Productive struggle and failing safely: implications for developing adaptive expertise in communication

Area of Science:

• Medical Education
• Communication Skills
• Physician Training

Background:

• Navigating difficult conversations is a key skill for physicians.
• Residents often struggle with these conversations and require support.
• Learning from failure is vital for developing adaptive expertise.

Purpose of the Study:

• To explore the role of failure in learning to navigate difficult conversations.
• To understand how workplace learning from failure contributes to adaptive expertise.

Main Methods:

• Constructivist grounded theory study.
• Semi-structured interviews with 13 physicians (residents and recent graduates).
• Constant comparative analysis informed by adaptive expertise framework.

Main Results:

• Physicians recognized that failure in difficult conversations prompted new knowledge generation and deeper understanding.
• Independent engagement with challenging conversations fostered adaptive expertise.
• Staff physicians sometimes shield residents from these experiences, limiting learning opportunities.

Conclusions:

• Failure in difficult conversations is a catalyst for learning and developing adaptive expertise in physicians.
• Protected learning environments can hinder residents' ability to gain crucial experience and feedback.
• Supported opportunities for residents to lead difficult conversations enhance conceptual understanding and adaptive expertise.