Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning

Abstract

Background: The ability to adapt expertise to both routine and uncommon situations, termed adaptive expertise, has been suggested as a necessary skill for physicians. The Master Adaptive Learner (MAL) framework proposes four phases necessary to develop adaptive expertise. The first phase, “planning” for learning, includes three stages: identification of gaps, prioritization of gaps, and identification of learning resources. This study explored key strategies used by MALs in “planning” for learning.

Methods: Focus groups were used to identify strategies that successful postgraduate trainees use to plan learning. Researchers analyzed transcripts using constant comparison analysis and grounded theory to guide the generation of themes.

Results: 38 participants, representing 14 specialties, participated in 7 focus groups. Six key strategies used in the “planning” phase of learning were found. During gap identification, they used performance-driven gap identification and community-driven gap identification. To prioritize gaps, they used the schema of triage and adequacy. To identify resources they used intentional adaptation and weighted curation. Barriers such as lack of time and inexperience were noted.

Conclusions: MALs use six strategies to plan learning, using patients, health-care team roles, and clinical questions to guide them. Understanding these strategies can help educators design learning opportunities and overcome barriers.

Acknowledgments

The authors thank Martin Pusic, MD, Ph.D., and Paula Ross, Ph.D., for their thoughtful review of this manuscript. This project was designed and conducted as part of a capstone project for the Master of Education in the Health Professions program at Johns Hopkins University.

Disclosure statement

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

Glossary

Adaptive expertise: Was first described in 1986 by Giyaoo Hatano to distinguish a concept separate from routine expertise. Routine experts are able to solve familiar problems both efficiently and accurately, while adaptive experts are able to “go beyond the routine competencies, and can be characterized by their flexible, innovative, and creative competencies,” Adaptive expertise allows a health professional to respond flexibly to clinical situations that were not familiar or never encountered before. Thus, routine expertise produces experts who can achieve mastery in the familiar over and over, while adaptive experts build on routine expertise by adding flexibility and innovation to create novel solutions to unfamiliar problems.

Hatano, Giyoo, and Yoko Oura. 2003. “Commentary: Reconceptualizing School Learning Using Insight From Expertise Research,” Educational Researcher 32, 32 (8). American Educational Research Association: 26–29. doi:10.3102/0013189X032008026.

Master Adaptive Learner: Describes a conceptual model defined in a manuscript published by the Accelerating Change in Education project of the American Medical Association in 2017. The Master Adaptive Learner framework describes four key phases of an integrated process of learning used by students to develop the skill of adaptive expertise. The first phase, Planning, incorporates three stages that a learner uses to plan future learning. They include: identifying a gap, selecting an opportunity for learning, and searching for resources for learning. The second phase, Learning, is the phase during which the learner engages in learning and internalizes new knowledge, skills or attitudes. The third phase, Assessing, is when learners try out their newly attained capabilities or knowledge and progress to a state of comfort through refinement by feedback and self-assessment. The last phase, Adjusting, describes a stage in which learning is routinely incorporated into daily practice and is able to be used in novel ways.

Cutrer, W. B., B. Miller, M. V. Pusic, G. Mejicano, R. S. Mangrulkar, L. D. Gruppen, R. E. Hawkins, S. E. Skochelak, and Moore, D.E., Jr. 2017a. “Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education,” Academic medicine: journal of the Association of American Medical Colleges 92, 92 (1). United States: 70–75.

“Brick Wall” Concept: The common idiom, “to hit a brick wall,” has been used to describe an encountering an obstacle that stops ones’ progress. In medical education, the “brick wall” concept describes the process whereby a trainee works independently to create differential diagnoses, implement plans, or attempt procedures until they come to the conscious realization that they have hit a “brick wall” – they do not know what the correct next step should be. This conscious realization prompts self-reflection, facilitates the identification of a gap that needs to be addressed, and prompts a next step, such as, discussion with a supervisor, in order to move forward. The “brick wall” represents a teachable moment for learners, and should be considered a key way for learners to receive formative feedback, as a part of the productive struggle of learning.

The Brick Wall is the self-identified learning gap and requires practice-based learning or teaching from a supervisor in order to complete the clinical task in progress https://grammarist.com/idiom/hit-a-brick-wall-vs-hit-the-wall/

Regan, L., Hopson L.R., Gisondi M.A., Branzetti, J. (2019) Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning. Medical Teacher. In press.

Additional information

Notes on contributors

Linda Regan

Linda Regan, MD, is the Emergency Medicine Residency Program Director, Vice Chair for Education, and Associate Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Laura R. Hopson

Laura R. Hopson, MD, is the Emergency Medicine Residency Program Director and Associate Professor at the University of Michigan Medical School, Ann Arbor, MI, USA.

Michael A. Gisondi

Michael A. Gisondi, MD, is Associate Professor and Vice Chair of Education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Jeremy Branzetti

Jeremy Branzetti, MD, is the Emergency Medicine Residency Program Director, Department of Emergency Medicine, New York University School of Medicine, New York City, NY, USA.