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J Eval Clin Pract. 2018 Mar 8. doi: 10.1111/jep.12905. [Epub ahead of print]

Developing the experts we need: Fostering adaptive expertise through education.

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The Wilson Centre and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
The Wilson Centre and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.


In this era of increasing complexity, there is a growing gap between what we need our medical experts to do and the training we provide them. While medical education has a long history of being guided by theories of expertise to inform curriculum design and implementation, the theories that currently underpin our educational programs do not account for the expertise necessary for excellence in the changing health care context. The more comprehensive view of expertise gained by research on both clinical reasoning and adaptive expertise provides a useful framing for re-shaping physician education, placing emphasis on the training of clinicians who will be adaptive experts. That is, have both the ability to apply their extensive knowledge base as well as create new knowledge as dictated by patient needs and context. Three key educational approaches have been shown to foster the development of adaptive expertise: learning that emphasizes understanding, providing students with opportunities to embrace struggle and discovery in their learning, and maximizing variation in the teaching of clinical concepts. There is solid evidence that a commitment to these educational approaches can help medical educators to set trainees on the path towards adaptive expertise.


adaptive expertise; clinical reasoning; innovation; medical education


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