Threshold Concepts in Medical Education

Randall, Virginia; Brooks, Robert; Montgomery, Agnes; McNally, Lauren

doi:10.15694/mep.2018.0000176.1

Cited by 16 publications

(40 citation statements)

References 4 publications

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“…Once completed and particularly when acknowledged by a more senior colleague, it results in an irreversible ontological shift in the way the new doctors view themselves professionally. As such, we believe this fulfils the notion of a threshold concept (Meyer and Land 2005;Randall et al 2018).…”

Section: The Impact Of Responsibility On Identitysupporting

confidence: 59%

‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis

Yardley

Kinston

Lefroy

et al. 2020

Adv in Health Sci Educ

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Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients. This multiphase ethnographic study explores realities of transition through anticipatory, lived and reflective stages. We utilised Labov's narrative framework (Labov in J Narrat Life Hist 7(1-4):395-415, 1997) to conduct in-depth analysis of complex relationships between changes in responsibility and development of professional identity. Our objective was to understand how these concepts interact. Newly qualified doctors acclimatise to their role requirements through participatory experience, perceived as a series of challenges, told as stories of adventure or quest. Rules of interaction within clinical teams were complex, context dependent and rarely explicit. Students, newly qualified and supervising doctors felt tensions around whether responsibility should be grasped or conferred. Perceived clinical necessity was a common determinant of responsibility rather than planned learning. Identity formation was chronologically mismatched to accepting responsibility. We provide a rich illumination of the complex relationship between responsibility and identity pre, during, and post-transition to qualified doctor: the two are inherently intertwined, each generating the other through successful actions in practice. This suggests successful transition requires a supported period of identity reconciliation during which responsibility may feel burdensome. During this, there is a fine line between too much and too little responsibility: seemingly innocuous assumptions can have a significant impact. More effort is needed to facilitate behaviours that delegate authority to the transitioning learner whilst maintaining true oversight.

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Section: The Impact Of Responsibility On Identitysupporting

confidence: 59%

‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis

Yardley

Kinston

Lefroy

et al. 2020

Adv in Health Sci Educ

View full text Add to dashboard Cite

show abstract

“…These questions were developed by building on 10 + years of experience developing surveys for medical students. The theoretical construct behind these questions was evaluating for the presence of "threshold concepts," or non-factual learning points often won through emotional difficulty, that produce attitudinal/belief changes that are representative of ontological and transformative experiences [7,8].…”

Section: Methodsmentioning

confidence: 99%

Learning Beyond the Basics of Cadaveric Dissection: a Qualitative Analysis of Non-academic Learning in Anatomy Education

Parker

Randall

2020

Med.Sci.Educ.

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“…Grasping the core idea leads to an 'aha' moment through integration of different learning elements, and marks an irreversible transformational shift in the identity of the learner. Learning and dealing with threshold concepts can often be troublesome: learners want to apply certain difficult skills, but fear making mistakes or that their knowledge is incomplete [41].…”

Section: Threshold Conceptsmentioning

confidence: 99%

GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study

et al. 2020

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Background: To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient's preferences and the physician's clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations. Methods: We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software. Results: GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor's experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning. Conclusions: Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning.

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Threshold Concepts in Medical Education

Abstract: Background -The theory of Threshold Concepts (TC) proposes that there are ideas necessary for a student to learn which enable them to think like a professional. Studies of TC in higher education have appeared since 2003. Studies in medical education are more recent.

Cited by 16 publications

References 4 publications

‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis

‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis

Learning Beyond the Basics of Cadaveric Dissection: a Qualitative Analysis of Non-academic Learning in Anatomy Education

GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study

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