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Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula

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Abstract

Inherent in every clinical preceptor’s role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts – troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity – can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner’s capacity to act competently as they develop their identity at various stages of training.

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Authors and Affiliations

  1. Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Medical Sciences Building, 3800 Finnerty Road, Victoria, BC, V8P5C2, Canada

    Laura M. Farrell

  2. Department of Medicine, University of British Columbia, Vancouver, Canada

    Cary Cuncic

  3. Department of Medicine, University of British Columbia, Victoria, Canada

    Shavaun MacDonald

  4. Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, Canada

    Bruce J. Wright

  5. Division of Medical Sciences, University of Victoria, Victoria, Canada

    Bruce J. Wright

  6. Centre for Health Education Scholarship and Professor Department of Medicine, University of British Columbia, Vancouver, Canada

    Kevin W. Eva

  7. Department of Medicine, Division of General Internal Medicine and Research Scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada

    Mark A. Goldszmidt

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  1. Laura M. Farrell
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  6. Mark A. Goldszmidt
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All authors contributed to theoretical discussions underlying this paper. The first draft of the manuscript was written by Laura Farrell and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Laura M. Farrell.

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Farrell, L.M., Cuncic, C., MacDonald, S. et al. Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula. Adv in Health Sci Educ 29, 349–359 (2024). https://doi.org/10.1007/s10459-023-10245-8

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