RESEARCH TO PRACTICE Defining , Developing , and Maintaining Clinical Expertise Alan

ast year, I wrote about the need for a theory of clinical expertise in speech-language pathology (Kamhi, 1994). In the changing health care market. considerable energies are einemg expended now on ways to measure and document the efficacy of our treatment methods. Much has been written concerning the particular knowledge, technical skills, interpersonal skills, and attitudes that contribute to clinical expertise (see, for example, Cornett & Chabon, 1988; American Speech-Language-Hearing Association's Speech-Language Pathology Skills Inventory [ASHA. 1994a], and the rich body of supervision literature). There is relatively little information, however, concerning the actual impact some of these factors have on treatment outcomes. To address these gaps in our clinical research, I suggested that clinicians and clinician characteristics need to become the focus of our studies (Kamhi, 1994). During the past couple of years, I have conducted a series of studies involving over 100 speech-language pathologists with varying levels of clinical experience. In this article, I will summarize some of the major findings from several of these studies, present a working model of clinical expertise, offer some speculative comments concerning the development and maintenance of clinical expertise, and discuss some of the problems with research in this area.