In response to a recent Wired column entitled, Let’s Bring The Polymath—and the Dabblers—Back, Amol Utrankar argues in this post for ‘institutional collaboration: a culture that prizes sharing, communicating, and coordinating between different pillars of expertise.’ I don’t find this be an ‘either-or’ proposition necessarily. I think we will need people well-versed in the myriad of ‘tools’ for the modern world as well as organizational culture and structure that fosters collaboration.

Perhaps this is just a restatement of the polymath argument [1], but I find the most useful way to think about this subject is the notion of the ‘T-shaped specialist’. This is something first popularized by Tim Brown (of IDEO). In his words:

[T-shaped specialists] have a principal skill that describes the vertical leg of the T—they’re mechanical engineers or industrial designers. But they are so empathetic that they can branch out into other skills, such as anthropology, and do them as well. They are able to explore insights from many different perspectives and recognize patterns of behavior that point to a universal human need.

In my own conceptualization, the vertical leg of the T represents a domain where you are an expert. Not only are you well-versed in the tools of that domain and can use them with aplomb, but you also understand the theoretical side of the domain. The broad part of the T represents related domains where you may know some of the tools and some of the theory, but could not independently create or function proficiently in that domain.

This is the theory that shapes medical education—4 years of broad education in theory and practice with the tools of the trade followed by 3+ years in a specific domain. Unfortunately, medicine seems to fail at the ideal because we rarely revisit the broad part of the T. In such a world, Utrankar’s notion of ‘institutional collaboration’ is paramount (and this is ostensibly what we see with general practitioners consulting specialists).

However, to take on the challenges facing medicine today, we need more T-shaped doctors. We need experienced physicians to revisit the broad part of the T. This can take many forms. Dr Amesh Adalja recently wrote about his cross-training in infectious diseases and critical care. I recently worked in a clinic where an experienced general pediatrician spends a half day each week seeing patients with pediatric dermatologists so she could learn how they approach skin issues and take that knowledge back to her practice and her partners. You don’t have to look too far to see doctors with additional degrees in public health, business, public policy, education, etc. They are bridging two domains and enriching each with their knowledge. Some argue doctors should be learning how to code in order to bridge the gap between medicine and information technology [2].

The challenge of medical education—specifically graduate medical education and continuing medical education—is finding a balance between specialty knowledge and cross-domain education. And the challenge for hospitals, private practices, and other health care organizations is how to cultivate T-shaped specialists amongst their own ranks.

I think there is more than a semantic difference between a ‘polymath’ and a ‘T-shaped specialist’. I conceptualize a polymath as someone with multiple deep expertises, cultivated over a long time with dedication to each of those fields. A T-shaped’ specialist, on the other hand, has one true expertise with some training/education in multiple other fields. ↩
Some argue that since you can’t become an expert in one of these other domains, why learn anything about them at all? The Digital Doctor podcast episode I’ve linked to addresses this nicely. It is not about being an expert in multiple disparate domains (which is what I would consider a ‘polymath’ to be), but being well-versed enough in those domains to engage others in meaningful collaboration (and—almost more importantly—to know when to engage others in those domains). ↩