Master Adaptive Learner: Definition and Development in Medical Education

The concept of the Master Adaptive Learner (MAL) has gained significant traction in medical education as a framework for cultivating lifelong learning skills essential for navigating the complexities of modern healthcare. This article explores the definition of a master adaptive learner, the importance of this concept in medical education, and strategies for fostering MAL skills in medical professionals.

Introduction to the Master Adaptive Learner

In the rapidly evolving healthcare landscape, physicians must continuously update their knowledge and skills to provide optimal patient care. The Master Adaptive Learner (MAL) is an individual who utilizes a metacognitive approach to self-regulated learning, leading to the development of adaptive expertise. This involves not only mastering routine tasks but also innovating and adapting to new challenges in the clinical environment.

Defining the Master Adaptive Learner

A master adaptive learner possesses a unique blend of skills and attributes that enable them to thrive in dynamic and complex environments. Key characteristics include:

Self-Directed Learning: Taking initiative in identifying learning needs and pursuing relevant resources.
Self-Regulated Learning: Employing metacognitive strategies to plan, monitor, and evaluate one's learning process.
Adaptive Expertise: Demonstrating the ability to apply existing knowledge to novel situations and develop creative solutions.
Lifelong Learning: Committing to continuous professional development and staying abreast of the latest advancements in medicine.

The AMA’s ChangeMedEd Initiative aims to assist physicians in becoming master adaptive learners-expert, self-directed, self-regulated and lifelong workplace learners.

The MAL Model: A Framework for Learning

The MAL model is a unifying framework that guides efforts to study and instill the skills and attributes of lifelong learning. Incorporated in the MAL model are four stages of self-regulated learning (SRL): planning, learning, assessment, and adjustment. The MAL model extends this SRL model to describe specific behaviors within each of the four phases as well as cognitive skills and internal characteristics that support SRL.

The MAL process consists of four interconnected phases:

Planning: Identifying knowledge gaps, setting learning goals, and selecting appropriate resources.
Learning: Actively engaging in the learning process, seeking out challenges and opportunities for growth.
Assessing: Evaluating one's progress, seeking feedback from multiple sources, and reflecting on performance.
Adjusting: Modifying learning strategies based on assessment, incorporating new knowledge into practice, and refining skills.

These four phases apply to all levels of learners, although the time spent in each phase may vary.

Importance of MAL in Medical Education

Medical schools need to prepare students for work that is complex and ever evolving. In addition to developing the knowledge and skills required to achieve competence, physicians must refine their practice amidst rapid changes in science, technology, and public health crises. The COVID-19 pandemic underscores the importance of adaptability now more than ever. Front-line providers care for increasingly complex patients and must rapidly incorporate new evidence into their daily practice and address novel challenges, thus demonstrating the application of adaptive expertise.

Given rapid changes in healthcare, it is essential that medical students develop into MALs. There is a need for an instrument that can capture MAL behaviors and characteristics.

Adapting to the Changing Healthcare System

Preparing today's medical students for careers in the changing health care system requires more than clinical skills. Faculty must help medical students develop skills in adaptive learning, too. By training them to be master adaptive learners, medical schools are giving them the tools to adapt to an uncertain future.

Read also: Government of Flanders Scholarship

The Gap Between Knowledge and Practice

Many physicians face a gap between the medical literature and their practice of medicine-one that requires better identification of deficiencies and targeted learning to correct them. At the same time, they face a gap between their knowledge and emerging challenges in the clinical environment, requiring new approaches that allow for the incorporation of creative ideas and novel solutions.

Strategies for Fostering MAL Skills

Various approaches have been proposed in the literature to facilitate MAL development, emphasizing the central role of educators in creating a supportive learning environment. One novel coaching approach consists of longitudinal, on-shift, and group coaching designed to facilitate the development of skills, processes, and habits necessary to become career-long, self-directed learners who can adapt.

Longitudinal, On-Shift, and Group Coaching

A three-pronged approach of group, on-shift, and longitudinal coaching can focus on different aspects of MAL development. The group coaching sessions focus on the metacognition of learning using the MAL framework. Faculty and fellows learn alongside each other to share ideas, create shared language, and build community and trust. On-shift and longitudinal coaching reinforce these concepts and provide fellows opportunities to practice the elements of MAL - specifically reflection, goal-setting, and action plan development.

On-shift coaching is a type of performance coaching focused on gap identification, performing informed self-assessment and creating an active plan for change, which are key components of the MAL process.

Creating a Supportive Learning Environment

Educators play a crucial role in facilitating MAL development by:

Read also: Learn Guitar Effectively

Providing regular and constructive feedback.
Encouraging reflection on performance and learning experiences.
Promoting a growth mindset and a willingness to embrace challenges.
Creating opportunities for collaborative learning and peer support.

Addressing Barriers to Learning

Fellows often lack a defined approach to learning and point to infrequent and poor-quality feedback as barriers to identifying gaps. Therefore, it is essential to address these barriers by:

Establishing clear learning goals and expectations.
Providing regular opportunities for feedback and self-assessment.
Creating a culture of open communication and trust.

Implementation and Evaluation of a Coaching Program

To gain support, it is important to elicit fellow and faculty input early in the development of any MAL program. Faculty and fellows can learn the approach for on-shift coaching during the group coaching sessions and have opportunities to practice via role play.

Key MAL Processes: Feedback Behaviors and Development

The faculty and fellows can be surveyed at the end of the pilot program regarding two key MAL processes: feedback behaviors and development; and use of learning goals and plans.

Impact on Learning Approach

Fellows describe how the pilot positively influences their approach to learning and normalizes their development by creating a conversation about learning. The regular intervals of the group and on-shift coaching keep learning at the forefront and provide opportunities to learn from each other. They describe feedback evolving from a static conversation to an ongoing conversation throughout shift. The fellows describe growth in the planning and assessing phases of MAL. Fellows describe being more proactive in identifying gaps and intentionally seeking feedback from multiple sources over the course of the pilot. The fellows describe on-shift coaching to be crucial to their identification of gaps, reinforcement of positive behaviors, and overall growth as a pediatric emergency physician.

Fellows reported trying out methods to identify gaps that their colleagues shared during the group sessions.

Differentiating Learning Tasks

Fellows differentiate learning tasks for medical knowledge from learning goals focused on procedural skills and non-technical skills such as interprofessional communication or leadership. Prior to starting the pilot, the fellows routinely prioritized gaps necessary for immediate patient care while on shift. The gaps not immediately critical to patient care were often lost by the time they had time to learn. The longitudinal sessions prompted the fellows to reflect on their overall performance, develop goals, and revisit prior goals. The fellows described on-shift coaching to be crucial to the informed self-assessment process.

Challenges and Limitations

Despite the success in facilitating MAL skill development, implementation may not always go as planned. For example, group-coaching sessions may need to be virtual due to unforeseen circumstances like a pandemic. Additionally, there may be variation in approach to on-shift coaching. It is important to interpret findings in the context of these limitations. Outcomes data may rely on recall and may be influenced by social desirability; frequency of skill use may not be measured. Other factors that were not measured may have contributed to the development of MAL skills.

Future Directions

This innovation demonstrates a novel coaching approach to facilitation of MAL development in PEM fellows. Initial evaluation of this pilot has informed next steps in enhancing and expanding the program. By eliciting input prior to implementation, highlighting need for these skills early, and making skills relevant to the ED, fellows were engaged from the beginning and felt this was relevant to their learning. Going forward, a fellow can be included on the core team to provide ongoing input to ensure continued engagement. The group sessions can continue to create an exchange of ideas and normalize the conversation around growth.

Despite declining attendance, faculty participation in the group sessions demonstrated to the fellows the faculty’s receptivity to having these coaching conversations even when not using the prescribed approach. Fellows felt comfortable seeking input about their development without concern for punitive response.

Addressing Gaps in Learning

A gap may be identified in facilitating growth in the learning and adjusting phases. This may be attributed to a higher starting point in these areas. However, content on learning strategies can be incorporated in the group sessions and faculty will model searching for resources on shift. For the adjusting phase, fellows have developed an approach to changing their own clinical practice and recognizing when they have mastered this change.

Measuring MAL Skills

The MAL framework incorporates several constructs, many of which have previously been measured using various tools and instruments. An instrument that measures the MAL construct may provide valuable diagnostic information. If a learner struggles with clinical reasoning or has context-specific challenges, a MAL instrument may help identify the domain of these issues and may streamline efforts for remediation. Such an instrument would allow for baseline determination of MAL skills, provide the ability to test relevant hypotheses, and may set the stage for measuring the outcome of curricular interventions designed to impact MAL development.

Development of a Shortened Instrument

One study developed a shortened instrument for measuring the MAL process in medical students and evaluated its psychometric properties. The researchers initially searched for published instruments measuring the constructs and subcomponents associated with the MAL framework and reviewed existing instruments focusing on whether the items and constructs aligned with the MAL model. The researchers identified four instruments including the Jefferson Scale of Physician Lifelong Learning - Medical Student version, the Self-Regulated Learning Perception Scale, the Brief Resilience Scale, and the Goal Orientation Scale, with 67 total items from the potential pool of instruments to be aligned with the MAL model.

Factors Identified

The EFA identified four categories of the MAL model: Planning, Learning, Resilience, and Motivation. Items came from the Jefferson Scale of Physician Lifelong Learning - Medical Student version, the Self-Regulated Learning Perception Scale, the Brief Resilience Scale, and the Goal Orientation Scale. The resultant instrument is 28 items (a 58% reduction in item load) with four subscales and reasonable internal consistency. The Planning phase incorporates three stages (identifying a gap, selecting an opportunity for learning, and searching for resources for learning). Items in this factor explore gap identification, goal setting, and resource identification. In the Learning phase, the student begins to engage in the learning process through challenges and opportunities. In addition to the process of MAL, there are “batteries” or internal characteristics that facilitate the MAL process, such as Motivation and Resilience.

The EFA did not identify factors associated with Assessing and Adjusting. Similarly, the a priori content alignment content alignment by the subject matter expert panel did not map these domains.

Implications of Results

First, an instrument that measures the MAL construct may provide valuable diagnostic information. If a learner struggles with clinical reasoning or has context-specific challenges, a MAL instrument may help identify the domain of these issues and may streamline efforts for remediation. Second, via further exploration of master adaptive learning through the lens of this instrument, the development of students’ learning processes can be better understood. The ability to assess learners utilizing a MAL framework will be a tangible way to codify areas for individual growth and facilitate research into the best ways to fill those gaps. Finally, these results may offer opportunity for answering existing questions.

tags: #master #adaptive #learner #definition