Adaptive Expertise in Plastic Surgery: The Plastic Surgeon Experience of Developing, Maintaining and Teaching Adaptive Expertise

Abstract

Background: Plastic surgery is a surgical field defined not by a particular anatomical domain, age group, nor pathology. Instead, it is characterized by problem-solving and innovation. Adaptive expertise, described initially by Hatano and Inagaki, is the ability to efficiently problem-solve in routine scenarios while also being able to innovate when faced with a new, previously unencountered problem. With the concept of adaptive expertise as our theoretical framework, we sought to answer the question- how do plastic surgeons develop and teach for adaptive expertise? Methods: Semi-structured interviews with attending plastic surgeons from two large academic centers in Boston were conducted to obtain individual perspectives. The interviews were transcribed and analyzed using qualitative thematic analysis as described by Braun and Clarke, with the goal of describing and identifying patterns within the data. Adaptive Expertise acted as our sensitizing lens. Institutional Review Board approval was obtained. Results: Ten attending plastic surgeons were interviewed. The plastic surgeons described learning to expect the unexpected in their daily work. They described their cases as having no correct solution and rarely routine, requiring creativity, innovation, and an ability to troubleshoot. They planned for this uncertainty by developing multiple preoperative plans. However, they reflected on the frequent need for intraoperative changes in plan. They described plastic surgeons with creativity, confidence, and tolerance as thriving, but those with inability to change and those who experienced fear and stress with unpredictability, as not enjoying plastic surgery. The plastic surgeons described, though did not name explicitly, several key instruments for teaching for adaptive expertise, including conceptual understanding, meaningful variation, and productive struggle. Conclusion: Plastic surgeons describe profession and personal characteristics that are present in adaptive experts. Additionally, they teach for adaptive expertise by utilizing several known adaptive expertise educational techniques. By acknowledging and standardizing these techniques, we can better train the next generation of plastic surgeons in creating new surgical solutions, a long-standing and critical function of plastic surgery.