By: Teri L. Turner, MD, MPH, MEd
Anyone who has driven through Houston knows that Interstate-45 appears to exist in a perpetual state of construction. Some portion is always being expanded, rerouted, repaired, or updated. The road is functional and heavily used, yet improvement never fully stops because the environment and demands around it continue to evolve.
Perhaps expertise in medical education is similar.
Competency-based health professions education (CBHPE) has fundamentally reshaped how we conceptualize learner development. We encourage trainees to seek feedback, embrace coaching, identify performance gaps, and adapt in response to evolving clinical environments. CBHPE aims to develop Master Adaptive Learners—professionals capable of reflection, adjustment, and lifelong growth.1
Yet faculty development culture often communicates a different message.
While CBHPE frames learning as developmental for trainees, many educational environments still position faculty expertise as polished, certain, and complete. This creates a developmental paradox: we ask learners to publicly embrace growth while faculty may feel pressure to privately maintain the appearance of mastery.
The ACGME Clinician Educator Milestones further highlight this tension.2 As educators progress toward increasing expertise, an important question emerges: what happens when faculty reach the top of the developmental framework? Too often, expertise is treated as a point of arrival rather than as an ongoing process of adaptation and refinement.
In many ways, the hidden curriculum of faculty expertise is the performance of certainty.
Yet medicine, learners, and clinical learning environments continuously evolve. Teaching strategies effective with one learner may be ineffective with another. Educational expertise cannot be understood as static mastery. CBHPE was never intended to produce routine experts who simply perform familiar tasks efficiently. Its broader promise is adaptive expertise—the ability to continuously learn, adapt, and respond to changing contexts.
Recent work exploring master clinical teachers through the Master Adaptive Learner framework demonstrated that highly effective educators intentionally refine their teaching through reflection, learner feedback, experimentation, and adaptation.3 Rather than viewing expertise as static achievement, these educators described ongoing refinement as an expected component of professional growth.
Perhaps that expectation should apply to educators as much as it does to learners.
Parker Palmer famously described teaching as a “daily exercise in vulnerability.”4 Teaching requires continual exposure to uncertainty, evaluation, and the possibility of failure. Yet vulnerability alone does not necessarily produce growth. Bullough’s work on teacher vulnerability and teachability suggests that educators often respond to vulnerability in one of two ways: some move toward defensiveness, while others remain open to reflection and growth.5
We intentionally design productive struggle for learners, yet often interpret visible “construction” in educators as inadequacy rather than ongoing development. Feedback directed toward teaching can feel uniquely personal because teaching is closely intertwined with professional identity. Critiques of teaching behaviors can feel like critiques of self.
As a result, faculty may understandably hesitate to publicly expose uncertainty or developmental struggle. This hesitation is not simply individual defensiveness. Faculty are often evaluated by peers, leaders, and promotion systems using learner ratings and teaching metrics that leave little visible room for developmental growth. In many environments, educators feel pressure to maintain consistently high evaluations and perceptions of competence rather than openly evolve over time. The hidden curriculum, therefore, may unintentionally communicate that growth is expected for learners but risky for educators.
Early in my teaching career, I received unexpectedly negative feedback from a learner despite strong prior evaluations and teaching recognition. My initial response was defensive. However, after meeting with the learner, I began to recognize that the issue was not whether I was broadly an effective or ineffective educator, but whether my approach met the needs of that particular learner. I had assumed learners should adapt to my teaching style rather than considering how I might adapt my teaching to support different learners more effectively. The experience reshaped how I fundamentally viewed feedback—not as a judgment of worth, but as an opportunity for growth.
More recently, I worked with a faculty member navigating concerns regarding mistreatment. What struck me most was how intentionally she approached her development. Rather than withdrawing defensively, she sought multiple forms of coaching, including perspectives from trainees. She created a personal “teaching board of directors” to provide diverse feedback and accountability. She also analyzed longitudinal learner evaluations to identify recurring patterns in her teaching behaviors.
This process was emotionally demanding, particularly when learner perceptions did not align with her intentions. Yet her approach reflected many of the same iterative processes we seek to cultivate in learners: reflection, feedback integration, experimentation, and adaptation.
Perhaps the most important role-modeling faculty do is not demonstrating perfection, but demonstrating recalibration.
Learners closely observe how educators respond to uncertainty, challenge, and feedback. If faculty present expertise as certainty rather than adaptation, learners may internalize that professional growth eventually ends. In contrast, when educators openly model reflection and adaptation, they normalize lifelong learning as an expected component of professional identity.
Medical educators can intentionally model adaptive expertise in several practical ways:
- Solicit learner feedback early and longitudinally.
- Look for patterns across feedback rather than reacting to isolated comments.
- Build a diverse network of coaches, mentors, and trusted colleagues who can provide developmental feedback.
- Debrief teaching sessions with colleagues rather than relying exclusively on learner ratings.
- Normalize in-the-moment course correction during rounds, conferences, and bedside teaching.
- Use reflective language during teaching interactions, such as:
- “That explanation was not as clear as I intended.”
- “What would have made this learning experience more effective for you?”
The challenge is not that educators remain “under construction,” but that systems expect the road to appear finished while ongoing refinement continues beneath the surface. Supporting adaptive expertise requires cultures that allow room for growth.
- Advocate for faculty evaluation systems that value longitudinal development over perfection.
- Normalize developmental feedback through peer observation and coaching.
- Reward recalibration and reflective practice—not only high learner ratings.
- Create psychologically safe spaces where faculty can discuss difficult teaching moments without judgment.
Expertise in CBHPE was never meant to signal completion. Like any complex system built to endure changing conditions, great educators must remain—at least in part—under construction.
Refrences:
- Cutrer WB, et al. Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education. Acad Med. 2017 Jan;92(1):70-75. doi: 10.1097/ACM.0000000000001323. PMID: 27532867.
- Accreditation Council for Graduate Medical Education. Clinician Educator Milestones [Internet]. Chicago (IL): Accreditation Council for Graduate Medical Education; [cited 2026 May 24]. Available from: https://www.acgme.org/education-and-resources/faculty-development/clinician-educator-milestones/
- Fromme HB, Mitre V, Karani R, Cutrer WB, Zaidi Z, Turner T, van Schaik SM. Modeling lifelong learning: exploring clinical teachers’ skill development through the master adaptive learner lens. Acad Med. 2026 May 1;101(5):550-557. doi: 10.1093/acamed/wvag025. PMID: 41629757.
- Palmer PJ. The courage to teach: exploring the inner landscape of a teacher’s life. 1st ed. San Francisco (CA): Jossey-Bass; 1998.
- Bullough RV Jr. Teacher vulnerability and teachability: a case study of a mentor and two interns. Teach Educ Q. 2005 Spring;32(2):23-39.
About the Author:
Teri L. Turner, MD, MPH, MEd is a tenured Professor of Pediatrics at Baylor College of Medicine, where she serves as the Assistant Dean of Graduate Medical Education and the Vice Chair of Educational Affairs. She is the Founder and immediate past Director of the Center for Research, Innovation, and Scholarship in Medical Education for the Department of Pediatrics
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