From struggle to strength: Embracing productive failure in clinical learning.

It has become increasingly apparent that healthcare is characterized by a great degree of novelty, ambiguity, and complexity. Traditional approaches to education in the health professions that emphasize the acquisition and assessment of isolated knowledge and skills as the gold standard do not prepare learners to adapt, innovate, and continue to learn throughout their careers. Productive failure, originating in the adaptive expertise literature, is an evidence-based instructional approach that has been shown to prepare students across the continuum of education for future learning. However, while productive failure is frequently used in classrooms, less is known about how to apply this approach in a clinical learning environment where learners are expected to learn while also fulfilling the work expectations of taking care of patients. In this paper, we define productive failure, describe research on how productive failure supports the development of adaptive expertise, and introduce the pedagogical implications of this work for educators, learners, administrators and patients. Drawing on cognitive and socio-culture research, and insights from quality improvement strategies, we will discuss how the clinical learning environment can be leveraged to ensure that learning through struggle is productive and safe.