Adaptive Expertise Research Articles

An early-curricular team learning activity to foster integration of biochemical concepts and clinical sciences in undergraduate medical education.

The ability to connect key concepts of biochemistry with clinical presentations is essential for the development of clinical reasoning skills and adaptive expertise in medical trainees. To support the integration of foundational and clinical sciences in our undergraduate health science curricula, we developed a small group active learning exercise during which interprofessional groups of students use clinical cases to explore the biochemistry, diagnostic strategy, and evidence-based treatment options of inborn errors of metabolism (IEM). We designed multistage learning modules consisting of (1.) low-fidelity case simulations of pediatric patients presenting with IEMs, (2.) guided group discussions on clinical biochemistry, differential diagnoses, and diagnostic strategies, (3.) oral presentations of clinical reasoning strategies, and (4.) discussion of relevant evidence-based medicine topics related to the cases. These modules Scientific Knowledge Integrated in Patient Presentations (SKIPPs) were added to a first-semester foundational sciences course serving five health professions programs. The assessment of learning outcomes by students and faculty shows that SKIPPs sessions are well-received activities that significantly improve trainees' ability to integrate foundational science concepts into clinical scenarios, to practice interprofessional teamwork and to develop clinical reasoning skills.

What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine.

The Master Adaptive Learner (MAL) model postulates that learners develop adaptive expertise through cycles of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors of MALs are not well characterized. We sought to define behaviors that characterize MALs within emergency medicine (EM) training. Using a constructivist grounded theory approach, we analyzed semistructured interviews with expert EM educators. These experts reflected on observable behaviors as well as factors in the clinical learning environment that may modulate these behaviors. We recruited using purposive sampling until thematic saturation. We identified four overall themes, of which three described groups of learner behaviors and a fourth described modifiers of these behaviors. Learner behaviors include: (1) critical interrogation of practice, (2) intellectual risk-taking, and (3) intentional curation of a learning network. Critical interrogation of practice encompasses several observable behaviors including learner-driven feedback conversations, independent synthesis of clinical information, appropriate deviation from algorithms based on their conceptual understanding of core principles, intentional use of case variation and hypothetical questioning, and continuous refinement of decisions. MALs also engage in intellectual risk-taking for their development by communicating clinical decision-making processes even at the risk of being wrong, openly addressing errors and gaps, and intentionally seeking out uncomfortable experiences. Intentional curation of a learning network is the deliberate development of a consortium of trusted individuals who serve as mentors and sounding boards. We also identified a fourth theme related to the expression of learner behaviors: learning environment modulates behaviors. Active promotion of psychological safety is necessary for learners to express these behaviors. This safety is mediated through trusting relationships and expert supervisors who serve as colearners and role models. We present several behaviors that allow identification of MALs among EM trainees. These data expand our understanding of MALs and the critical influence of the learning environment. Identification of these behaviors may allow for more precise categorization of targeted curricular interventions and meaningful learning outcomes.

Implementation of Deep-Learning Strategies that Support Development of Adaptive Expertise in Two First-Year Pharmacy Courses

The objective of this study was to describe the implementation of two deep-learning strategies targeting the development of adaptive expertise skills in two first-year Doctor of Pharmacy courses. To stimulate the development of an environment conductive to building adaptive expertise skills, productive failure and concept mapping were integrated in two courses. The results showed the benefits of building an instructional structure that supports the development of adaptive expertise skills through high self efficacy and perceived value of the two tools on own learning.

Measuring the “invisible”: Clarifying the concept of cognitive effort in translation and interpreting processes

Although translation and interpreting (T&I) involve multiple cognitive processes, the role of cognitive effort is often overlooked and needs to be conceptualized more fully to better understand the complexity of these tasks. This article seeks to “measure the invisible” by 1) exploring its definition and application in existing research, 2) conducting a multidimensional analysis based on cost and reward, and 3) highlighting its relevance to T&I research and education. Our framework includes internal cost, opportunity cost, need for cognition, and learned industriousness. This allows for a more precise measurement of effort and a better understanding of individual differences and task requirements in T&I research. For education, the framework offers insights into strategies for managing workload, distributing practice, and developing adaptive expertise. By clarifying the multidimensional nature of cognitive effort, we can improve T&I research and develop sustainable practices for practitioners. Keywords: cognitive effort, translation and interpreting (T&I), internal cost, opportunity cost, need for cognition, learned industriousness

Online teaching dexterity-implications for post-pandemic higher education online teaching competencies

ABSTRACT Lecturers’ pandemic challenges with transitioning to online teaching indicate them needing better ‘online teaching dexterity’ or the ability to negotiate a range of online teaching situations. This kind of teaching competency needs to be better understood as institutions are seeking more educational flexibility through online learning beyond the pandemic. Using phenomenology, this study distils the meaning of online teaching dexterity from lecturers’ online teaching experiences during the pandemic. Semi-structured interviews with 19 lecturers from a university in New Zealand found that they manifested online teaching dexterity through continuously reshaping their seeing, communicating, juggling, and engagement strategies to changing circumstances. Lecturers established future practices through reconstructing teaching routines and practice-based learning. The study discusses how the lens of online teaching dexterity can be used to reframe post-pandemic online teaching competencies as different forms of adaptive expertise.

Mathematical game performance as an indicator of deliberate practice

The traditional classroom setting presents challenges when it comes to strengthening adaptive expertise in mathematics education through deliberate practice. This study aimed to investigate whether the Number Navigation Game (NNG) could help promote deliberate practice, and whether students’ performance in the game was related to their development of Adaptive Number Knowledge, perceived challenge, flow, and math interest. NNG is a game-based learning environment that requires students to progress by solving increasingly complex arithmetic problems, which is crucial for promoting adaptive number knowledge. Game performances of 214 Finnish students were analyzed and compared to the best possible performance for each game level. A growth mixture model based on the students' relative performance levels was used to gain insight into how students' game performance changed throughout the game, and how this related to their knowledge gains, perceived challenge, math motivation, and flow. There were four different profiles of students' game performance. The largest profile consisted of students who steadily improved their performance in the game, despite initially having lower-than-average performance. This group experienced lower levels of flow but achieved larger learning gains than the other groups, suggesting that their engagement may be more aligned with deliberate practice.

Mixed-Reality Simulation to Support Practice Learning of Preservice Teachers

Before the COVID-19 pandemic, providing high-quality practice learning experiences for preservice teachers was already taxing due to the heavy reliance on school practicum, which is often besieged with challenges. Given these challenges, there is a growing urgency to explore alternative avenues for offering practice learning experiences to preservice teachers in addition to school practicum. With this backdrop, a qualitative study was conducted, employing observation and interviews as data collection methods to explore the potential of mixed-reality simulation (MRS) to strengthen the practice learning experiences of preservice teachers. The core teaching practice of questioning was chosen to explore the affordances of MRS for improving preservice teachers’ understanding of and proficiency in utilizing questioning. This study found that MRS provides a low-risk learning environment that preservice teachers perceive as authentic. For these reasons, this environment is conducive to improvement, and it enables deliberate practice, which is vital for nurturing metacognition and adaptive expertise. The findings also highlight the importance of coaching for maximizing MRS advantages. The absence of coaching will most likely limit the affordances of MRS as an approximation of teaching practice. While our findings are promising, the resource-intensive nature of MRS implementation means that scalability requires further investigation.

What pedagogy feels like: Teachers’ development of pedagogical empathy in rehearsal debriefs

ABSTRACT Background Emotions are inherently intertwined with learning and disciplinary identity, and this relationship demands that teachers attend and respond to students’ emotions. In this study, we forward a theory that the development of pedagogical empathy, or the capacity to understand the implications of student emotions and use emotional data to make adaptive pedagogical decisions, is a component of adaptive expertise. Methods Using qualitative methods to analyze the discourse in eight debrief discussions among secondary mathematics teachers following rehearsals of practice, we examine how teachers used this opportunity to generate and use emotional data in support of the development of pedagogical empathy. Findings We found that rehearsal debriefs provided an opportunity to make emotional data available to participants in three ways and that teachers then used that emotional data in six ways across the debriefs. Student emotions, both from teachers in the position of students and in consideration of hypothetical students in the classroom, were pervasive in the debrief discussions. Contribution After considering the ways in which emotional data were made visible and used, we return to theory to consider how these highlight the opportunities rehearsals offer to develop pedagogical empathy and discuss implications for teacher education and future research.

Developing pre-service teachers’ adaptive expertise through STEM-CT integration in professional development and residency placements

This paper focuses on how one innovative teacher education model, that included a unique residency model and the integration of computational thinking and digital teaching and learning in elementary classrooms, supported the development of adaptive expertise in pre-service teacher education programs. The theoretical frame applied in this study is adaptive expertise through the lens of sociocultural theory, and it employs tenets of ethnographic research procedure as methodology. Data demonstrated that the model provided pre-service teachers with a rigorous setting that allowed for practice of routine expertise as well as adaptive expertise. Additionally, analysis pointed to balancing efficiency and innovation and mentor-mentee collaboration as key components of the development of adaptive expertise in pre-service teachers.

Pre-service early childhood teachers’ perceptions of their playfulness and inquisitiveness

Recognizing one’s own playfulness is important for early childhood education (ECE) teachers, who are responsible for organizing and implementing child-initiated pedagogy in ECE centers. Playfulness research has focused on children’s play and playfulness in workplaces, but playfulness as a part of ECE teachers’ pedagogical and adaptive expertise is rarely studied. Using multiple playfulness and innovativeness instruments, first- and third-year pre-service ECE teachers’ (n = 208) self-reported playfulness and inquisitiveness was examined. Correlation coefficients and Student t-tests were performed to examine the connections between playfulness, the facets of playfulness, and inquisitiveness, also between the first- and third-year pre-service ECE teachers. The results of the study show that playfulness, the facets of playfulness and inquisitiveness are connected. The results also show that although there were no statistically significant differences among the first- and third-year pre-service ECE teachers’ playfulness and inquisitiveness, they had different orientations towards playfulness. Additional research is needed to explore how in-service teachers and pre-service teachers can learn playfulness and inquisitiveness as a part of their pedagogical expertise. The results are implementable for designing, developing and evaluating ECE teacher education.

Designing Serious Games for Senior Executive Strategic Decision Making

Senior executive strategic decision making is a prized skill. The analysis of available literature yields three key conclusions: i) strategic decision-making skills, especially in high complexity and ambiguity leverage ‘adaptive expertise' which is very different from the dominant discourse on narrow domain ‘expert performance;' ii) unlike focused skills which can be developed by concentrated, high repetition practice, adaptive expertise requires higher order meta-cognitive skills in addition to wide domain knowledge and managerial skills. Third, emerging literature suggests serious games can help to improve capabilities in decision making and cognitive skill, but there is a limited range of games or research explicitly focused on strategic decisions, while there is extensive body of knowledge on such simulations and measures for in-the-moment type decisions. The authors propose several frameworks and design requirements incorporating three levels of skills including higher cognition.

Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania.

Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.

Tool-based mentoring conversations in teacher education: new structures, opportunities and the role of adaptive expertise

PurposeThis paper aims to investigate how school-based mentors and preservice teachers (PTs) perceive mentoring conversations when applying a set of newly developed digital tools accompanied by discursive tools in mentoring in practicum.Design/methodology/approachThis study performed a thematic analysis of 12 interviews (5 with mentors and 7 with PTs) to explore how the participants perceived mentoring conversations when applying a combination of digital and discursive tools in school-based mentoring conversations. This study uses a model of adaptive expertise to discuss the findings.FindingsThis analysis revealed that the tools could alter the typical order of mentoring conversations. Mentors reported a change in their mentoring routines in which mentees took a more active role in conversations. The use of tools also allowed for richer conversations. From the perspective of PTs, the tools provided a structure for mentoring sessions, provided an alternative opening for mentoring conversations and enhanced their awareness of certain aspects of their own teaching.Originality/valueThis study's results suggest that the application of tools in mentoring enhances mentoring by facilitating reflection among PTs and mentors and fostering the development of adaptive expertise.

Development of an instrument for medical students’ self-assessment of facets of competence for patient-centred care

ObjectiveTo develop a facets of competence self-assessment instrument (FOCSI) with operationalised items for ten competence facets required for patient-centred care at the beginning of residency. MethodsWe conducted focus groups and cognitive interviews with final-year medical students to develop items that match students’ clinical experience. We tested 50 items in two samples and analysed model fit and internal consistency of all possible combinations to identify the optimal ten-item-solution. Item analysis was performed as well as correlation with six personality traits. ResultsAn optimal ten-item solution for the self-assessment instrument emerged for sample 1 (n = 101, 27.2 ± 3.5 years, 75.2 % female). We validated the model fit with sample 2 (n = 135, 27.7 ± 3.9 years, 66.7 % female): χ2(35) = 49.3, p = .055, CFI = .94, RMSEA = .055, SRMR = .058, Cronbach’s alpha = .78. The personality factors ‘Conscientiousness’ and ‘Extraversion’ correlate positively with most FOCSI items. ConclusionThe operationalised FOCSI items support undergraduate medical students close to graduation in realistic self-assessment of facets of competences for patient-centred care in their transition to residency. Practice implicationsRealistic self-assessment of facets of competence will provide medical students with the opportunity to monitor their competence development as part of self-directed learning for gaining adaptive expertise in professional, patient-centred care.

Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty

Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents’ workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.

Exploring the strategies used by Master Adaptive Learners in the planning of learning

Introduction: Due to changing health care system a learner has to re-establish prior knowledge to address current issues. A Master Adaptive Learner (MAL) utilizes a metacognitive approach to enhance the self-regulated learning which leads to an adaptive expertise development.Objective: To explore the strategies used by the Master Adaptive Learners in the planning of learning.Methods: A qualitative phenomenological study was carried out in 2021 May till to November in University College of Medicine and Dentistry. A total of five interviews were conducted, the number was restricted due to data saturation. Purposeful sampling technique was used to select doctors on head of department's recommendations as learners demonstrating exceptional performance during ward rounds and daily duties. Questionnaire was validated and piloted to ensure clarity.Interviews were recorded and transcribed verbatim. Confidentiality and anonymity was ensured.Results: Following themes were developed (1) Gap Identification: (a) Gaps in clinical practice (b) Gaps in teaching (2) Prioritization of Gaps: a) Prioritizing the patient (b) Prioritizing gaps in teaching (3) Identification of Resources. (4) Self-Regulation: (a) Scheduling (b) Self-awareness (5) Motivation: (a) Intrinsic (b) ExtrinsicConclusion: With the aim of providing a good healthcare system, the clinicians need a continuous learning- plan to effectively demonstrate adaptive expertise in routine practices. The current study concludes that the master Adaptive Learners use these five basic strategies that affect their planning and helps design learning opportunities to capitalize on these strategies through their role as coaches in the learning environment.Keywords: Learning, Master Adaptive Learner, Techniques

Surviving uncertainty: the impact of COVID-19 policies on the teaching practicum in Turkey

ABSTRACT The pandemic outbreak has yielded tremendous uncertainty in educational procedures worldwide, with teaching practicum among the most challenged areas. The internal actors in practicum (supervisors, mentor teachers, and pre-service teachers) had to go through an unprecedented process. In this respect, this study aims to scrutinise the experiences of teacher educators and pre-service teachers to unearth the influence of educational policies on COVID-dominated practicum, based on the data from nine universities in seven different regions across Turkey. Data obtained via interviews with teacher educators (9 supervisors and 11 mentors) and qualitative surveys with 35 pre-service teachers were analysed from an exploratory lens. The results indicate that educational policies during the pandemic and lack of a standard policy negatively influenced practicum experience and teacher learning. We suggest that professional flexibility and adaptive expertise are of utmost importance for teacher education, as a discipline both susceptible and responsive to radical changes in society.

Facilitating Adaptive Expertise in Learning Computed Tomography, A Randomized Controlled Trial

Facilitating Adaptive Expertise in Learning Computed Tomography, A Randomized Controlled Trial

Fostering Adaptive Expertise Through Simulation.

Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.

Tutoring during the pandemic: mentoring tutors’ formative experiences using digital and digital multimodal texts

ABSTRACT This survey-design study examined how 228 middle school preservice teachers perceived the implementation of digital and digital multimodal texts during course-required, mentored, tutoring sessions delivered in face-to-face and online settings prior to, during and toward the end of the COVID-19 pandemic. Tutors were able to recognize that texts could be used to elicit affective responses from their students, and had the potential to differentiate their lessons in accordance with learners’ needs, but the technology challenges they faced seemed insurmountable to some. Given their lack of teaching experience, tutors struggled to determine the appropriateness of the resources and they held distinct perceptions of the accomplishments and challenges related to their tutoring sessions. Mentor responsiveness exhibited by honouring tutors’ adaptive expertise can be seen as an important aspect of fostering tutors’ confidence. Focusing on the role of the mentor in preservice teachers’ tutoring field placements is a suggested area for future research.