Learning to balance efficiency and innovation for optimal adaptive expertise

Abstract

It is critical for health professionals to continue to learn and this must be supported by health professions education (HPE). Adaptive expert clinicians are not only expert in their work but have the additional capacity to learn and improve in their practices. The authors review a selective aspect of learning to become an adaptive expert: the capacity to optimally balance routine approaches that maximize efficiency with innovative ones where energy and resources are used to customize actions for novel or difficult situations. Optimal transfer of learning, and hence the design of instruction, differs depending on whether the goal is efficient or innovative practice. However, the task is necessarily further complicated when the aspiration is an adaptive expert practitioner who can fluidly balance innovation with efficiency as the situation requires. Using HPE examples at both the individual and organizational level, the authors explore the instructional implications of learning to shift from efficient to innovative expert functioning, and back. They argue that the efficiency-innovation tension is likely to endure deep into the future and therefore warrants important consideration in HPE.

Acknowledgements

The content reflects the views of the authors. The authors wish to thank all members of the Master Adaptive Learner Interest Group for their enthusiastic brainstorming of many of the ideas that made their way into this paper.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This manuscript was prepared with support from the American Medical Association as part of the Accelerating Change in Medical Education Initiative.

Notes on contributors

Martin V. Pusic

Martin V. Pusic, MD, PhD, is Associate Professor in the Ronald O. Perelman Department of Emergency Medicine, at the NYU School of Medicine, New York, NY, USA.

Sally A. Santen

Sally A. Santen, MD, PhD, is Professor in the Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.

Michael Dekhtyar

Michael Dekhtyar, MEd, is Research Associate, Medical Education Outcomes at the American Medical Association, Chicago, IL, USA.

Ann N. Poncelet

Ann N. Poncelet, MD, is a Professor of Neurology, William G. Irwin Endowed Chair, Department of Neurology, and Director of the Haile T. Debas/UCSF Academy of Medical Educators at the University of California San Francisco, USA.

Nicole K. Roberts

Nicole K. Roberts, PhD, is Assistant Dean for Medical Education and Faculty Development and Associate Professor, Medical Education, Department of Medical Education, CUNY School of Medicine/Sophie Davis Program for Biomedical Education.

Amy L. Wilson-Delfosse

Amy L. Wilson-Delfosse, PhD, is Professor of Pharmacology, Department of Pharmacology and Associate Dean for Curriculum at Case Western Reserve University School of Medicine in Cleveland, Ohio, USA.

William B. Cutrer

William B. Cutrer, MD, MEd, is Associate Professor of Pediatrics, Department of Pediatrics, and Assistant Dean for Undergraduate Medical Education at the Vanderbilt University School of Medicine, Nashville, TN, USA.