Cultivating Adaptive Expertise, Fostering Flexibility, and Finding Innovative Solutions
Three evidence-based strategies can be used to help students develop adaptive expertise
by Lauren Wilkinson, PharmD, PGY-1 Pharmacy Practice Resident, Magnolia Regional Health Center
Healthcare professionals are facing rapid change and increasing complexity in the workplace. Healthcare continues to evolve, and this evolution has been driven by advancements in technology, medical research, social shifts, and many more. Not to mention a historical global pandemic (aka COVID-19). Looking forward, the future promises even more revolutionary changes that may make well-established, routine practices insufficient to meet these challenges. During my first few months as a PGY-1 pharmacy resident, I sensed the evolving needs of healthcare. A medical resident asked me a question about new data on a medication that was recently published. Data I had not learned in school and called into question my previous understanding. However, we must be able to adapt, addressing situations involving novelty and ambiguity. So, how do we prepare our students to face the unknown and provide workable solutions? There has been an emerging model that addresses the challenge of preparing learners for the unknown. This model is called adaptive expertise.
Adaptive expertise refers to the ability to use deep knowledge to think flexibly, adapt to varied contexts, and gain new understandings. Adaptive expertise focuses on innovation and creativity to address unforeseen circumstances. Some authors have used an analogy to describe adaptive experts. They are like a spider weaving a web.2 Like a spider, adaptive experts build from within, casting out to make new connections, navigate, and explore. This model of expertise is particularly important for educators training health professional students who will face complexity and novelty during their careers.
Developing adaptive expertise will help students apply their knowledge flexibly and creatively. From the educator’s perspective, it is important to understand that fostering adaptive expertise does not require new tools or approaches. There are three evidence-based instructional design strategies educators can use that support the development of adaptive expertise.5
Cognitive Integration
Cognitive integration is most beneficial when the connections between clinical and basic sciences occur during a teaching session. It requires learning experiences to explicitly link the “what” with the “why.” The integration link between clinical signs and symptoms to basic science mechanisms can be made with a variety of instructional materials and learning experiences. Cognitive integration promotes retention, accurate problem identification, and the ability to solve complex cases. The goal is to be able to translate knowledge to unanticipated patient cases, recalling and applying previous knowledge in new ways.5
Productive Failure
Productive failure is a more recent instructional strategy. Manu Kapur developed this strategy in order to achieve desirable difficulty. In his TED talk, Kapur explains that failure can be a great teacher. He proceeds to ask, “If failure is such a good teacher, then why do we wait for it to happen? Why don’t we intentionally design for it?”7 Through failure, mental strength is enhanced, leading to growth and improved performance. Productive failure involves problem-solving followed by instruction rather than instruction being followed by problem-solving. Similarly, from my perspective as a pharmacy resident, productive failure is congruent with being unable to answer a question. It leaves a sour taste in your mouth. However, once you look up the answer to that question or talk through it with your preceptor, you’ll never forget it.
Two studies comparing productive failure to direct instruction among students studying mathematics aimed to measure learning effectiveness. In both studies, the productive failure and direct instruction conditions were the same. The studies used participants from the same school but from a different cohort. The students took a pretest one week before the study to measure prior knowledge. On the day of the study, students in both groups underwent two phases. There was a problem-solving phase and an instruction phase. The order of the phases depended on which group the students were randomly assigned. Immediately after the second phase, the students took a post-test, which measured procedural knowledge, conceptual understanding, and transfer. The findings suggest both methods produced high levels of procedural knowledge with no statistical difference in the two methods. However, in both studies, students who engaged in problem-solving before instruction demonstrated significantly greater conceptual understanding and the ability to transfer novel problems (p < 0.001).6
Inventing with Contrasting Cases
This approach introduces students to new concepts using contrasting cases and asks them to explore. The hope is that students will naturally use the cases to aid their learning and develop an underlying structure within the variability. A study in 2011 comparing tell-and-practice to invent-with-contrasting-cases examined eighth-grade students’ spontaneous transfer from lessons to problems. It was hypothesized that instruction before problem-solving may undermine learning. The tell-and-practice students were told the concepts and then practiced the cases. Whereas, the invent-with-contrasting-cases students had to invent their own solutions for the same cases without being taught the concepts until a debriefing occurred later. Twenty-four hours after completing these assignments, students were asked to reconstruct the worksheet. This memory test served as a measure of what students learned from the previous day. The investigators found that the invent-with-contrasting-cases students performed significantly better than the tell-and-practice students on the delayed transfer test (p < 0.001).9
In addition to the three evidence-based instructional strategies, here are twelve tips that educators can use to support the development of adaptive expertise.4
Understand that you are not producing experts but rather preparing future experts
Avoid cycles of instruction and assessment that reward only short-term performance
Cultivate long-term learning
Design instruction in the classroom to support cognitive integration
Understand that any form of mechanistic knowledge can be integrated
Ask “why” questions to reinforce cognitive integration and support conceptual knowledge development
Allow students to struggle and sometimes fail
Give immediate direct instruction or feedback to ensure struggle is productive
Expose students to meaningful variation
Ask “what if” questions to make variation meaningful
Assess frequently and formatively to gauge student understanding and provide feedback
Align instruction and assessment
Research supports the importance of adaptive expertise, and we should be cultivating it among health professional students to meet the challenges of an ever-changing healthcare landscape. Not only will these strategies and tips improve students’ long-term retention, but also supply them with the necessary mental tools for problem-solving and enhanced decision-making in situations that are novel and ambiguous.
References:
1. Mylopoulos M. Preparing Future Adaptive Experts: Why It Matters and How It Can Be Done. Med Sci Educ. 2020;30(Suppl 1):11-12.
2. Grotzer, TA, Forshaw T, & Gonzalez E. Developing Adaptive Expertise for Navigating New Terrain: An Essential Element of Success in Learning and the Workplace. The Next Level Lab at the Havard Graduate School of Education. President and Fellows of Harvard College: Cambridge, MA, 2021. Available at: https://projects.iq.harvard.edu/files/nextlevellab/files/nll_brief_3._adaptive_expertise._july_2021.pdfAccessed: February 10, 2025.
3. Branzetti J, Hopson LR, Gisondi MA, Regan L. Training for Adaptive Expertise: Why, What, and How. Acad Med. 2024;99(1):121.
4. Mylopoulos M, Steenhof N, Kaushal A, Woods NN. Twelve tips for designing curricula that support the development of adaptive expertise. Med Teach 2018;40(8):850-854.
5. Steenhof N. Adaptive Expertise in Undergraduate Pharmacy Education. Pharmacy (Basel). 2023;11(1):32.
6. Kapur M. Productive failure in learning math. Cogn Sci. 2014;38(5):1008-22.
7. Kapur, M. Productive Failure [Video]. TED: TED conferences’ 2019. Available at: https://www.ted.com/talks/manu_kapur_productive_failure Accessed: February 10, 2025.
8. Chin DB, Chi M, Schwartz DL. A comparison of two methods of active learning in physics: Inventing a general solution versus compare and contrast. Instructional Science. 2016;44(2):177–95.
9. Schwartz DL, Chase CC, Oppezzo MA, Chin DB. (2011). Practicing versus inventing with contrasting cases: The effects of telling first on learning and transfer. Journal of educational psychology 2011; 103(4): 759-775.