informed consent, ensuring that treatment aligns with both evidence and patient preferences. Expertise helps identify new research questions and detect emerging trends, contributing to the advancement of practice.
	Persson, 2019¹⁹	Science and proven experience: a Swedish variety of evidence-based medicine and a way to better risk analysis?	Commentary	Defining Clinical Expertise: – Suggest EBM is a restructuring of “science and proven experience” (VBE – an acronym for Swedish terms). Both EBM and VBE aim to incorporate science into decision-making but differ in their focus. The authors suggest EBM emphasizes using contemporary research to guide clinical decisions, while VBE focuses on ensuring patient safety by avoiding unnecessary risks. – The concept of VBE highlights the importance of blending both clinical experience and scientific knowledge to ensure effective healthcare decisions. – VBE emphasizes patient safety by minimizing risks through experienced clinical judgement. Clinicians must often balance scientific evidence with real-world conditions and individual patient needs to avoid harm. – EBM emphasizes a structured, research-based approach to guide clinical decisions, which complements the more individualized, experiential knowledge in VBE. Clinical expertise in EBP relies on synthesizing both—leveraging structured evidence with nuanced, personalized decision-making drawn from clinical experience.
	Peterson, 2016²⁰	The three-legged stool of evidence-based practice in eating disorder treatment: Research, clinical, and patient perspectives	Commentary	Clinical Expertise Operating within EBP: – Important to use research, clinical expertise, and patient preferences in guiding treatment for eating disorders – While randomized trials support specific treatments for these disorders, inconsistencies remain across the spectrum of disorders and for certain populations with the disorders. – Highlights how clinical expertise is vital in addressing this complexity of eating disorders, given the limitations of research in guiding treatment for diverse patient profiles. Factors like comorbidities, age, cultural context, and the patient’s physical state complicate treatment selection, making expert judgement crucial.
	Ratnani, 2023²⁵	Evidence-Based Medicine: History, Review, Criticisms, and Pitfalls	Commentary	Clinical Expertise Operating within EBP: – Argue that EBM has shifted away from its original pillars of clinical expertise and patient values, now emphasizing protocol-driven, guideline-based care that limits clinician judgement and patient autonomy. – This stems from the ‘foundations’ of EBM, which are the evidence pyramids, emphasizing standardized research evidence, particularly RCTs and systematic reviews. Suggest clinical decisions are reduced to following templates, sidelining physicians’ critical role in personalized care. – Argue EBM struggles in treating multi-morbid patients, as RCTs and systematic reviews, which form the backbone of EBM, focus on single conditions, failing to accommodate the needs of an aging population with multiple chronic diseases. In these situations, clinician expertise is needed to uniquely consider each patient, developing an appropriate care plan tailored to them.
	Salloch, 2018²⁴	What does physicians’ clinical expertise contribute to oncologic decision-making? A qualitative interview study.	Qualitative, Semi-Structured Interviews	Defining Clinical Expertise: – Introduce clinical expertise as “internal evidence” to be integrated with “external evidence”. – Identified direct patient contact on an individual basis and experience treating many patients contributed to a clinician’s expertise. – Bodily experience (the personal, lived aspect of clinical practice), non-explicit knowledge, and implicit biases were noted as likely influencing clinical expertise, but the use of measurable indicators in the study did not account for these factors. – Concluded clinical expertise may not be adequately understood using standardized quantitative measures, and must account for various independent factors
	Schlegl, 2017²¹	Different Weights of the Evidence-Based Medicine Triad in Regulatory, Health Technology Assessment, and Clinical Decision Making	Commentary	Clinical Expertise Operating within EBP: – EBM integrates best research evidence, clinical expertise, and patient values to address uncertainty in clinical decision-making – Regulatory bodies in healthcare primarily rely on research evidence, particularly RCTs, but have been adapting to real-world data and patient involvement due to recognition that certain treatments may still be beneficial for individual patients based on clinical judgement. – Clinical expertise is essential to ensuring that research evidence is applied in a way that aligns with the needs of individual patients in real-world settings.
	Szajewska, 2018²²	Evidence-Based Medicine and Clinical Research: Both Are Needed, Neither Is Perfect	Commentary	Clinical Expertise Operating within EBP: – Suggests the traditional EBM evidence hierarchy, suggesting diminishes clinical expertise, oversimplifies care, and serves commercial interests. – Concerns stated regarding the influence of industry, the overwhelming amount of evidence, and EBM’s failure to address complex, multi-morbidity cases. – Notes RCTs are the gold standard for determining efficacy of healthcare interventions, but criticizes them for limitations in external validity, leading to issues when generalizing results. – Emphasizes that EBM should prioritize the patient, indicating an important role for clinical expertise. The noted issues with clinical research rely on a clinician’s ability to effectively appraise and apply research – Argue that strict adherence to guidelines can overlook the nuances of clinical practice. – The acknowledgment of such criticisms indicates that clinical expertise is essential for interpreting guidelines in the context of individual patient needs.
	Tonelli, 2020⁴	Experiential knowledge in clinical medicine: use and justification	Commentary	Acquiring and Developing Clinical Expertise: – Suggests clinical expertise is derived from primary experience of day-to-day clinician activities. – Highlights the value of primary experience for clinicians to develop experiential knowledge such as diagnosing, treating, and assessing individual patients. – Suggests relying on clinician experience through care and engagement with patients contributes to the development of iterative and experiential knowledge, which is necessary for clinicians to posses in day-to-day practice. – Emphasizes clinical expertise should never be overlooked in EBP, but valued and strived for.
	Van de Vliet, 2023¹⁷	The Application of Evidence-Based Medicine in Individualized Medicine	Commentary	Clinical Expertise Operating within EBP: – Clinical expertise allows practitioners to apply external evidence to the specific needs of individual patients. While systematic research informs clinical decisions, it does not replace the judgement of the clinician. The process of EBM involves balancing three key components: best research evidence, clinical experience, and patient preferences. – Suggest EBM is often limited by an over-reliance on RCTs as the sole source of “best” evidence, overlooking real-world data and clinical experience, restricting clinicians from applying their expertise and adapting treatments to individual circumstances. – The risks of neglecting any of the three pillars of EBM include: Disregarding patient values, leading to impersonal or overly rigid care; Ignoring research evidence, resulting in outdated or empirical treatments; Overlooking clinical expertise, which may expose patients to inappropriate treatments. – In oncology, EBM’s success depends on the proper integration of these elements to ensure safe (which is the function of clinical expertise), high-quality care tailored to individual patients
	Welink, 2020²³	GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study	Qualitative, Semi-Structured Interviews	Acquiring and Developing Clinical Expertise: – Suggests “learning conversations” as a key tool for learning and discussing the implementation and practice of EBM for medical practitioners. – These conversations were defined as discussions that included a medical topic/question, prompting practitioners to reflect on these topics as they occurred in every day practice – Emphasize that respect is an important element in peer-to-peer conversations, and these conversations can prompt discussion and develop new insight and knowledge. – Highlight the important role of supervisors in these conversations, as supervisors guide their mentees to consider context-related factors specific to the individual patient, contributing to a comprehensive understanding beyond just the specific medical condition of the patient.
Nursing	Dewitt, 2021²⁶	The epistemic roles of clinical expertise: An empirical study of how Swedish healthcare professionals understand proven experience	Survey Analysis	Defining Clinical Expertise: – Discuss the concept of VBE, acronym in Swedish terms translating to “science and proven experience” – Suggests the VBE model allows for a more explicit understanding of the integration of evidence into practice, and its role. – States “proven experience” refers to the quality of having experience, instead of describing the content of the experience. This is tailored to the idea that clinical expertise in EBM is something clinicians acquire through experience. – VBE promotes reflection within clinicians, informing their application of relevant evidence to their patients’ clinical circumstances.
Nursing	Teolis, 2020²⁷	Improving Nurses’ Skills and Supporting a Culture of Evidence-Based Practice	Commentary	Acquiring and Developing Clinical Expertise: – Suggests that training programs that include hands-on workshops can improve a practitioner’s ability (nurses in this context) to seek, appraise, and apply evidence in practice. – Recommended collaborative learning between librarians and nursing education departments to develop evidence-based competencies within a supportive learning environment. Clinical Expertise Operating within EBP: – Authors reference a 7-step EBP model, highlighting the importance of clinical expertise in this model to integrate the best evidence with patient preferences to inform clinical decision-making. This tailors care to each individual patient’s needs. – Suggests EBP is not consistently implemented across healthcare systems, particularly in the nursing profession, as some nurses lack competence in certain EBP skills such as forming research questions and critically appraising evidence.
Occupational and physical therapy	Thomas, 2023³¹	Being and Becoming an Evidence-Based Practitioner: Occupational Therapists’ Journey Toward Expertise	Qualitative interpretive descriptive, semi structured interviews	Acquiring and Developing Expertise: – Humility, conscientiousness, curiosity, open-mindedness, and leadership were noted by therapists as essential for developing their expertise. – Defining moments in therapists’ careers, such as being at an impactful EBP conference, that made practitioners realize there was a gap in their care/knowledge – Motivators such as a desire to achieve better outcomes for patients, recognition of ethical obligations to provide the best care informed by evidence, and students acting as mentors by bringing new and recent information into practice – Questioning standard practices, using critical thinking, sharing knowledge, addressing knowledge gaps and integrating experience with research evidence were noted as factors used by EBP practitioners to integrate EBP into care (e.g., emulating clinical expertise) – Engaging in ongoing learning, formal teaching, and interacting with peers, students, and research were noted factors for improving practice – Extensive scientific resources available in the field facilitates expertise development
	Hallé, 2018²⁹	Attributes of evidence-based occupational therapists in stroke rehabilitation	Qualitative Analysis	Defining Clinical Expertise: – Authors defined two fields of expertise, including expert evidence-based occupational therapists and outstanding occupational therapists. – Expertise was attributed to clinician dedication, motivation to learn, achieving great patient outcomes, and working in a specialized setting. – ‘Expert evidence-based clinicians’ had extensive knowledge, skills, and experience, and were involved in continuing education and knowledge translation initiatives – ‘Outstanding clinicians’ had extensive specialized experience, expertise and expert qualities of intelligence, skill, and clinical knowledge.
	Carr, 2020³⁰	Developing clinical expertise in musculoskeletal physiotherapy: using observed practice to create a valued practice-based collaborative learning cycle.	Qualitative – “Constructivist Grounded Theory Study”	Acquiring and Developing Clinical Expertise: – Propose a three-staged cyclical process to support the advancement of clinical expertise using a mentor-learner model – Model functions to develop clinical expertise in the MSK physiotherapy workforce, and included three phases, including “requirements prior to learning activity”, the “learning activity”, and a “collaborative reflection and analysis” phase.
	Benfield, 2020²⁸	Initial development of a measure of evidence-informed professional thinking	Survey Analysis	Defining Clinical Expertise: – Notes that expertise requires the integration of external research evidence into clinical practice. Expertise must reflect critically on their practice, seek and discuss their experiences with their colleagues, and reflect on their own knowledge, beliefs, and values – Highlights clinical expertise involves both critical clinical reasoning and evidence informed practice activities, with a big overlap between the two. The study found practitioners who engage in more clinical reasoning also engage more in evidence-based practices, indicating the two are interconnected. – Note numerous qualities that should be considered when measuring clinical expertise, that their study did not, such as: specific client-related skills, evaluating evidence quality, communication abilities, and adapting/tailoring care to individual clients. Acquiring and Developing Clinical Expertise: – Requires the continued development of “habits of mind”. Habitual engagement in both critical clinical reasoning and evidence-informed practice behaviours is essential for developing and applying clinical expertise in practice. – Authors suggest the importance of participating in activities that foster clinical reasoning and reflection to improve or maintain clinical expertise, as these activities are strong indicators of clinical competency
Rehabilitation education	Halvari, 2021³³	Social, health and rehabilitation sector educators’ competence in evidence-based practice: A cross-sectional study	Descriptive Cross-Sectional	Acquiring and Developing Clinical Expertise: – Institutions can help health and rehabilitation educators develop clinical expertise by making educational resources and research accessible, as well as facilitating learning conversations. – While most educators rated their EBP competence positively, there were areas for improvement, particularly in knowledge retrieval and scientific publication engagement. Continuous education and time management were also highlighted as factors that could enhance EBP competence.
Psychotherapy	Huisman, 2018³⁴	Evidence-Based Practices in Cognitive Behaviour Therapy (CBT) Case Formulation: What Do Practitioners Believe is Important, and What Do They Do?	Survey Analysis	Defining Clinical Expertise: – Define clinical expertise in relation to the EBP model, as the mechanism of integrating the best available evidence into clinical practice to form a decision. Acquiring and Developing Clinical Expertise: – Case formulation (CF): described as a process within cognitive behavioural therapy where the clinician has the opportunity to integrate relevant theory and research into a particular individual case – Suggested that effectively using external evidence in CF is a clinical skill that can be developed with experience. More experienced clinicians, especially clinical psychologists, tend to endorse practices that involve external evidence as more important than less experienced clinicians. – Experienced psychologists rate certain evidence-based activities like evaluating hypotheses and using structured CF methods as ‘more important’. However, this perceived importance didn’t necessarily translate into more frequent practice, indicating a potential gap between knowledge and practical application.
Speech Language Therapy	Jackson, 2017³⁵	Professional expertise amongst speech-language therapists: “willing to share”	Survey Analysis	Defining Clinical Expertise: – Highlighted that expertise is not a given result of years of experience, nor knowledge, despite the two still being important for expertise – High experience and contextual knowledge were ranked as top elements of expertise, aligning with traditional views of expertise rooted in knowledge and experience. However, research expertise, such as holding a PhD or being involved in research, ranked lower, reflecting a preference for clinical over research expertise. – Suggests that building expertise involves both knowledge contribution and collection, and balancing these could enhance professional development. Shared knowledge, through teaching and learning helps shape the identity of an expert.
Speech Language Therapy	Douglas, 2019³⁶	Narratives of expert speech-language pathologists: Defining clinical expertise and supporting knowledge transfer	Interview Analysis	Acquiring and Developing Clinical Expertise: – Notes the importance of experience in developing expertise, but that it is not the sole contributor to expertise. – The length of time spent in practice does not equate to a clinician’s expertise. In some cases, the opposite can be true, in terms of reinforcing bad habits and a lack of new knowledge integration. – Factors like training, personal traits, networking opportunities, learning from mistakes, and good work sites contribute to clinical expertise.
Nutrition	Johnston, 2019³⁷	The Philosophy of Evidence- Based Principles and Practice in Nutrition	Commentary	Clinical Expertise Operating within EBP: – Highlights how optimal clinical decision-making requires the best available evidence and balancing this evidence with the patient context – Emphasizes importance of systematic summaries of evidence, and concerns over RCT results with regards to small study sizes and slow adoption by experts. Still, note that “high-quality” evidence is preferred, noting the example of the long-standing yet flawed dietary fat guidelines, which were based on lower-quality observational studies, eventually overturned by higher-quality evidence. – Acknowledge that large, consistent effects from observational studies can also yield high-certainty conclusions. – To be able to treat each patient uniquely, and apply accurate evidence, EBP requires clinical skills, such as accurate diagnosis, communication, and sensitivity to the patient’s context. Evidence should be integrated with each patient’s values, and clinician must address challenges such as time constraints and access to resources.

Table 1.