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What trainees grapple with: a study of threshold concepts on the medicine ward
Author(s) -
Bhat Chirag,
Burm Sarah,
Mohan Tricia,
Chahine Saad,
Goldszmidt Mark
Publication year - 2018
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.13526
Subject(s) - transformative learning , grounded theory , psychology , medical education , observational study , perspective (graphical) , clinical practice , pedagogy , medicine , nursing , qualitative research , sociology , social science , pathology , artificial intelligence , computer science
Objectives Socialisation theories of professional identity formation ( PIF ) consider clinical rotations to be critically intense transformative experiences. However, few studies have explored what trainees grapple with during these transformative experiences or their influence on performance. Applying a threshold concepts ( TC s) lens, this study investigates and documents ‘troublesome’ and ‘transformative’ concepts that junior trainees may encounter during a clinical rotation. Insights gained are essential for supporting trainee development. Methods Constructivist grounded theory was used to guide the collection and analysis of data for this two‐phase study. Phase 1 involved direct observation and field interviews with 17 junior trainees over two observation periods and phase 2 involved in‐depth interviews with 13 attending physicians. The theory of TC s was used as a sensitising concept. Results In total, nine TC s were identified and thematically grouped under the headings: Developing as a Professional, Providing Patient Care and Working Collectively. Across the interviewed attending physicians, there appeared to be a shared understanding of TC s strong trainees had crossed and weaker trainees struggled with. Observational and field interview data suggested that individual trainee actions were strongly influenced by the identified TC and whether or not the trainee appeared to have crossed any given threshold. Moreover, individual clinical practices could be influenced by more than one TC . Trainees were also observed to vary in the thresholds they had already crossed or struggled with. Conclusions The identified TC s offer important insights into the relationship between trainee actions and how they conceptualise practice. At their heart, many appeared to represent ideals of practice that trainees should incorporate into their developing identities as they explore what it means to be a physician. Future research should explore how to incorporate TC s into assessment and the support of trainee development.