Do We Need to Close the Door on Threshold Concepts?

Brown, Megan E. L.; Whybrow, Paul; Finn, Gabrielle M.

doi:10.1080/10401334.2021.1897598

Cited by 11 publications

(22 citation statements)

References 74 publications

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“…There was significant variation in characteristics used to identify possible TCs, which is consistent with findings in the wider literature, 8,64 and is one of the criticisms of the TCF. 10 There were also several papers in which the TCF was used to support the topic of discussion, but with no evidence to justify its inclusion. 27,33,47 Although no formal assessment of quality was carried out as part of this scoping review, a lack of experimental rigour was noted in several papers, particularly those focussed on the use of the TCF in teaching.…”

Section: Methodological Considerationsmentioning

confidence: 99%

“…61 Aligning the TCF with CBME also addresses some of the concerns raised by Brown et al with regards to the promotion of a single body of knowledge and perpetuation of traditional power imbalances in education. 10 A key component of CBME is a learner-centred approach 61 which can account for the individual variation in the experience of TCs. Indeed, Brown et al argue that EPAs are a preferable component of curriculum design to TCs, 10 but we contend that the two do not necessarily need to be viewed exclusively.…”

Section: Recursive Threshold Concepts and Implications For Curriculum...mentioning

confidence: 99%

“…However, Brown et al have challenged the suitability of the TCF in health professions curricula as it appears at odds with a constructivist paradigm by implying one body of knowledge and focussing on cognitive conceptions of identity. 10 They argue TCs should not be used to structure curricular and instead as a reflective prompt to aid discussions between students and educators. 10 There has been a growing interest in TCs in medical education in the last decade.…”

Section: Introductionmentioning

confidence: 99%

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Threshold concepts in medical education: A scoping review

Jones

Hammond

2022

Medical Education

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Introduction The threshold concept framework (TCF) was first described nearly 20 years ago, but its application in the field of medical education has recently seen a significant growth of interest with a diverse range of literature published on the subject. The transformative nature of threshold concepts (TCs) offers potential for the design of learning experiences and curricula across the medical education continuum. A scoping review was conducted to map the extent of the current literature regarding TCs in medical education—to describe the types of available evidence and its focus—and identify research gaps. Methods The review followed the JBI Manual for Evidence Synthesis approach for scoping reviews. Four databases and two additional websites were searched for articles exploring TCs in medical education. Data were analysed using quantitative and qualitative thematic approaches. A framework of conceptual change was used to synthesise the TCs identified. Results Thirty‐six papers, spanning undergraduate, postgraduate and continuing medical education, were included in the final analysis. The most frequent application of the TCF was in the identification of TCs, which related to basic scientific knowledge, ways of thinking and ways of practising in medicine. Uncertainty, patient care, clinical reasoning and professional identify formation were themes that emerged at multiple stages of training. Several papers evaluated the use of the TCF in teaching. Conclusion The understanding and embodiment of TCs increases in complexity across the medical education continuum, with TCs recurring with changes in clinical environment and responsibilities. This lends support to a holistic approach to curriculum design spanning all stages of training. Further research is needed to develop a consistent approach for describing and applying the TCF in medical education and to address how the TCF can be used in teaching and how threshold crossing can be measured.

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Section: Methodological Considerationsmentioning

confidence: 99%

Section: Recursive Threshold Concepts and Implications For Curriculum...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Threshold concepts in medical education: A scoping review

Jones

Hammond

2022

Medical Education

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“…Strategies for applying TCs into PGME in general practice have yet to become widely accepted and thus there is a need for research in this area. 62 Nevertheless, TC-based clinical teaching has been shown to be feasible, 63 and by using contextualised scenarios with discussions of lived experiences, TCs have been shown to benefit student learning and understanding. 64 Incorporating TCs into the curriculum requires a design which encourages students to self-reflect and to pay attention to the ‘how’ and ‘why’ rather than only ‘what’.…”

Section: Discussionmentioning

confidence: 99%

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

Hall

Chae

2022

BMJ Open

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ObjectiveTo identify threshold concepts (TCs) for physicians undergoing postgraduate medical education (PGME) in general practice.DesignAn explorative, qualitative study with 65 min focus group interviews and thematic analysis was used. Participants were asked to describe their most transformative learning experiences. Heuristical TCs were identified from the thematic analysis.SettingAotearoa/New Zealand (A/NZ).ParticipantsFifty participants, mostly comprising current trainees and educators from urban centres, and of NZ/European ethnicity.ResultsTwenty TCs covering many aspects of postgraduate general practice experience were derived from themes identified in the data. Presented in medical proverbial form for ease of recollection, these included: Money makes the practice go round; Be a legal eagle; Manage time or it will manage you; Guidelines, GPs’ little helpers; Right tool, right word, right place; The whole of the practice is greater than the sum of the parts; The personal enhances the professional; Beat biases by reflection; Chew the Complexity, Unpredictability, Diversity; Embrace the uncertainty; Not knowing is knowing; Seek and you shall find; Waiting and seeing, waiting and being; Look, listen, think between the lines; Treat the patient beyond the disease; No patient is an island; Words work wonders; Hearing is healing; Being you and being there; and; The relationship is worth a thousand consults. These TCs mapped onto core competencies in A/NZ’s PGME in general practice curriculum.ConclusionsParticipants readily identified transformative and troublesome moments in their PGME in general practice. These findings confirmed evidence for a wide range of TCs with many newly identified in this study. All TCs were fundamentally based on the doctor–patient relationship, although often involving the context and culture of general practice. Actively incorporating and teaching these identified TCs in PGME in general practice may enable trainees to grasp these important learning thresholds earlier and more easily and aid in identity and role formation.

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“…Assessing a shift in world view and in the language used to express this is difficult to assess objectively. Brown et al, (2021) remind us that threshold concepts are not the same as course learning outcomes and recommend that they be used as less prescriptive reflective prompts to stimulate discussions. They note that floating signifiers can mean different things to different people and that prescriptive application of threshold concepts can create power imbalance between staff and students as faculty determine what body of knowledge is essential to acquire; these authors also call into question the role of threshold concepts in the formation of professional identity.…”

Section: Is Recovery In Mental Health Nursing a Threshold Concept?mentioning

confidence: 99%

Conceptualising Recovery in Mental Health Nursing: A Word, A Journey or A Philosophy of Nursing Care?

Treloar¹,

Bleus²

2021

J Probl Based Learn

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Purpose: It is important for undergraduate mental health nursing students to develop an understanding of what recovery means in contemporary mental health nursing in order to practise in accordance with current models of care. However this concept can prove challenging for some. This paper looks at one particular undergraduate mental health nursing course with the aim of evaluating how effectively recovery is embedded in the course. Methods: Course material related to recovery and possible barriers to understanding of recovery, including both those contained in this particular undergraduate mental health nursing course and those which come from external factors, are discussed. Results: Ways to promote a better understanding of recovery-oriented mental health nursing care are suggested. Conclusions: To promote a greater understanding of recovery in mental health nursing there needs to be a better match between the consumer experience, educational materials provided in the course, tutor perspectives, student focus and assessment methods.

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Do We Need to Close the Door on Threshold Concepts?

Cited by 11 publications

References 74 publications

Threshold concepts in medical education: A scoping review

Threshold concepts in medical education: A scoping review

Identifying threshold concepts in postgraduate general practice training: a focus group, qualitative study

Conceptualising Recovery in Mental Health Nursing: A Word, A Journey or A Philosophy of Nursing Care?

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