Developing adaptive performance: A conceptual model to guide simulation-based training design.

Objectives: Effective emergency department care requires individuals and teams to adapt to changes in patient condition, team factors, environmental issues, and system-level challenges. Adaptability is often listed as an important skill for emergency medicine physicians; however, conceptual models describing the processes involved in adaptive performance have not been translated for health care settings. Similarly, educators have not described training design strategies that support the development of adaptive performance. Methods: We examined the team science and health care literatures for key concepts in adaptive performance, health care team performance, and diagnostic decision-making. Using expert consensus, we integrated these concepts to develop the team adaptive performance model and to identify training design approaches that support the development of adaptability. Results: We identify nine training principles supported by the team adaptive performance model and the adaptive learning system. Each training principle is accompanied by recommendations and mechanisms for implementation in emergency medicine simulation-based education. Conclusion: Training experiences can be designed to target processes that support adaptive performance.