#KeyLIMEPodcast 309: Smooth sailing doesn’t make a skilled sailor

Linda presents a scoping review on a hot topic: Adaptive expertise (AE). While a number of groups have written on the topic, Linda asks, what do we really know about it? 

The authors of the article looked to summarize existing evidence about AE, verify conceptual boundaries and map existing research gaps to further guide scholarship, and more…listen to the episode to find out!!

———————————————————————————————–KeyLIME Session 309

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Kua et. al., A scoping review of adaptive expertise in education. Medical Teacher. 2021, VOL. 43, NO. 3, 347–355


Linda Snell (@LindaSMedEd)


Adaptive expertise (AE) seems to be a hot topic in #meded these days. There are a number of groups writing about it … but what do we really know about it?

First described only 3 decades ago.

Defined as ‘the ability to learn new skills, attitudes, knowledge, make effective use of resources or invent new procedures to support problem solving in practice’ (Mylopoulos), or to adapt to variability, create solutions for unfamiliar, dynamic or complex issues.

Important in health professions and HPE, where we want  learners to have the ‘ability to transfer and adapt using one’s prior knowledge to support future learning’  in order to manage complex patients. Our current pandemic has shown us that ‘future physicians need to be able to rapidly integrate new information, adapt to available resources, invent new solutions to support learning and solve novel situations’.

There is a varied  but not abundant literature in and outside the health professions about what AE is, how it can be fostered, and how to measure it.

The one systematic review on the topic was 7 years ago, quantitative methodology, looked at adaptive performance.

‘Given the critical role of adaptive expertise in the development of health professionals in an era of social and technological change, the re-examination of this topic is imperative and timely.’


These authors set about to  summarize the existing evidence about the conceptual frameworks, development, and measurement for adaptive expertise. Used a scoping review to verify a working definition and conceptual boundaries of AE, map existing research gaps of AE to further guide scholarship.

Key Points on the Methods

Why a scoping review? The authors nicely explain that ‘scoping review approach was used for this study because it supports the synthesis of diverse literature to inform a systematic examination of a topic, including identification of  important concepts and current gaps in research;  commonly done in fields with a lack of rigorous evidence and incorporates a broad range of literature of various designs ‘

Used Arskey and O’Malley’s 5 steps: i) identify the initial research questions, ii) identify relevant studies, iii) select study, iv) chart the data and v) collate, summarize and report the results.

Key Outcomes

  1. identify the initial research questions: What is known about the conceptual framework for AE within and outside health professions education? How is AE developed and measured?
  2. & iii) Identify and select relevant studies: general education and HPE, 48 studies mainly north America and Europe; HPE (14 articles) mainly qual, non-HPE (34 articles) mainly quant. Used PRISMA guidelines
  3. chart the data:
  4. collate, summarize and report the results:
Conceptual framework (Green & Kreuter) – factors associated w AE

Development of AE – design strategies helpful:  (1) presenting abstract materials early in the  training, (2) facilitating integration of conceptual ideas with existing knowledge, (3) guided discovery with hypothesis testing and problem solving, and (4) metacognitive instruction.

Star Legacy Cycle and Master Adaptive Learner instructional techniques are described. Few validated measurement tools or techniques for AE

Key Conclusions

The authors conclude… research opportunities to study interventions involving the development of AE. Gaps in the development and validation of measurement tools.

Spare Keys – other take home points for clinician educators

Smooth sailing doesn’t make a skilled sailor.

There’s AE for teachers also.

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