Threshold concepts in health professions education research: a scoping review

Abstract

Threshold concepts (TCs) are increasingly used in health professions education (HPE) research. TCs are claimed to be conceptual gateways which are often traversed with substantial difficulty. In this paper, we report on a scoping review investigating the following research question: What is the scope and nature of the currently available research on threshold concepts in health professions education literature? We employed Arksey and O’Malley’s model for scoping reviews. A search for literature on TCs in HPE research between 2003 and 2020 yielded 999 records of which 59 were included in the review. The data set was subject to quantitative descriptive analysis of article characteristics as well as qualitative thematic analysis of the scope of research on TCs. Among the 59 articles selected for review, there were 30 empirical, 26 conceptual and three reviews. A majority were published in 2015 or later. Almost half of the included articles attempted to identify possible TCs within HPE. Others investigated how TCs can be traversed or suggested how TCs could influence curriculum design. Some critically appraised the framework of TC. Although TCs are increasingly utilised in HPE, the present review identified how researchers came across methodological challenges related to identifying possible TCs and definitional challenges around identifying the essential characteristics of TCs. Before embracing TCs as the next go-to theory for learning in HPE, we acknowledge the need for methodological stringeny and rigour as well as more data to support TCs. Until then, any implementation of TCs in HPE curricula should be done cautiously.

A Reflection On: Integrating Threshold Concepts and Ways of Think and Practising: Supporting Physiotherapy Students to Develop a Holistic View of the Profession through Concept Mapping

“…Unsurprisingly, there is an abundance of literature about threshold concepts and it continues to grow even as its original researchers have now retired from higher education. The international Threshold Concepts conference continues, as recently as July 2023 in Australia, and the field (particularly health professional education) is at a point where more scholars are conducting syntheses and reviews of threshold concepts research (Amin, 2019;Jones & Hammond, 2022;Liljedahl et al, 2022;Nicola-Richmond et al, 2018). To the best of our knowledge, we were the first to undertake such an analysis and it is perhaps half-surprising that these reviews, and other conceptual work in this space (i.e., Brown et al, 2022;Crookes et al, 2020) have reached similar conclusions: that researchers are still mainly in the business of identifying threshold concepts; that new additions to the threshold concepts terminology adds to its slipperiness; and that these different understandings have implications for research and the utility of threshold concepts.…”