Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. XXX, No. XXX / xxx XXX 1 Article The rapidly changing context of health care delivery is creating what some call an ongoing “knowledge and skills gap” between what people know at one moment and what they will need to know at the next moment in order to be successful in their everyday lives and the workplace. 1 These circumstances require clinicians to develop the expertise to function efficiently on everyday tasks, but also to create solutions for novel workplace challenges. 2 Adaptive Expertise for the Health Professions The predominant work of clinicians in their daily practice is problem solving. 3–5 In most cases, clinicians will possess the necessary knowledge and skills to address problems directly. There will be times, however, when clinical decision making will require new learning and innovative solutions to deal with problems. In an effort to explain these circumstances, scholars have drawn on the difference between routine and adaptive expertise. 6,7 Routine expertise involves mastering performance to the extent that it becomes highly efficient and accurate, drawing on the specific knowledge and skills that an expert has learned over time. With repetition (ideally with feedback 8 ), performance becomes increasingly automatic and is characterized by speed and accuracy reflecting the traits of an expert at the mastery stage in the Dreyfus brothers’ conceptualization of expertise. 9 Adaptive expertise is different. It seeks to balance the efficiency of routine expertise with more effortful learning and innovative problem solving. 2,7 A clinician is using the skills of adaptive expertise when she recognizes that a “routine” approach is not working optimally and reframes the problem in a way that allows her to explore new concepts (learn) and invent new solutions (innovate). Clinicians able to demonstrate both types of expertise have developed the capability to work within an “optimal adaptability corridor,” where they balance the efficiency and innovative dimensions of problem solving 10 (see Figure 1). Adaptive expertise is based on the ideal that individuals will learn and innovate in response to practice challenges. Reports have suggested that many clinicians may not be learning effectively in practice, making it difficult to employ adaptive expertise. 11,12 These clinicians may not be learning effectively in practice because they have not been “prepared for future learning.” 11,12 Preparation for future learning (PFL) is described as the capacity to learn new information, make effective use of resources, and invent new procedures to support learning and problem solving in practice. 10 Adaptive expertise requires (1) an openness to reflecting on practice, (2) meta-reasoning skills to recognize that routine expertise schema stored in long-term memory will not work, (3) critical thinking to challenge current assumptions and beliefs, and (4) the ability to reconstruct the problem space. 6 PFL enables clinicians to access encapsulated knowledge that contains basic science and clinical principles that help them develop innovative solutions to challenging novel problems. 13–15 In this way, they can function effectively within the “optimal adaptability corridor,” balancing the efficiency (routine expertise) and innovative (adaptive expertise) dimensions of clinical problem solving. To provide the best possible care to their patients in a highly complex, continuously changing health care environment, clinicians need to be prepared for future learning (i.e., PFL) so that they can balance routine and adaptive expertise in the optimal adaptability corridor. Training must begin during undergraduate medical education to ensure readiness for learning (i.e., PFL) and that individuals develop the skills and processes necessary to learn effectively in the workplace. Building on previously described PFL-related behaviors 12 such as asking pertinent questions, using resources that lead to practice change, and strategically seeking feedback, as well as other critical skills identified from the literature, we propose a conceptual model for a Master Adaptive Abstract Change is ubiquitous in health care, making continuous adaptation necessary for clinicians to provide the best possible care to their patients. The authors propose that developing the capabilities of a Master Adaptive Learner will provide future physicians with strategies for learning in the health care environment and for managing change more effectively. The concept of a Master Adaptive Learner describes a metacognitive approach to learning based on self-regulation that can foster the development and use of adaptive expertise in practice. The authors describe a conceptual literature-based model for a Master Adaptive Learner that provides a shared language to facilitate exploration and conversation about both successes and struggles during the learning process. Acad Med. 2016;XXX:00–00. First published online doi: 10.1097/ACM.0000000000001323 Please see the end of this article for information about the authors. Correspondence should be addressed to William B. Cutrer, 5121 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN 37232; telephone: (615) 936- 3968; e-mail: Bill.Cutrer@Vanderbilt.edu; Twitter: @BillCutrerMD. Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education William B. Cutrer, MD, MEd, Bonnie Miller, MD, Martin V. Pusic, MD, PhD, George Mejicano, MD, MS, Rajesh S. Mangrulkar, MD, Larry D. Gruppen, PhD, Richard E. Hawkins, MD, Susan E. Skochelak, MD, MPH, and Donald E. Moore Jr, PhD