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Productive struggle and failing safely: implications for developing adaptive expertise in communication

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Abstract

Navigating difficult conversations is a complex task that requires flexible and adaptive approaches. Residents developing this skill may initially struggle or fail, and require support. However, this experience may prepare residents for future learning which is essential to adaptive expertise. Limited understanding of how residents learn from failure in the workplace restricts the ability to maximize its potential benefits. The purpose of this study was to explore the role failure plays in learning to navigate difficult conversations during workplace learning. A constructivist grounded theory study was conducted using semi-structured interviews of 13 physicians (subspecialty residents and newly graduated physicians) from a Division of Developmental Paediatrics between 2017 and 2018. The authors used constant comparative analysis to identify themes iteratively. Themes were identified both inductively and deductively using the conceptual framework of adaptive expertise. Through independently leading difficult conversations, physicians were able to recognize that the failure that occurred in these encounters, prompted them to generate new knowledge which led to deeper conceptual understanding, thus supporting development of adaptive expertise. However, participants indicated that staff physicians often protect residents from difficult conversations, which limits their opportunity to receive feedback and engage in learning. Residents participate in difficult conversations that challenge them to go beyond their existing knowledge. Providing residents with opportunity to lead difficult conversations with patients and families while being supported by staff supervisors, allows for struggling through learning, which leads to a deeper conceptual understanding and supports development of adaptive expertise.

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Acknowledgements

The authors wish to thank the Family Leadership Program at Holland Bloorview, for reviewing the grant application and providing feedback and a letter of support.

Funding

This study was funded by a research Grant from the Paediatric Consultants Educational Scholarship Grant.

Author information

Authors and Affiliations

  1. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Jessica Lynch, Angela Orsino & Anne Kawamura

  2. Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd., Toronto, ON, M4G 1R8, Canada

    Jessica Lynch & Angela Orsino

  3. Bloorview Research Institute, Toronto, Canada

    Anne Kawamura

Authors
  1. Jessica Lynch
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  2. Angela Orsino
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  3. Anne Kawamura
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Corresponding author

Correspondence to Jessica Lynch.

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The conduct of this study was approved by the Bloorview Research Institute Research Ethics Board.

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Appendix A

Appendix A

Sample interview questions.

  1. 1.

    Can you think of a recent patient encounter where you needed to share difficult news or have a difficult conversation?

    1. a.

      Did you prepare for this meeting in advance? If yes, how did you prepare?

    2. b.

      What strategies did you use to navigate the discussion?

    3. c.

      Has this changed from when you first started residency?

  2. 2.

    Can you describe a time where you shared difficult news or had a difficult discussion and this did not go well or did not go as planned?

  3. 3.

    How do you think you developed your approach to having difficult conversations with patients and families?

  4. 4.

    What experiences helped you to learn about approaching difficult conversations?

  5. 5.

    Has reflecting on difficult discussions after they occur helped you learn about approaching difficult conversations?

  6. 6.

    Have you ever received formal training in managing difficult conversations with patients or breaking bad news?

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Lynch, J., Orsino, A. & Kawamura, A. Productive struggle and failing safely: implications for developing adaptive expertise in communication. Adv in Health Sci Educ 27, 1331–1344 (2022). https://doi.org/10.1007/s10459-022-10175-x

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