Starting Off on Solid Ground: A Learning Simulation to Scaffold the Planning Phase of the Master Adaptive Learner for EM Interns.

Abstract

Background: Emergency medicine (EM) residency programs must strive to teach adaptive expertise (AE) so that graduates can apply existing knowledge to innovatively address novel problems. The Master Adaptive Learner (MAL) framework describes a structured approach for the development of AE, yet its practical application in medical education, and specifically in EM training, is limited. This study aimed to explore how first-year EM residents approach identifying, prioritizing, and filling knowledge gaps during the planning phase of the MAL framework.

Methods: We conducted a prospective qualitative study using a simulation-based learning exercise at two U.S. academic medical centers across two consecutive years. The simulation placed EM interns in a realistic emergency department scenario where they had to independently address knowledge gaps before engaging in guided discussions. Data were collected through surveys and focus groups, transcribed, and thematically analyzed. Knowledge gaps were categorized by type (factual, conceptual, procedural, metacognitive), and success in filling selected gaps was recorded. Intern rationales for gap prioritization and resource selection were examined.

Results: Fifty-seven EM interns participated, identifying 305 knowledge gaps, with factual gaps being most common. Participants successfully filled 90% of their top-priority knowledge gaps using resources such as UpToDate and WikEM. Rationales for gap prioritization emphasized clinical urgency (e.g., airway management) and readiness to engage in decision-making and communication. Resource selection was driven by familiarity and perceived efficiency. Interns often explored multiple resources, highlighting intellectual curiosity and desire for conceptual application of knowledge.

Conclusions: This study demonstrates that EM interns possess developing skills aligned with the MAL planning phase and can effectively address knowledge gaps through structured learning simulations. Simulation-based exercises offer an impactful method for contextualizing medical education theory and preparing residents for future clinical challenges. These findings support the integration of MAL principles into early residency curricula to promote adaptive expertise development.