J. Branzetti is residency director, Emergency Medicine Residency, and assistant professor, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-2397-0566 .
C. Commissaris is emergency medicine residency assistant program director and clinical instructor, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-7099-4851 .
Acad Med. 2022 Nov 1;97(11):1691-1698. doi: 10.1097/ACM.0000000000004751. Epub 2022 May 24.
Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning.
Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory.
Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills.
Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.
适应性专长（AE）已被确定为未来医生需要培养的关键特质。四阶段主适应学习者（MAL）概念模型描述了发展 AE 所需的学习技能和行为。尽管先前的工作已经阐明了 MAL 在学习初始规划阶段使用的技能和行为，但大多数住院医师并不被认为是 MAL。在这项研究中，作者通过探索他们在学习规划阶段使用的策略，研究了这些大多数“典型”学习者如何发展 AE。
参与者是位于美国 4 所学术医疗中心的研究生医学教育（GME）培训计划中的住院医师。参与者于 2021 年参加了半结构化的个人访谈，访谈记录采用扎根理论的恒定性比较分析进行分析。
共采访了 14 名代表 8 个专业的受试者，生成了 152 页的分析转录本。确定了三个主题：“典型”学习者在从结构化本科医学教育学习过渡到较少结构化的 GME 学习时面临挑战，缺乏轻松驾驭这一过渡所需的技能，并且依赖试错来发展他们的学习技能。
参与者通过试错找到了学习策略，帮助他们应对从医学院过渡到住院医师时遇到的系统性挑战。这些努力的成功（或失败）与学习者在自我调节学习概念的能动性、元认知目标设定和动机方面的效能有关。提供了一个概念模型来描述这些因素对住院医师成为适应性学习者的能力的影响，并提供了可操作的建议，以帮助教育者培养适应性学习技能和行为。这些发现还为迄今为止一直缺乏的 MAL 模型提供了有价值的有效性证据。
