If you encounter a completely new situation and can determine how to handle it or solve the problem based on your accumulated learning, you have adaptive expertise. Medical trainees who demonstrate these skills could be considered master adaptive learners. It’s an area of education that MEHP alumnae Linda Regan, MD (MEHP ’19), and Laura Hopson, MD (MEHP ’23), have been researching and publishing papers about for the past several years.
Adaptive expertise differs from routine expertise, which involves doing something at a high level of competence the same way each time, explains Hopson, associate chair of education for the Department of Emergency Medicine at the University of Michigan Medical School in Ann Arbor. Master adaptive learning “is really a process of reflection, and then application and practice, all wired together with more reflection and further refinement,” she says.
Medical education has focused on routine expertise, making sure trainees can accomplish certain steps, says Regan, vice chair of education for the Department of Emergency Medicine at Johns Hopkins. But in many clinical areas, emergency medicine chief among them, learners will encounter new situations—such as an allergy to a drug typically used or an anatomic variant that may make central line placement challenging—and need to know how to apply their knowledge.
“The goal of my training is not that you can take care of the patient who comes in with classic chest pain that you read in the medical textbooks—everybody can do that,” Regan says. “The goal is that you’re not going to miss the 39-year-old diabetic woman who comes in with heartburn, because that’s not typical, and that you adapt what you know. … It’s really a critical piece of learning that we don’t talk about and that we don’t train people to think for. You’re not going to see every patient in your four years of training.”
Regan and Hopson have written four papers on the topic, along with emergency medicine physician educator colleagues Jeremy Branzetti, MD, MHPE, and Michael Gisondi, MD, with whom they’ve collaborated for about 10 years. Two of the papers were based on Regan’s and Hopson’s MEHP capstone projects. The work to date has described what master adaptive learners are doing and how they interact with the learning environment, Hopson says. A third paper looked at typical learners who exhibit some of the same behaviors as master adaptive learners but struggle more to create an effective learning strategy.
Their fourth paper (but 20th collaborative manuscript), which has been submitted for publication, describes a set of eight behaviors that master adaptive learners demonstrate in the learning environment. This includes taking ownership of the feedback process, Hopson says.
“Instead of me walking up to you and saying, ‘Can you give me feedback?’ and being a positive recipient, we see these master adaptive learners really own that process, and are willing to say, ‘Hey, I think this is how I did today. Can you fill in my misconceptions or provide more details and help me decide where I should go next?,’” Hopson says. “You can see the real difference in that behavior. One is very passive and one is very active.”
Master adaptive learners also display intellectual risk-taking behaviors, says Hopson, such as being willing to boldly express to supervisors their conclusions of what they think is happening with patients and what clinical steps should be taken, without fear of being proven wrong. The research could be used to develop interventions to promote these characteristics among all learners and to help program leaders identify trainees with these skills, Regan says.
“It’s been really great to feel like you’ve established an actual niche in a high-level educational area where you might actually be a national expert,” she says. “I just wanted to be a better researcher, and now I get texts from people who say, ‘We’re at this national conference and they were talking about your work.’ … It really helps us to have continued forward motion to build the area that’s exciting for us.”