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BACKGROUND: Health professionals need to be prepared for interdisciplinary research collaborations aimed at the development and implementation of medical technology. Expertise is highly domain-specific, and learned by being immersed in professional practice. Therefore, the approaches and results from one domain are not easily understood by experts from another domain. Interdisciplinary collaboration in medical research faces not only institutional, but also cognitive and epistemological barriers. This is one of the reasons why interdisciplinary and interprofessional research collaborations are so difficult. To explain the cognitive and epistemological barriers, we introduce the concept of disciplinary perspectives. Making explicit the disciplinary perspectives of experts participating in interdisciplinary collaborations helps to clarify the specific approach of each expert, thereby improving mutual understanding. METHOD: We developed a framework for making disciplinary perspectives of experts participating in an interdisciplinary research collaboration explicit. The applicability of the framework has been tested in an interdisciplinary medical research project aimed at the development and implementation of diffusion MRI for the diagnosis of kidney cancer, where the framework was applied to analyse and articulate the disciplinary perspectives of the experts involved. RESULTS: We propose a general framework, in the form of a series of questions, based on new insights from the philosophy of science into the epistemology of interdisciplinary research. We explain these philosophical underpinnings in order to clarify the cognitive and epistemological barriers of interdisciplinary research collaborations. In addition, we present a detailed example of the use of the framework in a concrete interdisciplinary research project aimed at developing a diagnostic technology. This case study demonstrates the applicability of the framework in interdisciplinary research projects. CONCLUSION: Interdisciplinary research collaborations can be facilitated by a better understanding of how an expert's disciplinary perspectives enables and guides their specific approach to a problem. Implicit disciplinary perspectives can and should be made explicit in a systematic manner, for which we propose a framework that can be used by disciplinary experts participating in interdisciplinary research project. Furthermore, we suggest that educators can explore how the framework and philosophical underpinning can be implemented in HPE to support the development of students' interdisciplinary expertise.

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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.

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BACKGROUND: Patients with complex care needs have multiple concurrent conditions (medical, psychiatric, social vulnerability or functional impairment), interfering with achieving desired health outcomes. Their care often requires coordination and integration of services across hospital and community settings. Physicians feel ill-equipped and unsupported to navigate uncertainty and ambiguity caused by multiple problems. A HIV Psychiatry resident elective was designed to support acquisition of integrated competencies to navigate uncertainty and disjointed systems of care - necessary for complex patient care. METHODS: Through qualitative thematic analysis of pre- and post-interviews with 12 participants - residents and clinic staff - from December 2019 to September 2022, we explored experiences of this elective. RESULTS: This educational experience helped trainees expand their understanding of what makes patients complex. Teachers and trainees emphasize the importance of an approach to "not knowing" and utilizing integrative competencies for navigating uncertainty. Through perspective exchange and collaboration, trainees showed evidence of adaptive expertise: the ability to improvise while drawing on past knowledge. CONCLUSIONS: Postgraduate training experiences should be designed to facilitate skills for caring for complex patients. These skills help residents fill in practice gaps, improvise when standardization fails, and develop adaptive expertise. Going forward, findings will be used to inform this ongoing elective.

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Pharmacy educators are grappling with concerns around curriculum overload and core pharmacist competencies in a rapidly changing and increasingly complex healthcare landscape. Adaptive expertise provides a conceptual framework to guide educators as they design instructional activities that can support students on their journey towards becoming pharmacists who can perform procedural tasks efficiently, as well as creatively handle new and difficult-to-anticipate problems that arise regularly in pharmacy practice. This article explores undergraduate pharmacy education through a cognitive psychology lens and foregrounds three instructional design strategies which support the development of adaptive expertise: (1) cognitive integration, (2) productive failure, and (3) inventing with contrasting cases. These three evidence-based strategies cultivate long-term learning and provide a practical mechanism to combat curriculum overload and backwards-facing assessments. Pharmacy education can encourage the development of procedural and conceptual knowledge and position pharmacy students to excel as they move into more complicated and ambiguous roles in our healthcare system.

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Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians.This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework.We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise.Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know.For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.

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Professionals will increasingly be confronted with new insights and changes. This raises questions as to what kind of expertise professionals need, and how development of this expertise can be influenced within the contexts of both education and work. The terms adaptive expertise and adaptive performance are well-known concepts in the domains of education and Human Resource Development respectively. The literature, however, lacks a conceptual overview. Our research seeks to provide an overview on how adaptive expertise and adaptive performance are conceptualized. In addition we looked for what individual, task and organizational characteristics relate to adaptive expertise. We mined information drawn from existing reviews in an overview of reviews. Nine reviews met the inclusion criteria. Adaptive performance is best referred to as the visible expression of an adaptive expert and this is triggered by 'change'. The scope of this 'change' lies somewhere between change that is 'new for the learner' and change that is 'new for everyone in the whole world'. The extent to and way in which a learner or professional is able to deal with this change depends on the maturity of the learner or professional. We found numerous individual, task and environmental characteristics related to adaptive expertise and adaptive performance. The nature and relation of these characteristics, and their specificity in relation to adaptive expertise and adaptive performance are visualized in a figure, but also provide several suggestions for future research.

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Adaptive expertise (AE) and reflective practice (RP), two influential and resonant theories of professional expertise and practice in their own right, may further benefit health professions education if carefully combined. The current societal and systemic context is primed for both AE and RP. Both bodies of work position practitioners as agentive, learning continually and thoughtfully throughout their careers, particularly in order to manage unprecedented situations well. Similar on the surface, the roots and practices of AE and RP diverge at key junctures and we will focus on RP's movement toward critically reflective practice. The roots of AE and RP, and how they relate to or diverge from present-day applications matter because in health professions education, as in all education, paradigmatic mixing should be undertaken purposefully. This paper will explore the need for AE and RP, their shared commitments, distinctive histories, pedagogical possibilities both individually and combined, and next steps for maximizing their potential to positively impact the field. We argue that this exploration is urgently needed because both AE and RP hold much promise for improving health care and yet employing them optimally-whether alone or together-requires understanding and intent. We build an interprofessional education case situated in long-term care, throughout the paper, to demonstrate the potential that AE and RP might offer to health professions education individually and combined. This exploration comes just in time. Within the realities of uncertain practice emphasized by the pandemic, practitioners were also called to act in response to complex and urgent social movements. A combined AE and RP approach, with focus on critically reflective practice in particular, would potentially prepare professionals to respond effectively, compassionately, and equitably to future health and social crises and challenges.

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Navigating difficult conversations is a complex task that requires flexible and adaptive approaches. Residents developing this skill may initially struggle or fail, and require support. However, this experience may prepare residents for future learning which is essential to adaptive expertise. Limited understanding of how residents learn from failure in the workplace restricts the ability to maximize its potential benefits. The purpose of this study was to explore the role failure plays in learning to navigate difficult conversations during workplace learning. A constructivist grounded theory study was conducted using semi-structured interviews of 13 physicians (subspecialty residents and newly graduated physicians) from a Division of Developmental Paediatrics between 2017 and 2018. The authors used constant comparative analysis to identify themes iteratively. Themes were identified both inductively and deductively using the conceptual framework of adaptive expertise. Through independently leading difficult conversations, physicians were able to recognize that the failure that occurred in these encounters, prompted them to generate new knowledge which led to deeper conceptual understanding, thus supporting development of adaptive expertise. However, participants indicated that staff physicians often protect residents from difficult conversations, which limits their opportunity to receive feedback and engage in learning. Residents participate in difficult conversations that challenge them to go beyond their existing knowledge. Providing residents with opportunity to lead difficult conversations with patients and families while being supported by staff supervisors, allows for struggling through learning, which leads to a deeper conceptual understanding and supports development of adaptive expertise.

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The study of adaptive expertise in health professions education has focused almost exclusively on cognitive skills, largely ignoring the processes of adaptation in the performance of precision technical skills. We present a focused review of literature to argue that repetitive practice is much less repetitive than often perceived. Our main thesis is that all skilled movement reflects components of adaptive expertise. Through an overview of perspectives from the field of motor control and learning, we emphasize the interplay between the inherent noisiness of the human motor architecture and the stability of motor skill performances. Ultimately, we challenge the very idea of routine. Our goal is threefold: to reconcile common misconceptions about the rote nature of routine precision skill performance, to offer educators principles to enhance adaptive expertise as an outcome of precision skill training, and to expand the conversation between 'routine' and 'adaptive' forms of expertise in health professions education.

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Residents must develop knowledge, skills, and attitudes to handle a rapidly developing clinical environment. To address this need, adaptive expertise has been suggested as an important framework for health professions education. However, research has yet to explore the relationship between workplace learning and adaptive expertise. This study sought to investigate how clinical supervision might support the development of adaptive expertise. The present study used a focused ethnography in two emergency departments. We observed 75 supervising situations with the 27 residents resulting in 116 pages of field notes. The majority of supervision was provided by senior physicians, but also included other healthcare professionals. We found that supervision could serve two purposes: closure and discovery. Supervision aimed at discovery included practices that reflected instructional approaches said to promote adaptive expertise, such as productive struggle. Supervision aimed at closure-included practices with instructional approaches deemed important for efficient and safe patient care, such as verifying information. Our results suggest that supervision is a shared practice and responsibility. We argue that setting and aligning expectations before engaging in supervision is important. Furthermore, results demonstrated that supervision was a dynamic process, shifting between both orientations, and that supervision aimed at discovery could be an an appropriate mode of supervision, even in the most demanding clinical situations.

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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.

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Ensuring trainees develop the flexibility with their knowledge to address novel problems, and to efficiently build upon prior knowledge to learn new knowledge is a common goal in health profession education. How trainees come to develop this capacity to transfer and transform knowledge across contexts can be described by adaptive expertise, which focuses on the ability of some experts to innovate upon their existing knowledge to develop novel solutions to novel problems. While adaptive expertise is often presented as an alternative framework to more traditional cognitivist and constructivist expertise models, it is unclear whether the non-routine and routine forms of transfer it describes are distinct from those described by other accounts of transfer. Furthermore, whether what (e.g., knowledge) is transferred and how (e.g., cognitive processes) differs between these views is still debated. In this review, we describe various theories of transfer and present a synthesis clarifying the relationship between transfer and adaptive expertise. Informed by our analysis, we argue that the mechanisms of transfer in adaptive expertise share important commonalities with traditional accounts of transfer, which when understood, can complement efforts by educators and researchers to foster and study adaptive expertise. We present three instructional principles that may better support transfer and adaptive expertise in trainees: i) identifying and incorporating meaningful variability in practice, ii) integrating conceptual knowledge during practice iii) using assessments of trainees' transfer. Taken together, we offer an integrative perspective to how educational systems and experiences can be designed to develop and encourage adaptive expertise and transfer.

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Adaptive expertise has been promoted as an emerging model of expertise in health professions education in response to the inherent complexities of patient care; however, as the concept increasingly influences the structure of professional training and practice, it creates the potential for misunderstandings of the definition and implications of adaptive expertise. To foster a common understanding of the concept, we conducted a scoping review to explore how adaptive expertise has been discussed within health professions education literature. Five databases-MedLine, PubMed, ERIC, CINAHL, and PsycINFO-were searched using the exact term "adaptive expertise", producing 212 unique articles. Fifty-eight articles met inclusion criteria. In the included articles, authors discussed the conceptual implications of adaptive expertise for health professions education, strategies for training for adaptive expertise, and research findings aimed at supporting the development of adaptive expertise or utilizing adaptive expertise as a theoretical framework. The goal of this scoping review is to establish a resource for frontline educators tasked with fostering the development of adaptive expertise in learners through education initiatives. A common understanding of adaptive expertise is essential to ensuring effective implementation in training programs.

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Teachers' adaptive expertise (TAE) has received increasing attention in the current English as foreign language (EFL) teaching field, however, it has seldom been examined with adaptive practices by teachers in on-going classes among existing literature. Adopting a mixed-method design with data triangulation, this study was conducted to explore the complexity of teachers' adaptive expertise (TAE) and adaptive teaching practices that an EAP writing teacher demonstrated in academic writing courses, from a Complex Dynamic Systems Theory (CDST) perspective. Semi-structured interviews, classroom observations, and questionnaires were arranged to collect qualitative and quantitative data from an EAP writing teacher and 43 EFL learners in a Chinese university. Thematic analysis and SPSS were mainly used in the current work for data analysis. Our findings confirmed (1) the complexity of TAE and ATP with specific features of non-linearity, interconnectedness, and self-organization, which are classic CDST characteristics; (2) the TAE evolved with meta-cognitive, cognitive, affective and social components that are intertwined and contributed to the teacher's adaptive teaching practices (ATP) in her academic writing course; (3) being facilitated by TAE, the teacher's adaptive teaching practices significantly enhanced EFL learners, learning motivation of academic writing and their learning efficiency. Findings of the current work pave the way for future studies in researching TAE and ATP with a thorough consideration of language teachers, students and contexts from the CDST perspective. Moreover, pedagogical contributions are highlighted through the detailed examinations of the EAP writing teacher's ATP, including the class design, teaching plans, and methods, which would be fruitful for the development of tertiary EAP writing research.

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Nursing professionals are constantly required to adapt to technological changes, and especially so in the wake of COVID-19, which has prompted the development of new digital tools. A new and specific form of job crafting in relation to new technology has recently emerged in the literature; that is, adoption job crafting. However, little is known about this specific form of job crafting, especially within the pandemic context. We aim, in this study, to explore the advantages of and barriers to adoption job crafting. We used NVivo software to analyze 42 semi-structured interviews conducted during COVID-19. Our findings revealed that nurses had proactive and positive attitudes toward new technology (adoption job crafting) to enhance efficiency, sustainability, well-being, virtual teamwork, communication, and knowledge sharing. We also identified many barriers to adoption job crafting due to several organizational obstacles, such as the lack of human resource management practices, especially training, and the characteristics of the technology used. We contribute to the literature by documenting innovative cases of and barriers to adoption job crafting, which have not been explored before. These findings stress the necessity to adopt human resources practices, especially training, to foster positive job crafting among nurses and safeguard their adaptive expertise.

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OBJECTIVES: To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise. METHODS: Residents (n = 77) completed a 4 h RCC training and shared resultant RCC goals with Coaches (n = 15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise. RESULTS: Pediatric residents reported significant increases (p < 0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts. CONCLUSION: Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise. PRACTICE IMPLICATIONS: Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.

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Whilst adaptive experts have well-researched beliefs and attitudes towards learning, what is unclear are the interactions that occur within the learning environment that constitute their learning experiences. The practice of geriatric medicine emphasises the interdisciplinary care of complex frail older adults. Our study sets out to understand the learning experiences of adaptive experts in geriatric medicine by examining how interactions at the intra-personal, inter-personal and organisational levels contributed to the development of adaptive expertise. We conducted an exploratory qualitative study through semi-structured interviews of 16 geriatricians experts from a tertiary hospital in Singapore. Data were analyzed via reflexive thematic analysis. The core essence of the learning experiences was described as a journey of 'knowing when we do not know', which was characterised by three themes: (i) Anchoring ethos of person-centric care where the experts drew upon their values to develop a holistic view of the patient beyond the medical domain, (ii) Enabling stance of being curious where their curiosity and openness to learning was nurtured through the practice of reflection, and with the benefit of time as a commodity and for development of expertise, and (iii) Scaffolding organisational culture of inquiry where an environment that is supportive of learning is built on the culture of psychological safety and the culture of mentoring. Taken together, our study highlighted the importance of interactions at the intra-personal, inter-personal and organisational levels in the learning experiences of adaptive experts.

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BACKGROUND: Adaptive expertise is a highly valued outcome of mathematics curricula. One aspect of adaptive expertise with rational numbers is adaptive rational number knowledge, which refers to the ability to integrate knowledge of numerical characteristics and relations in solving novel tasks. Even among students with strong conceptual and procedural knowledge of rational numbers, there are substantial individual differences in adaptive rational number knowledge. AIMS: We aimed to examine how a wide range of domain-general and mathematically specific skills and knowledge predicted different aspects of rational number knowledge, including procedural, conceptual, and adaptive rational number knowledge. SAMPLE: 173 6th and 7th grade students from a school in the southeastern US (51% female) participated in the study. METHODS: At three time points across 1.5 years, we measured students' domain-general and domain-specific skills and knowledge. We used multiple hierarchal regression analysis to examine how these predictors related to rational number knowledge at the third time point. RESULT: Prior knowledge of rational numbers, general mathematical calculation knowledge, and spontaneous focusing on multiplicative relations (SFOR) tendency uniquely predicted adaptive rational number knowledge, after taking into account domain-general and mathematically specific skills and knowledge. Although conceptual knowledge of rational numbers and general mathematical achievement also predicted later conceptual and procedural knowledge of rational numbers, SFOR tendency did not. CONCLUSION: Results suggest expanding investigations of mathematical development to also explore different features of adaptive expertise as well as spontaneous mathematical focusing tendencies.

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Adaptive expertise encompasses efficiency and innovation; however little is known about the state of research of adaptive expertise in medical education. Our scoping review summarizes existing evidence in the conceptual frameworks, development, and measurement for adaptive expertise. We searched Pubmed, MEDLINE, ERIC, CINAHL and PsycINFO for original research articles published from 1986 onwards in English. Given the heterogeneity of the studies, no quantitative syntheses were conducted and the articles were summarized qualitatively. Of the 48 articles that met inclusion criteria, 19 examined conceptual frameworks, 24 explored interventions supporting development and 5 examined measurement. Conceptual frameworks are consistent within and beyond health professions education. Factors influencing development include: predisposing factors such as knowledge (ability to integrate knowledge and innovate), beliefs and attitudes (high motivation and humility), enabling factors such as skills (people skills, implementing reflection and scholarly activities), resources such as curricular enablers (providing variability of cases, allowing flexibility to generate solutions, critical appraisal of textbooks) and reinforcing factors such as mentor-guided feedback and constant curricular review. Two validated measurement tools exist for adaptive expertise. Substantial research opportunities exist in studying interventions involving the development of adaptive expertise. Notable gaps exist in the development and validation of measurement tools.

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