Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Med Educ. 2018 Jun;52(6):620-631. doi: 10.1111/medu.13526. Epub 2018 Feb 27.
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 (TCs) 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.
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 TCs was used as a sensitising concept.
In total, nine TCs 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 TCs 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.
The identified TCs 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 TCs into assessment and the support of trainee development.
职业认同形成的社会化理论（PIF）认为临床实习是至关重要的、具有变革性的经历。然而，很少有研究探讨受训者在这些变革性经历中所面临的问题，或这些经历对表现的影响。本研究应用阈概念（TCs）的视角，调查和记录初级受训者在临床轮转期间可能遇到的“麻烦”和“变革性”概念。获得的见解对于支持学员的发展至关重要。
本研究采用建构主义扎根理论方法指导数据的收集和分析，分为两个阶段。第一阶段包括在两个观察期内对 17 名初级受训者进行直接观察和实地访谈，第二阶段对 13 名主治医生进行深入访谈。TCs 理论被用作敏感概念。
共确定了九个 TCs，并根据主题分为以下几类：专业发展、提供患者护理和集体协作。在接受访谈的主治医生中，似乎对强大的受训者已经跨越的 TCs 和较弱的受训者难以跨越的 TCs 有共同的理解。观察和实地访谈数据表明，个体受训者的行动受到所确定的 TCs 的强烈影响，以及受训者是否似乎已经跨越了任何给定的门槛。此外，个体的临床实践可能受到不止一个 TCs 的影响。受训者在他们已经跨越或正在努力的门槛上也存在差异。
所确定的 TCs 为受训者的行动与他们如何概念化实践之间的关系提供了重要的见解。在本质上，许多 TCs 似乎代表了实践的理想，受训者在探索成为一名医生的意义时，应该将这些理想纳入他们不断发展的身份中。未来的研究应探讨如何将 TCs 纳入评估和支持学员发展。
