Because change is ubiquitous in healthcare, clinicians must constantly make adaptations to their practice to provide the highest quality care to patients. In a previous article, Cutrer et al. described a metacognitive approach to learning based on self-regulation, which facilitates the development of the Master Adaptive Learner (MAL). The MAL process helps individuals to cultivate and demonstrate adaptive expertise, allowing them to investigate new concepts (learn) and create new solutions (innovate). An individual's ability to learn in this manner is driven by several internal characteristics and is also impacted by numerous aspects of their context. In this article, the authors examine the important internal and contextual factors that can impede or foster Master Adaptive Learning.

We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients' personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed extensive violence perpetrated against these women, demonstrating that FGM/C is only part of the trauma experienced. The high level of mental health disorders and endured violence has implications for providers working with FGM/C survivors and indicates the need for accessible mental health services and trauma-informed care.

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