Threshold Concepts in Preclinical Medical Education: Students’ Perceptions

Abstract

Threshold concepts are those ideas that learners often find difficult, but must understand in order to master a discipline. Nearly all research into threshold concepts has been from the perspective of teachers. We argue that the students' perspectives can also be helpful. In this commentary, we explore this issue and inform the debate by drawing on insights from a pilot study in which medical students articulated their own views on what constituted threshold concepts from recent learning experiences in physiology. Combining insights, from teachers and students, into candidate threshold concepts could be used to improve the medical curriculum.

Threshold concepts in medical education: A scoping review

“…38,46 Potential TCs were identified in relation to physiology and biomedical science, including secondary messenger systems, pressure gradients, preload and afterload, cell membrane potential, and polarity. 38,46 Ventilation-perfusion (V/Q) mismatch 37 and an X-ray being a 2D representation of a 3D structure 24 were proposed as TCs based on professional experience. Evaluation of this type of TC is of fundamental importance because grasping them may help in the subsequent mastery of other difficult concepts and development of skills.…”

“…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,…”

“…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, 40 paediatrics, 38 palliative care,…”

“…Ten papers focused on identifying TCs in undergraduate medical education. 22,24,25,28,[36][37][38]42,49,53 Four papers examined TCs in junior postgraduate medical education (encompassing the roles in different health care systems of interns, foundation year doctors or core trainees) or senior postgraduate medical education (senior residents, specialist trainees, registrars or fellows). 21,23,26,48 One paper looked at both undergraduate and junior postgraduate medical education, 39 and one paper focused on continuing medical education involving senior clinicians.…”

“…21,23,26,48 One paper looked at both undergraduate and junior postgraduate medical education, 39 and one paper focused on continuing medical education involving senior clinicians. 47 A variety of data collection methods were used by the primary researchers to identify potential TCs including interviews, 21,23,24,26,39,40,47,49 focus groups and discussion, 25,28,42,48 written reflections, [36][37][38] audio-diary recordings 22,25 and questionnaires. 26,28 Data were gathered from the population of interest, 21,22,[36][37][38]42,[47][48][49] educators or experts 28,40 or from both learners and trainers to triangulate the data around possible TCs.…”