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2 Prototypical Learning Curve. In Learning Curve Theory, a sigmoid-shaped relationship exists between the amount of effort expended in learning and the resulting improvement in performance. Initial learning is slow and laborious. The second phase is a near-exponential increase associated with learning the easier part of the material. An inflection point signals a slowing rate of learning as it becomes more difficult (the law of diminishing returns). Finally learning enters an asymptotic phase up to a system-specific maximum. (Adapted from Pusic MV et al. Learning curves in health professions education. Acad Med. 2015;90(8): 1034-1042.)
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In this final chapter, we zoom out to take a higher perspective on master adaptive learning (MAL). This has two purposes. First, in this book we have presented a great deal of detailed evidence so as to illuminate and justify the MAL approach to both learning to be a clinician and to learning as a clinician. We propose this chapter as a resting pla...
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To enhance diverse students’ learning experiences, tertiary educational institutions are increasingly adopting adaptive technologies. Although there are views that adaptive learning platforms contribute to learning within higher education, efficacy research of such systems yields mixed results. This is an indication that more could be studied conce...
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... broader organization of people and resources around them [47]. The adjustment phase especially applies to learning by practicing clinicians, who can change the clinical microsystem around them and, by extension, influence the larger organization. ...
... In the Adjustment Phase of Master Adaptive Learning, the individual's relationship to larger learning trends is explicitly considered, to the benefit of both the individual and the organization. Taken with permission from [47] ...
All of us possess mental models for how to learn; however, these models are usually implicit and not adequate for managing the exponential increase in content load and critical thinking necessary for modern healthcare practice. Ideally, we explicitly monitor our own learning, engaging in metacognition and adapting our learning approaches in a variety of contexts. Here the authors present the Master Adaptive Learner (MAL) framework, which offers a comprehensive, integrated evidence-informed model for learning in medicine. The authors contend that this framework can both inform remediation and form the basis of teaching and learning in the health professions more generally.KeywordsMaster Adaptive LearnerLearning curveExpertise developmentAdaptive expertiseMindsetSelf-regulationMetacognitionLearning environmentResilienceProductive failure
... Helping learners reconceptualize to an adaptive expertise framing requires educators who have this shared language, an express goal of the more general Master Adaptive Learner framework. MAL is a knowledge translation device that brings together foundational education science theories -centered around adaptive expertise -in an accessible format that can inform both curriculum development and coaching processes (Lomis et al., 2021a;Pusic et al., 2019b). In this regard, the Mayo Clinic CPD example is informative for its institution-wide embrace of the MAL framework as a basis for emphasizing learning adaptive expertise at the organizational level. ...
Adaptive expertise represents the combination of both efficient problem-solving for clinical encounters with known solutions, as well as the ability to learn and innovate when faced with a novel challenge. Fostering adaptive expertise requires careful approaches to instructional design to emphasize deeper, more effortful learning. These teaching strategies are time-intensive, effortful, and challenging to implement in health professions education curricula. The authors are educators whose missions encompass the medical education continuum, from undergraduate through to organizational learning. Each has grappled with how to promote adaptive expertise development in their context. They describe themes drawn from educational experiences at these various learner levels to illustrate strategies that may be used to cultivate adaptive expertise.
At Vanderbilt University School of Medicine, a restructuring of the medical school curriculum provided multiple opportunities to use specific curricular strategies to foster adaptive expertise development. The advantage for students in terms of future learning had to be rationalized against assessments that are more short-term in nature. In a consortium of emergency medicine residency programs, a diversity of instructional approaches was deployed to foster adaptive expertise within complex clinical learning environments. Here the value of adaptive expertise approaches must be balanced with the efficiency imperative in clinical care. At Mayo Clinic, an existing continuous professional development program was used to orient the entire organization towards an adaptive expertise mindset, with each individual making a contribution to the shift.
The different contexts illustrate both the flexibility of the adaptive expertise conceptualization and the need to customize the educational approach to the developmental stage of the learner. In particular, an important benefit of teaching to adaptive expertise is the opportunity to influence individual professional identity formation to ensure that clinicians of the future value deeper, more effortful learning strategies throughout their careers.
... The context could vary from the clinician's immediate microsystem (eg, a clinical practice group), to larger scales such as institutional, regional, or national health care organizations. 49 The key is that the individual clinician is involved in a learning dialogue with the larger organization that results in effective change in both. 50 The individual also has an important role to play in negotiating what data analysis and interpretation is carried out by the information system and which remains the responsibility of the clinician. ...
The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.
Learning curves can be used to design, implement, and evaluate educational interventions. Attention to key aspects of the method can improve the fidelity of this representation of learning as well as its suitability for education and research purposes. This paper addresses when to use a learning curve, which graphical properties to consider, how to use learning curves quantitatively, and how to use observed thresholds to communicate meaning. We also address the associated ethics and policy considerations. We conclude with a best practices checklist for both educators and researchers seeking to use learning curves in their work.
This chapter describes a structured, evidence-based approach to professionalism remediation in four phases: ‘Identify and Evaluate’, ‘Explore and understand’, ‘Remediate’, and ‘Gather evidence for dismissal’. Illustrative cases provide guidelines for the frontline teachers who conduct essential tasks in the first two phases, such as explicitly and implicitly setting professionalism standards, identifying trainees’ lapses in professionalism, clarifying possible causes, intervening, and assessing professionalism. Trainees who move to the ‘Remediate’ phase engage with specialized professionalism remediation coaches. For those few trainees who do not demonstrate reflectiveness and improvement despite remediation attempts, we discuss formal procedures focused on gathering evidence for dismissal.KeywordsHealth professions educationProfessionalismRemediationLearningTraining supportUnprofessional behavior
The COVID-19 pandemic has resulted in a massive adaptation in health professions education, with a shift from in-person learning activities to a sudden heavy reliance on internet-mediated education. Some health professions schools will have already had considerable educational technology and cultural infrastructure in place, making such a shift more of a different emphasis in provision. For others, this shift will have been a considerable dislocation for both educators and learners in the provision of education.
To aid educators make this shift effectively, this 12 Tips article presents a compendium of key principles and practical recommendations that apply to the modalities that make up online learning. The emphasis is on design features that can be rapidly implemented and optimised for the current pandemic. Where applicable, we have pointed out how these short-term shifts can also be beneficial for the long-term integration of educational technology into the organisations' infrastructure.
The need for adaptability on the part of educators and learners is an important over-arching theme. By demonstrating these core values of the health professions school in a time of crisis, the manner in which the shift to online learning is carried out sends its own important message to novice health professionals who are in the process of developing their professional identities as learners and as clinicians.
