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The Master Adaptive Learner (MAL) concept in American medical education refers to a framework designed to prepare U.S. medical students, residents, and medical practitioners to continually adapt and respond to the rapidly evolving landscape of medical knowledge and practice.[1] This metacognitive approach to learning or “learning to learn”[2] is based on self-regulation that fosters the development and use of adaptive expertise in practice.[3] This concept emphasizes the importance of lifelong learning, self-regulation, and adaptability, enabling health professionals to provide high-quality care in an ever-changing environment.[3]

The MAL concept aligns with competency-based medical education,[4][5] which is becoming more common and focuses on defining specific competencies or skills required for effective practice, assessing learners based on these competencies, and allowing progression based on demonstrated proficiency rather than time-based criteria.[6][7][8] MAL also aligns to the newer concept of precision education which is being proposed as a model for lifelong learning for medical students, residents, fellows, and physicians. Precision education is an educational approach that tailors learning experiences and interventions based on individual student needs, strengths, and learning styles.[9] Precision education utilizes data-driven insights and personalized strategies to optimize educational outcomes, fostering greater student engagement, understanding, and achievement.[10]

History[edit]

The MAL framework was first outlined in the scientific literature in 2017.[3] The concept emerged from the recognition that medical knowledge is expanding at an unprecedented rate.[3] Traditional frameworks for medical education, which often focus on the acquisition of static knowledge, are insufficient to prepare health professionals for the dynamic nature of medical practice.[3] The MAL framework aims to cultivate skills that help learners not only acquire new knowledge but also adapt and apply this knowledge effectively in diverse and unpredictable clinical settings.[3]

Core principles[edit]

The Master Adaptive Learner framework is built on four key principles:

1. Self-regulated learning[11]

Self-regulated learning involves the ability to set goals, monitor progress, and adjust learning strategies as needed.[12] This includes self-assessment, reflection, and the ability to seek feedback.[12] The MAL framework encourages learners to take an active role in their education, fostering independence and self-efficacy.[13]

2. Adaptive expertise[3][14]

Adaptive expertise is the ability to apply knowledge and skills flexibly and innovatively in different situations.[15][16] Unlike routine experts, who rely on well-practiced routines,[17][18] adaptive experts can think critically and creatively, making them more effective in novel or complex scenarios.[19]

3. Lifelong learning

Lifelong learning is the continuous pursuit of knowledge and skills throughout a professional's career. The MAL framework promotes a culture of ongoing education and professional development, recognizing that medical knowledge and best practices are constantly evolving.[20]

4. Reflection and Feedback[21]

Reflection and feedback are crucial components of the MAL framework.[3] Reflective practice involves regularly analyzing one's own experiences and performance to identify strengths and areas for improvement.[22] Constructive feedback from peers, mentors, and patients helps learners refine their skills and knowledge.[23]

Implementation in Medical Education[edit]

Implementing the MAL framework in medical education requires a multifaceted approach.

Curriculum design[edit]

Medical curricula should incorporate opportunities for self-directed learning, critical thinking, and problem-solving.[24] This includes case-based learning, simulations, and other active learning strategies that encourage students to apply knowledge in practical settings.[25]

Assessment methods[edit]

Assessments should evaluate not only factual knowledge but also the ability to apply knowledge adaptively.[13] This may involve formative assessments, reflective exercises, and performance-based evaluations that provide meaningful feedback and guide further learning.[13][26]

Faculty development[edit]

Faculty members play a crucial role in fostering the skills associated with the MAL framework.[27] Training programs for educators should focus on mentoring, providing effective feedback, and creating an environment that supports adaptive learning.[28]

Learning environment[edit]

Creating a supportive learning environment is essential.[28] This includes access to resources, opportunities for collaboration, and a culture that values continuous improvement and innovation.[28]

Coaching[edit]

Coaching is frequently a part of medical school curricula that incorporates the MAL framework.[26] This coaching helps learners take appropriate action in response to feedback and assessment.[26][29]

Informatics[edit]

A learning environment focused on the MAL framework requires a robust informatics infrastructure to identify learning needs[30] and assist in guiding learners on individualized paths.[8]

Benefits[edit]

Limited evidence indicates that the MAL framework can reduce burnout and increase resiliency, although the mechanism of this is unclear.[31]

Challenges[edit]

While the MAL framework holds promise, its implementation faces challenges. Implementing the MAL framework is resource intensive, requires a cultural shift, and new assessment methods.[1]

Implementation into physical therapy education[edit]

The MAL framework is increasingly spreading from medical schools to physical therapy education.[32] The MAL framework has been proposed as a strategy to address the physical therapy needs of those with COVID-19 as well as address systemic racism and other injustices.[33]

Future directions[edit]

The Master Adaptive Learner concept represents a paradigm shift in medical education, focusing on developing health care professionals who are equipped to navigate and excel in an ever-changing medical landscape.[1] By fostering self-regulation, adaptive expertise, and lifelong learning, the MAL framework aims to enhance the quality of health care and ensure that practitioners remain competent and innovative throughout their careers.[1] It will most likely have a significant role as medical education increasingly incorporates competency-based medical education and precision education modalities.

References[edit]

  1. ^ a b c d Cutrer W, Vanderbilt University, Pusic M, Harvard Medical School, Gruppen L, University of Michigan Medical School, Hammoud MM, University of Michigan Medical School, Santen SA, University of Cincinnati College of Medicine (2020). The Master Adaptive Learner. Philadelphia: Elsevier. ISBN 9780323711111.
  2. ^ Regan, Linda; Hopson, Laura R.; Gisondi, Michael A.; Branzetti, Jeremy (November 2019). "Learning to learn: A qualitative study to uncover strategies used by Master Adaptive Learners in the planning of learning". Medical Teacher. 41 (11): 1252–1262. doi:10.1080/0142159X.2019.1630729. ISSN 1466-187X. PMID 31287741.
  3. ^ a b c d e f g h Cutrer, William B.; Miller, Bonnie; Pusic, Martin V.; Mejicano, George; Mangrulkar, Rajesh S.; Gruppen, Larry D.; Hawkins, Richard E.; Skochelak, Susan E.; Moore, Donald E. (January 2017). "Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education". Academic Medicine: Journal of the Association of American Medical Colleges. 92 (1): 70–75. doi:10.1097/ACM.0000000000001323. ISSN 1938-808X. PMID 27532867.
  4. ^ Holmboe, Eric S.; Sherbino, Jonathan; Long, Donlin M.; Swing, Susan R.; Frank, Jason R.; for the International CBME Collaborators (August 2010). "The role of assessment in competency-based medical education". Medical Teacher. 32 (8): 676–682. doi:10.3109/0142159X.2010.500704. ISSN 0142-159X. PMID 20662580. {{cite journal}}: |last6= has generic name (help)
  5. ^ Van Melle, Elaine; Frank, Jason R.; Holmboe, Eric S.; Dagnone, Damon; Stockley, Denise; Sherbino, Jonathan (July 2019). "A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs". Academic Medicine. 94 (7): 1002–1009. doi:10.1097/ACM.0000000000002743. ISSN 1040-2446. PMID 30973365.
  6. ^ Ross, Shelley; Hauer, Karen E.; van Melle, Elaine (2018-04-12). "Outcomes are what matter: Competency-based medical education gets us to our goal". MedEdPublish. 7: 85. doi:10.15694/mep.2018.0000085.1. ISSN 2312-7996. PMC 10711948. PMID 38089223.
  7. ^ Hall, Andrew K.; Schumacher, Daniel J.; Thoma, Brent; Caretta-Weyer, Holly; Kinnear, Benjamin; Gruppen, Larry; Cooke, Lara J.; Frank, Jason R.; Van Melle, Elaine; on behalf of the ICBME Collaborators (2021-07-03). "Outcomes of competency-based medical education: A taxonomy for shared language". Medical Teacher. 43 (7): 788–793. doi:10.1080/0142159X.2021.1925643. ISSN 0142-159X. PMID 34038673. {{cite journal}}: |last10= has generic name (help)
  8. ^ a b Lomis, Kimberly D.; Mejicano, George C.; Caverzagie, Kelly J.; Monrad, Seetha U.; Pusic, Martin; Hauer, Karen E. (2021-04-08). "The critical role of infrastructure and organizational culture in implementing competency-based education and individualized pathways in undergraduate medical education". Medical Teacher. 43 (sup2): S7–S16. doi:10.1080/0142159X.2021.1924364. ISSN 0142-159X. PMID 34291715.
  9. ^ Triola, Marc M.; Burk-Rafel, Jesse (July 2023). "Precision Medical Education". Academic Medicine. 98 (7): 775–781. doi:10.1097/ACM.0000000000005227. ISSN 1040-2446. PMID 37027222.
  10. ^ Desai, Sanjay V.; Burk-Rafel, Jesse; Lomis, Kimberly D.; Caverzagie, Kelly; Richardson, Judee; O’Brien, Celia Laird; Andrews, John; Heckman, Kevin; Henderson, David; Prober, Charles G.; Pugh, Carla M.; Stern, Scott D.; Triola, Marc M.; Santen, Sally A. (April 2024). "Precision Education: The Future of Lifelong Learning in Medicine". Academic Medicine. 99 (4S): S14–S20. doi:10.1097/ACM.0000000000005601 (inactive 2024-07-03). ISSN 1040-2446. PMID 38277444.{{cite journal}}: CS1 maint: DOI inactive as of July 2024 (link)
  11. ^ White, Casey B; Gruppen, Larry D; Fantone, Joseph C (2013-10-22), Swanwick, Tim (ed.), "Self-regulated learning in medical education", Understanding Medical Education (1 ed.), Wiley, pp. 201–211, doi:10.1002/9781118472361.ch15, ISBN 978-1-118-47240-8, retrieved 2024-07-03
  12. ^ a b Zimmerman, Barry J. (2015-01-01), "Self-Regulated Learning: Theories, Measures, and Outcomes", in Wright, James D. (ed.), International Encyclopedia of the Social & Behavioral Sciences (Second Edition), Oxford: Elsevier, pp. 541–546, ISBN 978-0-08-097087-5, retrieved 2024-07-03
  13. ^ a b c Stringer, J. K.; Gruppen, Larry D.; Ryan, Michael S.; Ginzburg, Samara B.; Cutrer, William B.; Wolff, Margaret; Santen, Sally A. (2022-01-04). "Measuring the Master Adaptive Learner: Development and Internal Structure Validity Evidence for a New Instrument". Medical Science Educator. 32 (1): 183–193. doi:10.1007/s40670-021-01491-9. ISSN 2156-8650. PMC 8726526. PMID 35003878.
  14. ^ Bohle Carbonell, Katerina; Stalmeijer, Renée E.; Könings, Karen D.; Segers, Mien; van Merriënboer, Jeroen J.G. (June 2014). "How experts deal with novel situations: A review of adaptive expertise". Educational Research Review. 12: 14–29. doi:10.1016/j.edurev.2014.03.001. ISSN 1747-938X.
  15. ^ Cupido, Nathan; Fowler, Nancy; Sonnenberg, Lyn K; Karwowska, Anna; Richardson, Denyse; Snell, Linda; Thoma, Brent; Mylopoulos, Maria (2023-03-21). "Adaptive Expertise in CanMEDS 2025". Canadian Medical Education Journal. 14 (1): 18–21. doi:10.36834/cmej.75445. ISSN 1923-1202. PMC 10042796. PMID 36998497.
  16. ^ Kua, Joanne; Lim, Wee-Shiong; Teo, Winnie; Edwards, Roger A. (2021-03-04). "A scoping review of adaptive expertise in education". Medical Teacher. 43 (3): 347–355. doi:10.1080/0142159X.2020.1851020. ISSN 0142-159X. PMID 33251895.
  17. ^ Steenhof, Naomi (2020-02-18). "Adaptive Expertise in Continuing Pharmacy Professional Development". Pharmacy: Journal of Pharmacy Education and Practice. 8 (1): 21. doi:10.3390/pharmacy8010021. ISSN 2226-4787. PMC 7151660. PMID 32085631.
  18. ^ Mylopoulos, Maria; Kulasegaram, Kulamakan; Woods, Nicole N. (June 2018). "Developing the experts we need: Fostering adaptive expertise through education". Journal of Evaluation in Clinical Practice. 24 (3): 674–677. doi:10.1111/jep.12905. ISSN 1356-1294. PMID 29516651.
  19. ^ Ng, Stella L; Forsey, Jacquelin; Boyd, Victoria A; Friesen, Farah; Langlois, Sylvia; Ladonna, Kori; Mylopoulos, Maria; Steenhof, Naomi (2022). "Combining adaptive expertise and (critically) reflective practice to support the development of knowledge, skill, and society". Advances in Health Sciences Education. 27 (5): 1265–1281. doi:10.1007/s10459-022-10178-8. ISSN 1382-4996. PMC 9645329. PMID 36350488.
  20. ^ Hojat MJ, Veloski J, Gonnella JS, Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University (2009). "Physician Lifelong Learning: Conceptualization, Measurement, and Correlates in Full-Time Clinicians and Academic Clinicians". Handbook of Lifelong Learning Developments. Nova Science Publishers, Inc. pp. 26–69. ISBN 978-1-60876-177-7.
  21. ^ Carmelli, Guy; Fullmer, Rodney; Goodrich, Margaret; Grawey, Tom; Pearce, Elspeth; Santen, Sally A.; Schnapp, Benjamin H. (2022-12-20). "Creating master adaptive learners during emergency medicine clerkships". AEM Education and Training. 6 (6): e10829. doi:10.1002/aet2.10829. ISSN 2472-5390. PMC 9763970. PMID 36562025.
  22. ^ Hewson, M. G. (1991). "Reflection in clinical teaching: an analysis of reflection-on-action and its implications for staffing residents". Medical Teacher. 13 (3): 227–231. doi:10.3109/01421599109098987. ISSN 0142-159X. PMID 1745113.
  23. ^ Orsini, Cesar; Rodrigues, Veena; Tricio, Jorge; Rosel, Margarita (2022). "Common models and approaches for the clinical educator to plan effective feedback encounters". Journal of Educational Evaluation for Health Professions. 19: 35. doi:10.3352/jeehp.2022.19.35. ISSN 1975-5937. PMC 9842479. PMID 36537186.
  24. ^ Kaur, Mandeep; Mahajan, Rajiv (2023). "Inculcating Critical Thinking Skills in Medical Students: Ways and Means". International Journal of Applied and Basic Medical Research. 13 (2): 57–58. doi:10.4103/ijabmr.ijabmr_214_23. ISSN 2229-516X. PMC 10443455. PMID 37614845.
  25. ^ McLean, Susan F. (2016-04-27). "Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature". Journal of Medical Education and Curricular Development. 3: JMECD.S20377. doi:10.4137/JMECD.S20377. ISSN 2382-1205. PMC 5736264. PMID 29349306.
  26. ^ a b c Hauer, Karen E.; Iverson, Nicholas; Quach, Alekist; Yuan, Patrick; Kaner, Stephanie; Boscardin, Christy (October 2018). "Fostering medical students' lifelong learning skills with a dashboard, coaching and learning planning". Perspectives on Medical Education. 7 (5): 311–317. doi:10.1007/s40037-018-0449-2. ISSN 2212-2761. PMC 6191394. PMID 30187391.
  27. ^ Wolff, Margaret; Hammoud, Maya; Carney, Michele (January 2023). "Developing Master Adaptive Learners: Implementation of a Coaching Program in Graduate Medical Education". Western Journal of Emergency Medicine. 24 (1): 71–75. doi:10.5811/westjem.2022.12.57636. ISSN 1936-900X. PMC 9897244. PMID 36735006.
  28. ^ a b c Auerbach, Lisa; Santen, Sally A.; Cutrer, William B.; Daniel, Michelle; Wilson-Delfosse, Amy L.; Roberts, Nicole K. (November 2020). "The educators' experience: Learning environments that support the master adaptive learner". Medical Teacher. 42 (11): 1270–1274. doi:10.1080/0142159X.2020.1801998. ISSN 1466-187X. PMID 32755327.
  29. ^ Hammoud, Maya M.; Deiorio, Nicole M.; Moore, Margaret; Wolff, Margaret, eds. (2023). Coaching in medical education. The AMA MedEd innovation series. Philadelphia, PA: Elsevier. ISBN 978-0-323-84726-1. OCLC 1308439489.
  30. ^ Cutrer, William B.; Spickard, W. Anderson; Triola, Marc M.; Allen, Bradley L.; Spell, Nathan; Herrine, Steven K.; Dalrymple, John L.; Gorman, Paul N.; Lomis, Kimberly D. (July 2021). "Exploiting the power of information in medical education". Medical Teacher. 43 (sup2): S17–S24. doi:10.1080/0142159X.2021.1925234. ISSN 1466-187X. PMID 34291714.
  31. ^ Santen, Sally A.; Ginzburg, Samara B.; Pusic, Martin V.; Richardson, Judee; Banks, Erika; George, Karen E.; Hammoud, Maya M.; Wolff, Meg; Morgan, Helen K. (2024-04-05). "The Association of Master Adaptive Learning With Less Burnout and More Resilience in Obstetrics and Gynecology Residents". Academic Medicine: Journal of the Association of American Medical Colleges. doi:10.1097/ACM.0000000000005733 (inactive 2024-07-03). ISSN 1938-808X. PMID 38579263.{{cite journal}}: CS1 maint: DOI inactive as of July 2024 (link)
  32. ^ "Intentional infusion of the master adaptive framework in residency". acapt.org. Retrieved 2024-07-03.
  33. ^ Nordstrom, Terry; Jensen, Gail M.; Altenburger, Peter; Blackinton, Mary; Deusinger, Susan; Hack, Laurita; Patel, Rupal M.; Tschoepe, Barbara; VanHoose, Lisa (2022-07-04). "Crises as the Crucible for Change in Physical Therapist Education". Physical Therapy. 102 (7): pzac055. doi:10.1093/ptj/pzac055. ISSN 1538-6724. PMID 35554600.
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