The troublesome nature of intraprofessional collaboration: A threshold concept perspective

Bhat, Chirag; Goldszmidt, Mark

doi:10.1111/medu.14346

Cited by 6 publications

(7 citation statements)

References 10 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty‐six papers published between 2012 and 2021 were included in the final analysis (see Figure 1 for PRISMA flow diagram). Most papers originated in the United Kingdom ( n = 15 21–35 ), North America ( n = 11 36–46 ) and Australasia ( n = 7 47–53 ). Some papers focused on particular medical specialities and subject areas, including surgery ( n = 5 21,23,41,47,54 ), medical physiology and biomedical science ( n = 4 42,43,51,55 ), geriatric medicine and dementia care ( n = 3 26,27,29 ), psychiatry ( n = 2 24,35 ), general practice ( n = 2 34,50 ), military medicine ( n = 2 36,37 ), anaesthetics, 46 internal medicine, 39 neurology, 40 paediatrics, 38 palliative care, 48 population health, 28 rheumatology 52 and transplant science 30 .…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-six papers published between 2012 and 2021 were included in the final analysis (see Figure 1 for PRISMA flow diagram). Most papers originated in the United Kingdom (n = 15 [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] ), North America (n = 11 [36][37][38][39][40][41][42][43][44][45][46] ) and Australasia (n = 7 47-53 ). Some papers focused on particular medical specialities and subject areas, including surgery (n = 5 21,23,41,47,54 ), medical physiology and biomedical science (n = 4 42,43,51,55 ), geriatric medicine and dementia care (n = 3 26,27,29 ), psychiatry (n = 2 24,35 ), general practice (n = 2 34,50 ), military medicine (n = 2 36,37 ), anaesthetics, 46 internal medicine, 39 neurology,…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

“…Other publications Commentary 4 [42][43][44][45] Conceptual analysis 3 32,33,46 Narrative review 1 53 Theoretical paper 1 57 Comment 1 34 Letter to the editor 1 35 3.4 | Ways of thinking (discipline conceptual change)…”

Section: Basic Conceptual Changementioning

confidence: 99%

See 2 more Smart Citations

Threshold concepts in medical education: A scoping review

Jones

Hammond

2022

Medical Education

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Threshold concepts in medical education: A scoping review

Jones

Hammond

2022

Medical Education

View full text Add to dashboard Cite

show abstract

“…TCs have been identified in various disciplines such as nursing,4–7 dentistry,8 9 occupational therapy,10–13 pharmacy14 and physiotherapy 15. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Hall

Chae

2022

BMJ Open

View full text Add to dashboard Cite

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.

show abstract

“…Collaborative practice between primary care (PC) physicians and medical specialists (MSs) is vital and requires mutual trust and respect. 1 , 2 , 3 , 4 In the deep‐rooted hierarchical contexts of hospitals, however, it could be a measure of status for MSs to disrespect lower‐status professionals with impunity, 5 such as PC physicians. 3 , 6 , 7 Power dynamics based on traditional hierarchies are inherently present in (intra)professional interaction and learning processes 5 , 6 , 8 , 9 , 10 and could have an adverse effect on collaborative practices 5 , 8 leading to adverse events in healthcare.…”

Section: Introductionmentioning

confidence: 99%

Exploring power dynamics and their impact on intraprofessional learning

et al. 2021

View full text Add to dashboard Cite

Background: During postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements.Methods: This study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in-depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data. Results:We defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning.Conclusions: Power dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.

show abstract

The troublesome nature of intraprofessional collaboration: A threshold concept perspective

Abstract: Bhat and Goldszmidt discuss how healthcare providers can struggle with enacting intraprofessional collaboration when faced with systemic barriers.

Cited by 6 publications

References 10 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

Exploring power dynamics and their impact on intraprofessional learning

Contact Info

Product

Resources

About