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. 15 students and 7 tutors kept audio diaries over two terms. Data were analysed qualitatively for content. The key themes were then cross referenced to threshold concept criteria (for example 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. 3 complex and contextual nature of professionalism learning is increasingly being recognised, as is its potential as a transformational, life changing process rather than simply involving the acquisition of knowledge and skills (Wilson et al. 2013). Recent literature suggests that meaningful professionalism learning and professional identity development can be fostered by authentic experiences in and around the workplace (Reich, Rooney, and Boud 2015, Wilson et al.2013) and by providing opportunities for guided, critical reflection on such experiences (Mann 2009; Webster-Wright 2009; Trede, Macklin, and Bridges 2012). Moreover, where curricula provide opportunities for students to reflect on experiences which challenge or disrupt their worldviews and to share and to discuss their reflections with peers, this can lead to "more powerful and generative understandings" (Ryan and Carmichael 2015). Coherence, the ability to link theory and practice and see the practical relevance of learning, particularly when developed through interactions with peers and teachers, can be key to fostering students' identification with their profession (Heggen and Terum 2013). One way curricula can achieve many of the goals above is through facilitated small group learning, where students reflect on their experiences with peers, are encouraged to consider issues from multiple perspectives and challenged to consider things more deeply (Platzer 2000; Kahn 2013). This can result in more sophisticated and embodied understandings of professionalism (Monrouxe, Rees, and Hu 2011). Yet exactly how small group learning impacts on students' professionalism development and identity is under-researched; we know very little about students' lived experiences of such learning, including which professionalism concepts are troublesome and transformative and which elements of the small group setting facilitate shifts in student understandings. Threshold concepts There is growing int...

What trainees grapple with: a study of threshold concepts on the medicine ward

“…The identified TCs both confirm findings from prior research and offer novel insights into how we might be able to support trainee development. They confirm previous findings, in that, for each identified TC, we could identify studies supporting their importance in trainee development . When identified and labelled as we have done, they also offer a potentially novel opportunity for supporting trainee development .…”

“…Although threshold concepts are relatively new to the field of medical education, they show potential in offering insights into the types of things trainees grapple with . Clouder produced one of the first descriptions of TCs in health care when she identified ‘caring in the clinical workplace’ as a threshold .…”

“…More specifically, Clouder identified that working in clinical contexts may cause some trainees to grapple with their previous conceptions of caring and, over time, to undergo a paradigm shift in how they understand and enact caring . Following on from this work, Neve et al have identified seven TCs that, based on audio‐diaries, may play a role in trainees’ PIF. Moreover, their findings suggest that these troublesome concepts medical trainees struggle with can have moral or value‐based components that, depending on how they are taken up or understood, can influence trainees’ development …”

Threshold Concepts in Medical Education

“…Since then, they have been studied in Europe, Australia, and New Zealand in such diverse professions as architecture, literature, social studies, and accounting. A handful of studies identifying TCs in medical education have appeared recently from authors in the United Kingdom (Neve, Wearn and Collett, 2016a;Barradell and Peseta, 2017;Collett, Neve and Stephen, 2017;Neve, Lloyd and Collett, 2017b;Neve, Lloyd and Collett, 2017a). …”

“…Collett and Neve and their colleagues in the UK (Neve, Wearn and Collett, 2016b;Collett, Neve and Stephen, 2017;Neve, Lloyd and Collett, 2017a) have studied the TC encountered by medical students captured in audiodiaries, in which they found concepts including appreciating uncertainty, recognizing a bigger picture, not needing to know everything, and an appreciation of the physicians' professional culture. Barradell and Peseta (Barradell and Peseta, 2017) from Australia have provided a qualitative research synthesis of studies of TC in healthcare.…”