Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.417
K. Nicola-Richmond, G. Pépin, Helen Larkin
In the current higher education environment, there is a growing expectation that universities ensure students graduate with skills and attributes that enable them to be work-ready, particularly within the health and social care disciplines. One curriculum design approach that has been proposed as facilitating this transformation from student to professional is the threshold concepts framework. A recent study identified ten threshold concepts within the discipline of occupational therapy. These were: Understanding the models and theories of occupational therapy ; Evidence-based practice; Clinical reasoning; Discipline-specific skills and knowledge; Practising in context; A client-centred approach; Occupation; The occupational therapist role; Reflective practice; and, A holistic approach . This study aimed to explore whether these threshold concepts were taught within an Australian occupational therapy program. Twelve occupational therapy educators participated in focus groups, and five themes emerged from the data. These were: professional identity; time; the impact of the learning environment; explicit versus implicit content and language; and, the value and understanding of the threshold concepts framework. The study found that the integrated use of threshold concepts may make them unique to the discipline. Findings also indicated that using the threshold concepts framework facilitates the transformation from student to occupational therapist. However, students may not acquire all of the threshold concepts prior to graduation. Practice-based learning was considered pivotal for threshold concept acquisition. This study explores the application of the threshold concepts framework, providing insights for educators who are seeking to produce graduates who are well-equipped for employment in complex healthcare environments.
{"title":"‘Once You Get the Threshold Concepts the World Is Changed Forever’: The Exploration of Threshold Concepts to Promote Work-ready Occupational Therapy Graduates: The exploration of threshold concepts to promote work-ready occupational therapy graduates","authors":"K. Nicola-Richmond, G. Pépin, Helen Larkin","doi":"10.18552/IJPBLHSC.V6I1.417","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.417","url":null,"abstract":"In the current higher education environment, there is a growing expectation that universities ensure students graduate with skills and attributes that enable them to be work-ready, particularly within the health and social care disciplines. One curriculum design approach that has been proposed as facilitating this transformation from student to professional is the threshold concepts framework. A recent study identified ten threshold concepts within the discipline of occupational therapy. These were: Understanding the models and theories of occupational therapy ; Evidence-based practice; Clinical reasoning; Discipline-specific skills and knowledge; Practising in context; A client-centred approach; Occupation; The occupational therapist role; Reflective practice; and, A holistic approach . This study aimed to explore whether these threshold concepts were taught within an Australian occupational therapy program. Twelve occupational therapy educators participated in focus groups, and five themes emerged from the data. These were: professional identity; time; the impact of the learning environment; explicit versus implicit content and language; and, the value and understanding of the threshold concepts framework. The study found that the integrated use of threshold concepts may make them unique to the discipline. Findings also indicated that using the threshold concepts framework facilitates the transformation from student to occupational therapist. However, students may not acquire all of the threshold concepts prior to graduation. Practice-based learning was considered pivotal for threshold concept acquisition. This study explores the application of the threshold concepts framework, providing insights for educators who are seeking to produce graduates who are well-equipped for employment in complex healthcare environments.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47208766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.421
L. Hudson, P. Engel-Hills, C. Winberg
This article identifies potential threshold concepts in radiation physics, and explains their relationship to professional practice in radiation therapy (that is,. the practice of radiation treatment and care of cancer patients). Concepts such as how the radiation beam spreads out (beam divergence), and how the distance from the ionising source affects the beam (inverse-square law), can be challenging for students entering higher education and experiencing their first clinical placements. Through observations of radiation therapy students in practice, mastery of these (and other concepts) appears essential for them to progress in their professional practice learning. The study used ‘transactional curriculum inquiry’ ( Cousin 2009 ) in order to understand why particular concepts might be troublesome to students, and how mastery of these concepts could potentially lead to safe and accurate practice. While the study was conducted in a particular Bachelor of Science in Radiation Therapy programme, it has implications for how academic and clinical educators in other contexts might facilitate students’ acquisition of the threshold concepts that underpin professional practice. The findings suggest that the typical progression in professional education that assumes the application of theoretical concepts to practice, might not be the best way to acquire the threshold concepts that lead to transformed practice.
{"title":"Threshold Concepts in Radiation Physics Underpinning Professional Practice in Radiation Therapy","authors":"L. Hudson, P. Engel-Hills, C. Winberg","doi":"10.18552/IJPBLHSC.V6I1.421","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.421","url":null,"abstract":"This article identifies potential threshold concepts in radiation physics, and explains their relationship to professional practice in radiation therapy (that is,. the practice of radiation treatment and care of cancer patients). Concepts such as how the radiation beam spreads out (beam divergence), and how the distance from the ionising source affects the beam (inverse-square law), can be challenging for students entering higher education and experiencing their first clinical placements. Through observations of radiation therapy students in practice, mastery of these (and other concepts) appears essential for them to progress in their professional practice learning. The study used ‘transactional curriculum inquiry’ ( Cousin 2009 ) in order to understand why particular concepts might be troublesome to students, and how mastery of these concepts could potentially lead to safe and accurate practice. While the study was conducted in a particular Bachelor of Science in Radiation Therapy programme, it has implications for how academic and clinical educators in other contexts might facilitate students’ acquisition of the threshold concepts that underpin professional practice. The findings suggest that the typical progression in professional education that assumes the application of theoretical concepts to practice, might not be the best way to acquire the threshold concepts that lead to transformed practice.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46278213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.419
S. Barradell, T. Peseta
The work practices of a health professional involve a complex weaving together of knowing what , knowing how, and knowing why . To help students engage with what is required for practice, educators need to have an expansive view of what it means to be a health professional in the rapidly changing real-world contexts that people inhabit today. Threshold concepts, and the complementary framework Ways of Thinking and Practising (WTP), are educational ideas that can help educators to think in those broad ways about health’s knowledge base, behaviours, and values, and how these appear in the curriculum. This article offers a case example from a pre-clinical entry-level physiotherapy subject to illustrate how threshold concepts and WTP informed what students came to understand about health professional practice. A curriculum that considers threshold concepts and WTP in combination helps both educators and students to engage with learning from multiple perspectives and to develop a connected understanding of their chosen profession. Helping students to articulate the connections between knowledge (e.g. threshold concepts) and how this knowledge is put to use (e.g. through the WTP of the profession) enables them to reconsider practice-related contexts in meaningful ways.
{"title":"Integrating Threshold Concepts and Ways of Thinking and Practising: Supporting Physiotherapy Students to Develop a Holistic View of the Profession through Concept Mapping","authors":"S. Barradell, T. Peseta","doi":"10.18552/IJPBLHSC.V6I1.419","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.419","url":null,"abstract":"The work practices of a health professional involve a complex weaving together of knowing what , knowing how, and knowing why . To help students engage with what is required for practice, educators need to have an expansive view of what it means to be a health professional in the rapidly changing real-world contexts that people inhabit today. Threshold concepts, and the complementary framework Ways of Thinking and Practising (WTP), are educational ideas that can help educators to think in those broad ways about health’s knowledge base, behaviours, and values, and how these appear in the curriculum. This article offers a case example from a pre-clinical entry-level physiotherapy subject to illustrate how threshold concepts and WTP informed what students came to understand about health professional practice. A curriculum that considers threshold concepts and WTP in combination helps both educators and students to engage with learning from multiple perspectives and to develop a connected understanding of their chosen profession. Helping students to articulate the connections between knowledge (e.g. threshold concepts) and how this knowledge is put to use (e.g. through the WTP of the profession) enables them to reconsider practice-related contexts in meaningful ways.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46689528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.517
R. Land, Hilary Neve, L. Martindale
Note: Hilary Neve and Linda Martindale, members of the editorial team for this special Issue of the International Journal of Practice-based Learning in Health and Social Care , undertook this interview with Ray Land in June 2018. The interview was transcribed verbatim and subsequently edited for publication. In this, Ray Land considers the impact of threshold concepts generally as well as key implications for the healthcare education and practice.
{"title":"Threshold Concepts, Action Poetry and the Health Professions: An Interview with Ray Land","authors":"R. Land, Hilary Neve, L. Martindale","doi":"10.18552/IJPBLHSC.V6I1.517","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.517","url":null,"abstract":"Note: Hilary Neve and Linda Martindale, members of the editorial team for this special Issue of the International Journal of Practice-based Learning in Health and Social Care , undertook this interview with Ray Land in June 2018. The interview was transcribed verbatim and subsequently edited for publication. In this, Ray Land considers the impact of threshold concepts generally as well as key implications for the healthcare education and practice.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42903323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.420
I. Wilkinson
Older adults make up the largest proportion of patients in UK hospitals. This will increase further over the next twenty years. To manage unwell older adults requires specific skills – yet many are looked after by non-specialists (be they doctors, nursing staff or therapists). Threshold Concepts (TCs) represent a means of examining the changes which take place in doctors in becoming ‘a geriatrician’, and thus may identify the key concepts to focus education on about the care of older patients. This article presents a qualitative study of trainers (consultants, the educational supervisors of junior doctors) and trainees (the junior doctors themselves). Twelve semi-structured interviews were analysed using a concept mapping technique in combination with a traditional qualitative analysis to identify TCs, which were then explored in more detail with a structured questionnaire delivered to trainees. The study shows that whilst there are a number of troublesome areas in geriatric medicine training, two concepts stood out as TCs. Appreciation of the ‘ complexity of medical care’ of older patients and what that entails, and a new concept of ‘ nurturing-care’ (focused on the wider care issues for the patient) – are proposed as TCs in geriatric medicine. Both have large degrees of tacit knowledge, and rely on a networked model of thinking. Identification of these TCs in geriatric medicine can allow a focused analysis of postgraduate medical curriculums to ensure they are covered by doctors of all grades to improve the standard of care of older patients in the UK health service.
{"title":"Nurturing and Complexity – Threshold Concepts in Geriatric Medicine","authors":"I. Wilkinson","doi":"10.18552/IJPBLHSC.V6I1.420","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.420","url":null,"abstract":"Older adults make up the largest proportion of patients in UK hospitals. This will increase further over the next twenty years. To manage unwell older adults requires specific skills – yet many are looked after by non-specialists (be they doctors, nursing staff or therapists). Threshold Concepts (TCs) represent a means of examining the changes which take place in doctors in becoming ‘a geriatrician’, and thus may identify the key concepts to focus education on about the care of older patients. This article presents a qualitative study of trainers (consultants, the educational supervisors of junior doctors) and trainees (the junior doctors themselves). Twelve semi-structured interviews were analysed using a concept mapping technique in combination with a traditional qualitative analysis to identify TCs, which were then explored in more detail with a structured questionnaire delivered to trainees. The study shows that whilst there are a number of troublesome areas in geriatric medicine training, two concepts stood out as TCs. Appreciation of the ‘ complexity of medical care’ of older patients and what that entails, and a new concept of ‘ nurturing-care’ (focused on the wider care issues for the patient) – are proposed as TCs in geriatric medicine. Both have large degrees of tacit knowledge, and rely on a networked model of thinking. Identification of these TCs in geriatric medicine can allow a focused analysis of postgraduate medical curriculums to ensure they are covered by doctors of all grades to improve the standard of care of older patients in the UK health service.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42219041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-01DOI: 10.18552/IJPBLHSC.V6I1.435
Julian A. Smith, S. Blackburn, D. Nestel
The transition from trainee to consultant cardiothoracic surgeon may be challenging. Curricula for cardiothoracic surgical training and for the professional development of cardiothoracic surgeons need to address the issues in transition that are the most difficult. This research used threshold concepts to identify the areas within this transition that are the most problematic. Semi-structured, in-depth, face-to-face, individual interviews were conducted with 13 junior cardiothoracic surgeons (in practice for ten years or less) who were purposively recruited. Transcripts were generated from the interviews and subjected to thematic analysis. Data was independently analysed by three researchers. Problematic areas in the transition to consultant practice included: (1) taking ultimate responsibility for patient care including clinical judgment, decision-making and unsupervised operating; (2) designing a career; (3) navigating new work environments; (4) managing relationships with colleagues, trainees and other team members; (5) managing technical challenges; (6) managing the previously unseen or unexpected; and (7) coping with adverse events. Uncertainty associated with each of these challenges was the most prominent threshold concept. Successfully addressing some or all of these problematic areas resulted in (8) change as a person or surgeon that positively influenced each individual’s sense of worth and identity as a cardiothoracic surgeon. Despite the completion of surgical education and training, time and the passing of the Fellowship examination, significant challenges remain for individuals commencing cardiothoracic surgical practice. There exist further curricular opportunities for the education of senior trainees and for the professional development of junior consultant surgeons to assist in the negotiation of these challenges.
{"title":"Challenges in the Commencement of Consultant Surgical Practice: A Study of Threshold Concepts in Junior Cardiothoracic Surgeons","authors":"Julian A. Smith, S. Blackburn, D. Nestel","doi":"10.18552/IJPBLHSC.V6I1.435","DOIUrl":"https://doi.org/10.18552/IJPBLHSC.V6I1.435","url":null,"abstract":"The transition from trainee to consultant cardiothoracic surgeon may be challenging. Curricula for cardiothoracic surgical training and for the professional development of cardiothoracic surgeons need to address the issues in transition that are the most difficult. This research used threshold concepts to identify the areas within this transition that are the most problematic. Semi-structured, in-depth, face-to-face, individual interviews were conducted with 13 junior cardiothoracic surgeons (in practice for ten years or less) who were purposively recruited. Transcripts were generated from the interviews and subjected to thematic analysis. Data was independently analysed by three researchers. Problematic areas in the transition to consultant practice included: (1) taking ultimate responsibility for patient care including clinical judgment, decision-making and unsupervised operating; (2) designing a career; (3) navigating new work environments; (4) managing relationships with colleagues, trainees and other team members; (5) managing technical challenges; (6) managing the previously unseen or unexpected; and (7) coping with adverse events. Uncertainty associated with each of these challenges was the most prominent threshold concept. Successfully addressing some or all of these problematic areas resulted in (8) change as a person or surgeon that positively influenced each individual’s sense of worth and identity as a cardiothoracic surgeon. Despite the completion of surgical education and training, time and the passing of the Fellowship examination, significant challenges remain for individuals commencing cardiothoracic surgical practice. There exist further curricular opportunities for the education of senior trainees and for the professional development of junior consultant surgeons to assist in the negotiation of these challenges.","PeriodicalId":36796,"journal":{"name":"International Journal of Practice-Based Learning in Health and Social Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49524272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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