Training for constraint in Southeast Asia: Rethinking adaptive expertise in a region of contrasts.

Abstract

Modern clinical training is increasingly conducted in technology-rich environments supported by advanced diagnostics, automated systems, and structured workflows. These environments support efficient learning but may offer fewer opportunities for trainees to develop adaptive expertise, particularly when familiar resources, technologies, or processes are unavailable. Resource availability, however, exists on a spectrum, and even well-resourced systems can become stretched during pandemics, supply-chain disruptions, workforce shortages, or service overload. In such situations, clinicians need to prioritise, communicate clearly, reason with incomplete information, and adapt to changing conditions. For this reason, exposure to settings where resources are stretched, variable, or constrained can complement modern training by strengthening clinical judgement, observation, teamwork, and confidence in core clinical skills. Evidence on elective placements has described self-reported improvements in clinical examination skills, reduced reliance on extensive investigations and greater cultural awareness. However, such experiences must also be ethically and feasibly structured, with attention to host-institution needs, supervision, scope of practice, financing, and equity of access. Since external placements may not be available to all trainees, adaptive expertise should also be cultivated within existing training programmes through history-and-examination-first teaching, no-investigation case discussions, simulation under constraint, and structured reflection. The aim is not to privilege 1 training environment over another, but to prepare clinicians to practise safely and thoughtfully across the full spectrum of resource availability by intentionally building adaptive expertise.