title: Promoting the Development of Adaptive Expertise: Exploring a Simulation Model for Sharing a Diagnosis of Autism With Parents.
abstract: To explore how a simulation model promoted the development of integrated competencies associated with adaptive expertise in senior health professions trainees as they learned to share a diagnosis of autism with parents.
  
  
  
  A qualitative instrumental case study method was used at the University of Toronto in 2014 to explore what eight developmental pediatrics residents and two clinical psychology interns learned from participating in a simulation model designed to enable trainees to practice sharing a diagnosis of autism with parents. This model incorporated variability (three cases), active experimentation in a safe environment, and feedback from multiple perspectives (peers, faculty, standardized patients, and a parent). Field notes were collected, and semistructured interviews were conducted to explore what participants learned. Constant comparative analysis was used to identify themes iteratively. Team analysis continued until a stable thematic structure was developed and applied to the entire data set.
  
  
  
  Four themes were identified. Three themes described how participating in the simulation model changed residents' and interns' approaches to sharing a diagnosis of autism with parents from using a structured, scripted framework to share the diagnosis; to being flexible within the structured framework; and, finally, to being attentive and responsive to parents by adapting and creating new approaches for sharing the diagnosis. The fourth theme described how the multiple perspectives in the simulation model prompted learners to develop adaptive approaches.
  
  
  
  This simulation model helped residents and interns move beyond use of a structured, scripted communication framework toward development of adaptive expertise.
authors.affiliation: A. Kawamura is assistant professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. M. Mylopoulos is assistant professor, University of Toronto, Faculty of Medicine, and scientist, Wilson Centre, University Health Network, Toronto, Ontario, Canada. A. Orsino is assistant professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. E. Jimenez is assistant professor, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. N. McNaughton is research director, Standardized Patient Program, and affiliated scholar, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Kawamura
authors.forename: Maria
authors.initials: M
authors.lastname: Mylopoulos
authors.forename: Angela
authors.initials: A
authors.lastname: Orsino
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jimenez
authors.forename: Nancy
authors.initials: N
authors.lastname: McNaughton
mesh_terms: D000223:Adaptation, Psychological; D001321:Autistic Disorder / Q000175:diagnosis; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D017145:Models, Educational; D010290:Parents; D010372:Pediatrics / Q000193:education*; D011369:Professional-Patient Relations; D011586:Psychology, Clinical / Q000193:education*; D036301:Qualitative Research; D000066908:Simulation Training / Q000379:methods*; D014342:Truth Disclosure