Continuing Competence: Adaptive or Routine Expertise

  •   March 9, 2020
  •  Audrey Lowe, Manager of Continuing Competence Program

Three months into 2020 you might be thinking about the Self-Selected Activity you will use for renewal this September. As you seek out knowledge for practice improvement, ask yourself “what type of expertise am I developing, routine or adaptive?” Let me explain.

The hallmark of any health-care professional is his/her ability to not only efficiently solve routine workplace problems, but also to deal with ambiguity, in the face of uncertainty, find unique solutions to complex problems. There are two types of mindsets practitioners adopt to survive in our modern workplaces, routine expertise and adaptive expertise.2, 3

Routine expertise is a mindset oriented toward solving routine problems encountered in practice. If a practitioner is focused on solving routine problems, they tend to seek out procedural knowledge. Procedural knowledge is acquired and applied to well understood problems. Routine experts aim to become highly efficient at solving routine problems. They focus on storing and completing sophisticated sets of routines and applying them efficiently in practice, often without much thought.

In contrast, an adaptive expertise mindset is oriented towards innovation and solving non-routine problems. Adaptive expertise manifests when a practice situation presents with novelty and complexity. The practitioner is required to apply their knowledge and skills flexibly and innovatively to arrive at new and novel solutions. The non-routine situation itself is viewed as an opportunity to learn and discover something new. Knowledge is used as a starting point for creating new knowledge, approaches and procedures for the purpose of addressing complex non-routine problems. The practice setting is integral to developing adaptive expertise, it must be one that requires a practitioner to think flexibly and innovatively.

Adaptive experts have a unique relationship with knowledge and problem-solving. Knowledge is considered assumptive, improvable and dynamic. The adaptive expert sees themself as an accomplished novice, always in a learning state, striving to build upon existing knowledge and mindfully seeking out new knowledge as a foundation for innovative problem-solving. The problem-solving episode is a launching point to create new knowledge which in turn is used for further practice improvement. In this model of adaptive expertise, experience alone does not make one an expert because the unreflective accrual of experience does not result in practice improvement. Reflection during and retrospectively on practice is essential because it allows the adaptive expert to adjust their theories about their work in response to these daily reflections. Reflection creates newfound knowledge which allows them to adjust and improve their practice.

Adaptive experts deliberately and mindfully cultivate adaptive expertise as they engage in progressive problem solving, continually taking new learnings from the novel situations and making them routine. As they integrate new knowledge on aspects of their practice in one domain, this then frees up cognitive resources which they reinvest into solving new and more complex problems encountered in existing or new domains. Over their career, they are able to address increasingly complex practice problems both efficiently and innovatively.

Adaptive experts work in an optimal adaptability corridor balancing the need for efficiency and innovation. They know when to adopt a mindset of routine expertise and when to use adaptive expertise. The adaptive expert reads the practice context and uses the appropriate strategy. They do not fall into the trap of using old solutions to address non-routine problems or using novel solutions for routine problems. To remain an adaptive expert, an individual must deliberately and continually strive for innovation and practice improvement. If they stop the commitment to practice improvement, they lose their ability to deal with the non-routine and become “experienced” non-experts.

So again, I emphasize when you start narrowing down your Self-Selected Activity for this September ask yourself “Does the activity I complete and the knowledge I acquire help me develop ‘routine’ expertise or ‘adaptive’ expertise?” The DO.LEARN.GROW. program allows you to develop either routine or adaptive expertise, but remember your Self-Selected Activity must always improve:

  • PERSONAL COMPETENCE via the acquisition of current knowledge or skills which updates and reinforces existing knowledge or skills or supports the development of new competencies.
  • Must improve 2 or 3 (2) PATIENT CARE PRACTICES as evidenced by tangible results which can be measured (i.e., outcomes, effectiveness, efficiency).
  • OR (3) PHYSIOTHERAPY OR HEALTH CARE SERVICES as evidenced by tangible or measurable outputs (i.e., products, directives, indicators).

Admittedly, I am biased towards a lifelong orientation towards the development of adaptive expertise. Health care is always changing, it needs physiotherapists with well-cultivated adaptive expertise to help find innovative solutions to evolve practice and patient care.

I acknowledge and thank thought leader Maria Mylopolous, as a good portion of this article is drawn directly from her publications.

Already completed your Self-Selected Activity? Why don’t you login to your Member Portal to write it up? Need help with understanding the program? Contact Audrey Lowe Manager Continuing Competence Program competence@physiotherapyalberta.ca 780.438.0338, 1.800.291.2782


  1. Adaptive Expertise https://en.wikipedia.org/wiki/Adaptive_expertise
  2. Mylopoulos M. Competence as expertise: Exploring constructions of knowledge in expert practice. The Questions of Competence: Reconsidering Medical Education in the Twenty‐First Century. 2012:97-112.
  3. Mylopoulos M, Woods NN. When I say… adaptive expertise. Medical education. 2017 Jul;51(7):685-6.
  4. Scardamalia, M. & Bereiter, C. Knowledge Building. In Encyclopedia of Education (2003). (2nd ed. pp. 1370-1373). New York: MacMillan Reference