ChangeMedEd Initiative

Why the physician of the future is a master adaptive learner

Timothy M. Smith , Contributing News Writer

Physicians, residents and medical students can all miss valuable opportunities to learn when they are focused solely on getting their clinical work done. A new learning model, the master adaptive learner (MAL), provides both a common language and a shared mental model to help learners at all stages of their medical careers develop the adaptive expertise they need to deliver high-quality health care, during a pandemic and beyond.

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The master adaptive learner model makes an important distinction between routine expertise—mastering performance to the extent that it becomes highly efficient and accurate, drawing on the specific knowledge and skills that an expert has learned over time—and adaptive expertise, which is based on the ideal that individuals will learn and innovate in response to practice challenges.

Following are highlights from “Who Is the Master Adaptive Learner?,” chapter 1 of The Master Adaptive Learner, an instructor-directed textbook designed to produce the habits of mind for lifelong learning in medicine. It is the first book in the AMA MedEd Innovation Series, which provides practical guidance for local implementation of the education innovations tested and refined by the AMA Accelerating Change in Medical Education Consortium.

On the one hand, the authors wrote, many physicians face a gap between the medical literature and their practice of medicine—one that requires better identification of deficiencies and targeted learning to correct them. This illustrates the pursuit of routine expertise.

At the same time, they face a gap between their knowledge and emerging challenges in the clinical environment. Here, the authors noted, physicians need new approaches that allow for the incorporation of creative ideas and novel solutions. This is adaptive expertise, so vital to the rapidly evolving health care environment.

“A different type of learner, a master adaptive learner—described as an ‘individual who utilizes the metacognitive approach to self-regulated learning that leads to adaptive expertise development’—is needed,” wrote William B. Cutrer, MD, MEd, associate dean for medical education at Vanderbilt University School of Medicine; Vishesh Jain, MD, who at the time of writing the chapter was a medical student at Vanderbilt University School of Medicine: and Alice Walz, MD, assistant professor at Medical University of South Carolina.

Learn more with the AMA about how adaptive expertise can make or break the COVID-19 response.

Using before-and-after vignettes of a hypothetical day in an academic medical center—a typical day in nonpandemic times, that is—the chapter explores how gaps in knowledge can get in the way of effective care delivery and how those gaps can be filled by this new self-directed learning model.

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The MAL process, described in greater detail in subsequent chapters, has four phases: planning, learning, assessing and adjusting.

“All four phases of the MAL process will apply to all levels of learners, though different learners may spend a larger proportion of time in a specific phase,” the authors wrote.

Read more about the four phases to making goal of lifelong physician learner a reality.

Medical students. Due to performance pressures in many learning environments, students might initially try to hide their knowledge gaps, take passive approaches, avoid asking for feedback and be slow to take up non-test-oriented studying. The MAL model provides a structure to bolster transparency in learning, helping students openly track and seek help for their knowledge gaps (planning), adopt active learning attitudes (learning), embrace feedback opportunities (assessing) and be more deliberate about practicing clinical skills (adjusting).

Residents. Due to institutional expectations for clinical service, residents may frequently be reactive to the clinical environment, prioritize work over knowledge building, see quality improvement as distinct from self-improvement and have little time remaining to advocate for patients or themselves. The MAL process can help them be more intentional about learning (planning), look for opportunities to combine learning with work (learning), model feedback-seeking behavior (assessing) and use their knowledge of the system to enact change (adjusting).

Practicing physicians and faculty. Due to practice demands, physicians might rely exclusively on self-assessment to identify knowledge gaps (which is known to be faulty), get stuck within silos of CME based on personal interest rather than learning needs, request feedback only rarely or episodically and routinize their practices as they strive for efficiency. They can draw on the MAL model to acquire a growth mindset (planning), pursue new lifelong learning opportunities (learning), seek feedback continuously (adjusting) and adopt more collaborative, interdisciplinary and innovative approaches to practice (assessing).

Find out how medical schools—disrupted by COVID-19—can get back on track.

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“So much of the work around learning is centered on the individual and developing skills and approaches, often ignoring the hidden curriculum, time pressures and other things that we would never intentionally put into a learning environment,” Dr. Cutrer said in an interview.

“We really want to challenge readers to think about how a learner who has this skill set can engage in a suboptimal environment better than one who doesn’t. We need to fix the environment too, but we are very hopeful that, with some of these additional tools, a learner will be able to thrive even in an environment that isn't ideal.”

Other chapters in The Master Adaptive Learner include “How Does Master Adaptive Learning Advance Expertise Development,” “How Do You Measure the Master Adaptive Learner,” and “How Will the Master Adaptive Learner Process Work at the Bedside?”

Discover more about envisioning the adaptive learner.