Hilary Neve

What are threshold concepts and how can they inform medical education

Abstract The notion of “threshold concepts” is being widely applied and researched in many disciplines but is rarely discussed within medical education. This article is written by three medical educators who regularly draw on threshold concept theory in their work. They explore here the nature of threshold concepts and describe how the theory can offer medical educators new perspectives in terms of how they design curricula, approach teaching and support learners.

Understanding students’ experiences of professionalism learning: a ‘threshold’ approach

ABSTRACT Professionalism is a core element of curricula in many disciplines but can be difficult to teach and learn. This study used audio-diary methodology to identify professionalism threshold concepts in a small group learning setting in undergraduate medicine and to understand factors that might facilitate students to ‘get’ such concepts. Fifteen students and seven tutors kept audio-diaries over two terms. Data were analysed qualitatively for content. The key themes were then cross referenced to threshold concept criteria (e.g. where language indicated that learning was troublesome, integrative or transformative). Seven potential threshold concepts were identified which centred on students’ developing professional identities including working with uncertainty, considering the bigger picture, not needing to know everything and professional culture. Reflection on workplace experiences within a small group helped students ‘get’ these concepts. The study concludes that threshold concepts and audio-diaries are useful tools for understanding lived experiences of professionalism learning.

When I say … capability.

Neither of us are chefs, but we can both confidently prepare and cook a tasty spaghetti bolognese and our families regularly judge us as competent at the task. Imagine, however, having to cook the same dish as a team task on television’s competitive ‘Masterchef’ programme. The judges scrutinise us as we get to grips with equipment and ingredients that bear little resemblance to those we use at home. We are cooking not for two or four, but for a factory workforce of 50. To make matters worse, our team members have their own ideas and we argue about adding extra ingredients and whether the spaghetti is cooked. The pressure mounts and our stress levels increase. The recipe and approach that work so successfully in our own kitchens now seem entirely redundant. When the meal is served, the sauce is unpleasant, the spaghetti soggy and neither the factory staff nor the judges are impressed.

Evaluation of an innovative, evidence-guided, PBL approach

To understand the experiences of students and problem‐based learning (PBL) facilitators during an evidence‐based curriculum change to a PBL programme within an undergraduate medical course in South West England.

Empowering students with the hidden curriculum

The hidden curriculum (HC) refers to unscripted, ad hoc learning that occurs outside the formal, taught curriculum and can have a powerful influence on the professional development of students. While this learning may be positive, it may conflict with that taught in the formal curriculum. Medical schools take a range of steps to address these negative effects; however, the existence and nature of the concept tends to be hidden from students.

Editorial: Special Issue on Threshold Concepts in Health and Social Care

The idea for this special issue on threshold concepts in health and social care originally arose from a conversation between Sarah Barradell, Linda Martindale and Tracy Fortune in Melbourne in 2015. A year later, discussions at the 6th International Biennial Threshold Concepts Conference in Halifax, Canada saw the idea take further shape. With more than ten years passing since the term threshold concepts came into being, it seemed fitting to bring together work from scholars in healthcare disciplines and explore how threshold concepts are being put to use, whether this is learning for practice or learning based in practice.

Learning to become a primary care professional: insights from threshold concept theory

ABSTRACT Threshold Concepts are fundamental ideas within a discipline which are transformative, integrative, irreversible and usually troublesome. This article describes the threshold concept framework and discusses how it can offer new insights into how we focus teaching and facilitate learning around these concepts, such as uncertainty. Relevant research from a range of health disciplines are explored to consider which concepts may be critical to thinking and practising effectively in primary care. In addition, it is proposed that threshold concepts may have relevance to the GP recruitment crisis.