148EMF Moving Beyond “I Know It when I See It”: A Qualitative Study to Develop a Behavioral Definition of the Master Adaptive Learner for Emergency Medicine Trainees

The Master Adaptive Learner (MAL) conceptual model postulates that learners develop adaptive expertise through a cycle of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors and actions MALs use to learn are not well elucidated. Without a clear definition of MAL behaviors, we cannot reliably differentiate MALs from non-MALs nor assess curricular interventions to develop MALs. We sought to define observable behaviors that characterize MALs within emergency medicine (EM) training. Using a constructivist approach to grounded theory, we analyzed one-on-one, semi-structured interviews with expert EM educators. We used purposive sampling to recruit participants, and the final number of interviews was determined by thematic saturation. We asked these experts to describe observable MAL and non-MAL behaviors and to identify factors in the clinical learning environment that may influence these behaviors. We identified 3 major themes describing MAL behaviors: (1) critical interrogation of practice; (2) intellectual risk taking and (3) intentional curation of learning resources. Critical Interrogation of Practice encompasses several behaviors including: learner-driven feedback conversations; independent synthesis of clinical information for diagnostic, therapeutic, and teaching purposes; appropriate deviation from algorithms based on their conceptual understanding of core principles; intentional use of case variation and hypothetical questioning; and continuous refinement of decisions based on new data. MALs also engage in Intellectual Risk Taking that furthers their development by communication of clinical decision-making processes even at the risk of being wrong; openly engaging with errors and gaps to foster their development; and intentionally seeking out uncomfortable experiences. Intentional Curation of Learning Resources refers to the deliberate use of educational products and a consortium of trusted individuals who serve as mentors and sounding-boards for their development. We identified a fourth theme that was related to MAL development and agency: Learning Environment Modulates Behaviors. Specifically, active promotion of psychological safety is necessary for learners to acknowledge gaps and take intellectual risk. This safety is mediated through trusting relationships and expert supervisors serve both as stewards of the CLE and as co-learners and role-models. We present several behaviors that allow identification of MALs within emergency medicine trainees These data expand our understanding of MAL behaviors and may allow for more precise categorization and selection of individuals for study of targeted curricular interventions and meaningful learning outcomes.