Exploring the development of adaptive expertise through the lens of threshold concepts
Bibliographic record
Abstract
INTRODUCTION: While expert clinical practice requires a flexible approach to problem solving, evidence shows that medical clerks tend to focus on knowledge acquisition as the key to expertise. It is not until residency training that learners shift their understanding of expertise towards developing adaptive approaches to clinical problems. This raises the possibility that adaptive expertise is a threshold concept and that authentic clinical experiences involving complex problem solving are required to create the liminal state that enables transformation to an adaptive expertise mindset. With this possibility in mind, the current study examined the conceptualisations of expertise held by recently graduated physical therapists using the framework of threshold concepts as a sensitising lens. METHODS: An exploratory qualitative study in the Constructivist Grounded Theory tradition was conducted, utilising 14 one-on-one semi-structured interviews with recently graduated physical therapists. RESULTS: Most participants were in a transitional state regarding their conceptualisation of expertise, sometimes focusing on the acquisition of knowledge and routinisation of practice as their hallmark of expertise and at other times acknowledging the need for developing more dynamic and adaptive problem-solving approaches to patient care. These mixed responses were expressed not only in their framing of patient management but also in their reasons for valuing colleagues and in their approach to continuing professional development. Notably, many participants suggested that the interview itself was a key impetus to their reflecting on these issues. CONCLUSION: Our findings suggest that participants were only beginning to transition into an adaptive expertise mindset upon entering practice, reinforcing the possibility that authentic practice may be an important impetus for recognising the limits of routine expertise. However, spontaneous comments from participants suggest that this transition might be better supported though active guided reflection in addition to meaningful clinical engagement with patients and colleagues.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".