Medical students’ experiences of a longitudinal integrated clerkship: a threshold concepts analysis

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

“…Our depth of data collection and analysis also allows for a more nuanced understanding of previously identified TCs. For example, uncertainty is a concept which has been repeatedly identified as an important TC across multiple medical specialties for both undergraduate and postgraduate medicine 20 22 23 27 34 60. We found the sources of uncertainty for GPs compromise three factors: the complexity of patient presentations, the unpredictably of any working day, and the sheer diversity of what could occur (hence ‘Chew the Complexity, Unpredictability, Diversity, CUD’).…”

“…Neve discussed several TCs (primarily uncertainty) identified in other medical disciplines as having the theoretical potential to be relevant to PGME in general practice 20. Gupta and Howden identified three major TCs in undergraduate primary care learning: ‘professional identity formation’, being an ‘agentic learner’ and ‘comfort with uncertainty’ 23. Vaughan et al identified ‘being the good doctor’, ‘healthcare without a prescription’, ‘an ethic of care through relationship’, ‘negotiating the boundaries of care’ and ‘uncertainty and anxiety’ as TCs in PGME in general practice 35.…”

“… 20 Gupta and Howden identified three major TCs in undergraduate primary care learning: ‘professional identity formation’, being an ‘agentic learner’ and ‘comfort with uncertainty’. 23 Vaughan et al identified ‘being the good doctor’, ‘healthcare without a prescription’, ‘an ethic of care through relationship’, ‘negotiating the boundaries of care’ and ‘uncertainty and anxiety’ as TCs in PGME in general practice. 35 A further paper by Vaughan, 36 identified ‘dispositional attributes’ relating to self-identity, breaking bad news, collecting clinical evidence, learning from colleagues, self-reflection, being present and listening; and relational aspects as also possible TCs.…”

“…Some TCs are shared by multiple healthcare professions; ‘caring’,16 ‘role of touch’,17 ‘intraprofessionality and interprofessionality’,18 19 ‘holistic approach’, ‘uncertainty’, ‘complexity of care’, ‘consider the whole person’, ‘collective competence’ and ‘patient-centredness’ 20. TCs identified in undergraduate medical teaching include; ‘understanding of pain’,21 ‘the nature of evidence’, ‘homoeostasis’, ‘empathy’, ‘embodied shared care’,22 ‘identity formation’, ‘becoming an agentic learner’, ‘comfort with uncertainty’23 and those regarding professional identity formation 24. Discipline-specific TCs have been identified in pathology,25 anaesthetics,26 cardiothoracic surgery,27 geriatrics,28 29 neurology,30 palliative care31 and psychiatry 32…”

“…Neve20 explored the potential for identifying TCs in postgraduate primary care, and Gupta and Howden23 described TCs identified in undergraduate primary care teaching. Although other studies have described specific, important or difficult aspects of primary care - such as the role of touch and uncertainty—these were not defined as TCs by the authors 33 34.…”