Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency

Abstract

Background Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. Methods Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. Results We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. Conclusions Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional ‘learner’ identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.

Learning experiences of adaptive experts: a reflexive thematic analysis

“…Previous studies allude to the impact on self as the adaptive expert interacted with the external environment in which one is situated (Regan et al, 2022 ). Similarly, as one participant shared, viewing the patient in a holistic manner beyond the biomedical domain functioned as an anchor of their learning journey: “see(ing) the patient not only from the medical perspective but also the functional and social perspective, and that moulds the entire clinical judgment” (I14).…”

“…It has been suggested that responsibility towards patients drives the learning process and hence sets the foundation for expertise development (Regan et al, 2022 ). The experts shared how values like empathy helped lay the groundwork for person-centric care.…”

“…Of cardinal interest is how adaptive experts developed these traits. A recent study evaluated the impact of the learning environment and its influence on the development of adaptive expertise during residency (Regan et al, 2022 ). The authors examined the contributions of personal, social, organisational and physical/ virtual components and how these supported the environment for an adaptive expert to thrive.…”

Students’ perceptions of and satisfaction with their Orthopaedic posting learning environment using the Healthcare Education Micro- Learning Environment Measure (HEMLEM) questionnaire

“…A constructive, nurturing learning environment is an essential part of learning. Staff behavior and attitude make a student feel comfortable, a place where healthy relationships with peers and teachers ourish (23). Moreover, learning process can be improved by constructing a positive and encouraging atmosphere (24).…”

Developing Master Adaptive Learners: Implementation of a Coaching Program in Graduate Medical Education

“…Although there are no published curricula to develop MAL skills, various approaches have been proposed in the literature. 3 , 5 , 8 , 9 These proposals emphasize the central role of educators in facilitating MAL development and creating a supportive learning environment. Specifically, educators must provide teaching that focuses on metacognition, direct observation with frequent feedback, and support for learning plan development.…”