The increasing relevance of immunobiology within a connected animal science curriculum

Modern technological agriculture emerged in the 20th century and has expanded into a global enterprise occupying approximately 38% of the Earth's land area and accounting for over 40% of the world's workforce. The United Nations Food and Agriculture Organization estimates that to feed a world population of 9-billion people in 2050 will require an almost doubling of overall food production, including meat, dairy, and egg production over 2010 levels. However, our collective ability to meet this demand cannot be taken for granted. Despite many successes, global agricultural systems now face multiple unprecedented challenges including a dearth of new treatments for livestock diseases. The discovery of antibiotics led to a complacency now reflected in a dependency on exogenous antimicrobials and a growing threat of antimicrobial resistance. Developments within the field of immunobiology had led to significant breakthroughs in understanding of human health and disease. However, despite over 60% of infectious diseases being zoonotic in nature and nonhuman animals acting as an important disease reservoir, research in livestock immunobiology has not been as resourced. As a direct result, recalcitrant animal diseases continue to threaten sustainability of animal production systems, security of the food chain and human health. It is within the context of collective One Health action that ambitious innovation in the connectivity of animal science undergraduate curricula is urgently required, specifically to include threshold concepts in immunobiology. Fostering transformative learning is critical to equip future generations of animal scientists with the knowledge and interdisciplinary skills to counter these existential challenges of our time.

Identification of histological threshold concepts in health sciences curricula: Students' perception

Students' metacognitive skills and perceptions are considered important variables for high-quality learning. In this study, students' perceptions were used to identify histological threshold concepts (integrative, irreversible, transformative, and troublesome) in three health sciences curricula. A specific questionnaire was developed and validated to characterize students' perceptions of histological threshold concepts. A sample of 410 undergraduate students enrolled in the dentistry, medicine, and pharmacy degree programs participated in the study. Concepts assessed in the study were clustered to ten categories (factors) by exploratory and confirmatory factor analysis. Concepts linked to tissue organization and tissue functional states received the highest scores from students in all degree programs, suggesting that the process of learning histology requires the integration of both static concepts related to the constituent elements of tissues and dynamic concepts such as stem cells as a tissue renewal substrate, or the euplasic, proplasic and retroplasic states of tissues. The complexity of integrating static and dynamic concepts may pose a challenging barrier to the comprehension of histology. In addition, several differences were detected among the students in different degree programs. Dentistry students more often perceived morphostructural concepts as threshold concepts, whereas medical students highlighted concepts related to two-dimensional microscopic identification. Lastly, pharmacy students identified concepts related to tissue general activity as critical for the comprehension and learning of histology. The identification of threshold concepts through students' perceptions is potentially useful to improve the teaching and learning process in health sciences curricula.

Movement System Theory and Anatomical Competence: Threshold Concepts for Physical Therapist Anatomy Education

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal systems are all included within this schema as the movement system theory encompasses all body systems interacting to create movement across the lifespan. Implementing movement system theory requires an ability to use human anatomy in physical therapist education and practice. Understanding the human body is a mandatory prerequisite for effective diagnosis, assessment, treatment, and patient evaluation. Anatomical competence refers to the ability to apply anatomic knowledge within the appropriate professional and clinical contexts. Exploring the required anatomical concepts for competent entry-level physical therapist education and clinical practice is warranted. The recommended threshold concepts (fluency, dimensionality, adaptability, connectivity, complexity, stability or homeostasis, progression or development, and humanity) could serve as an integral and long-awaited tool for guiding anatomy educators in physical therapy education.

Medical students' experiences of a longitudinal integrated clerkship: a threshold concepts analysis

Longitudinal Integrated Clerkships (LIC) are known to provide several pedagogical advantages including transformational educational experiences. The study explored the learning experience of undergraduate medical students who undertook a rural LIC in a Scottish primary care setting. This paper presents an analysis of the transformative role of LIC placements using the Threshold Concept (TC) theory. This qualitative study gathered students' perceptions of their LIC experience longitudinally through written and audio diaries over a period of 1-2 months. The issues narrated in diaries were followed-up in individual semi-structured interviews. Transcripts were thematically analysed to identify key characteristics of TCs using a criterion-based approach. Data from 12 audio and nine written diaries, and five interviews led to identification of three inter-connected themes associated with the LIC year: professional identity formation, becoming an agentic learner and comfort with uncertainty. These appeared transformative in nature and resembled threshold concepts in their character and effect. An active and legitimate role in the healthcare team, longitudinality and transdisciplinary learning during LIC placements were contributary towards navigating these thresholds. The LIC exposure provided transformative learning experiences, and a stable environment that facilitated acquisition of specific TCs in the medical students' journey towards becoming a doctor. LIC affordances fostered a transformed view of self, which was more confident in dealing with uncertainty, comfortable in the emerging professional identity, and described having enhanced agentic capabilities.

Threshold concepts in group-based mentoring and implications for faculty development: A qualitative analysis

INTRODUCTION

The literature on faculty development programs for mentors is scarce. This study examines mentors' experiences and challenges, with the aim of identifying threshold concepts in mentoring. It also discusses the implications for the faculty development of mentors.

METHODS

Semi-structured interviews solicited personal narratives and reflections on mentors' lived experiences. Data analysis was guided by the threshold concepts framework allowing for the identification of significant and transformative shifts in perspectives.

RESULTS

We interviewed 22 mentors from two Norwegian and one Canadian medical school with group-based mentoring programs. The mentoring experience involved four significant threshold concepts: focusing on students' needs; the importance of creating a trusting learning space; seeing oneself through the eyes of students; and aligning mentor and physician identities.

CONCLUSION

Taking on a mentor role can provoke personal and professional dilemmas while also sparking growth. The trajectories of developing as a mentor and as a professional physician may be seen to mutually validate, mirror and reinforce each other. Faculty development programs designed specifically for mentors should aim to stimulate reflection on previous learning experiences and strive for a successful alignment of the distinct pedagogical and clinical content knowledge required to fulfill various professional roles.

Threshold Concepts in a Literary Magazine Produced by Health Care Students

This article was migrated. The article was marked as recommended. Introduction: Progress Notes is a literary magazine featuring works from health care students in the USA. It is edited by medical students at the Uniformed Services University of the Health Sciences (USUHS) to provide a space for their creative works. Since the magazine's inception in 2016, four volumes have been published, containing 130 works of poetry, fiction, reflection, and artwork. Goal: To understand the themes and perspectives of the published works. Methods: After Institutional Review Board approval, two researchers used qualitative thematic analysis to examine the texts, coding independently and resolving differences by discussion. They arranged the codes into themes which were discussed until consensus. A third researcher read the texts, codes and themes and verified that they were an accurate reflection of the published works. Artwork was assigned themes by the same two researchers who analyzed the written works, and a sample selection was verified by the third researcher. Results: Researchers identified eight themes across poetry, fiction, and reflective essays: vocation, death, failure/resilience, emotional restraint, personhood of the patient, approach to the patient, military physicians, and moments of personal realization. Four themes were identified in the artwork: death; comradeship/aloneness; vocation/quest; and competence. Discussion: Students submitted creative works in which they grapple with what it means to be a physician. Analyzed through the lens of the threshold concepts, researchers identified: "I am a healer;" "I can deal with ambiguity;" "The patient is the focus;" "As a military medical officer, I serve two masters;" and "As a physician, I have a unique and complex relationship with death." These threshold concepts represent an ontological shift in the students' professional identity. Conclusion: A literary magazine edited, and featuring works by, health care students provides a forum in which health care students wrestle with the elusive and enigmatic fundamental principles of being a physician.

Aiding Transformation from Student to Practitioner by Defining Threshold Concepts for the Pharmacists' Patient Care Process

Objective. To explore critical milestones in the transition from student to practitioner by identifying the threshold concepts associated with learning the Pharmacists' Patient Care Process (PPCP). Methods. A threshold concept represents a transformed way of thinking about a topic or discipline. This study convened five focus groups to identify possible threshold concepts related to learning the PPCP. The data were analyzed by deductive content analysis and confirmed by an expert consensus panel using a modified nominal group technique. Results. Moving beyond the process outlined by the PPCP, the five focus groups identified additional elements of learning required in becoming a patient care practitioner. These elements were focused on the more intangible aspects of patient-centered care, such as practitioner priorities, attitude, and approach. As such, the data help to describe how practitioner's think, feel, and act (ie, their identity). Deductive content analysis resulted in five Patient Care Threshold Concepts (PCTC), which were confirmed by the expert consensus panel. Conclusion. The five PCTCs provide pharmacy educators with an additional tool to use in teaching the PPCP. The PCTCs can aid in the student-practitioner transformation by helping to make implicit aspects of patient care more explicit. They are supplements to patient care competencies that help explain the practitioner's priorities, attitude, and approach. They can also serve as guidance to pharmacy educators in evaluating curricular activities and assessments, as well as identity formation. This approach can be applied to the identification of threshold concepts in other areas of pharmacy education, such as leadership.

Learning to communicate with people with dementia: Exploring the impact of a simulation session for medical students (Innovative practice)

There is a recognised need to improve undergraduate education within dementia care. UK medical schools provide dementia-specific teaching, but this has previously been found to focus more on student knowledge and skills rather than behaviours and attitudes and does not often involve the wider multidisciplinary team. A simulation day was established, based on communicating with a person with dementia in a number of scenarios. This article aims to identify if this method of teaching within dementia care is successful. It is a qualitative study and draws on data from postcourse questionnaire responses and field notes of the simulation day. The data offered rich insights into how the session allowed participants to be challenged and taken to their perceived thresholds of capability. It highlights that behaviours and skills can be learnt via simulation and leads to a transformative change in the language learners used, suggesting that learning may happen through threshold concepts.

Tackling the threshold concepts in physiology: what is the role of the laboratory class?

Laboratory practical programs are expected to fulfill many roles in the learning process, including the development of laboratory skills and problem-solving skills. However, little is known about the role of laboratory practical classes in the conceptual learning of physiology. Therefore, the main aims of this study were to identify some of the threshold concepts in physiology and to explore the role of our laboratory practical program in helping students to tackle these concepts. An online questionnaire gathered opinions from students on the value of the laboratory classes in helping them to learn. Interviews with students and with lecturers were performed to ascertain which concepts students find particularly difficult, why they find these concepts difficult, and what their opinions are on the role of the laboratory practical classes in helping students to grasp difficult concepts. A number of threshold concepts in physiology were identified, and some possible reasons underlying the difficulties were explored. Overall, the majority of respondents found that the laboratory practical program helped them to learn physiology. While the laboratory classes were found to promote conceptual learning in a number of ways, a prominent finding was that the laboratory classes help students to grasp the theory because they allow students to visually see the physiological events, they bring the theory to life, and they allow students to experience some applications of the theory. The study also highlighted areas for further development in relation to the promotion of conceptual learning within the teaching laboratory.

Troublesome Knowledge: A New Approach to Quality Assurance in Mental Health Nursing Education

Background Quality assurance and quality enhancement processes in nursing education are vital to the establishment of a strong program. Existing quality assurance methods in nursing education such as professional self-regulation and external examination rely on provincial and national nursing associations for evaluation, putting minimal responsibility and accountability on internal program examiners. Threshold concepts and troublesome knowledge provide a framework as outlined by Land that utilizes internal examiners from both student and faculty groups and represents an alternative to traditional quality assurance in nursing education. Purpose To identify troublesome mental health nursing content in a nursing curriculum by exploring students and faculty perspectives. Method A sequential mixed methods design that utilized surveys and focus groups to explore student and faculty perspectives on troublesome mental health nursing content. Results The project data were able to be organized into five main content themes that were identified as being troublesome: the spectrum of mental illness, therapeutic relationships and boundaries, praxis, professionalism in nursing, and brain chemistry and its management. Conclusion The findings from this project are unique to the program of review but show the potential of this new approach to quality assurance and program enhancement initiatives in nursing education.

Threshold concepts in prosthetics

BACKGROUND

Curriculum documents identify key concepts within learning prosthetics. Threshold concepts provide an alternative way of viewing the curriculum, focussing on the ways of thinking and practicing within prosthetics. Threshold concepts can be described as an opening to a different way of viewing a concept. This article forms part of a larger study exploring what students and staff experience as difficult in learning about prosthetics.

OBJECTIVES

To explore possible threshold concepts within prosthetics.

STUDY DESIGN

Qualitative, interpretative phenomenological analysis.

METHODS

Data from 18 students and 8 staff at two universities with undergraduate prosthetics and orthotics programmes were generated through interviews and questionnaires. The data were analysed using an interpretative phenomenological analysis approach.

RESULTS

Three possible threshold concepts arose from the data: 'how we walk', 'learning to talk' and 'considering the person'.

CONCLUSION

Three potential threshold concepts in prosthetics are suggested with possible implications for prosthetics education. These possible threshold concepts involve changes in both conceptual and ontological knowledge, integrating into the persona of the individual. This integration occurs through the development of memories associated with procedural concepts that combine with disciplinary concepts. Considering the prosthetics curriculum through the lens of threshold concepts enables a focus on how students learn to become prosthetists. Clinical relevance This study provides new insights into how prosthetists learn. This has implications for curriculum design in prosthetics education.

The transition to self-regulated learning for first-year dental students: threshold concepts

Research shows that when students arrive at university they are often not prepared for independent learning. New students enter a period of transition during their first year, which is often characterised by emotional destabilisation, as they move towards becoming more self-regulating in their new learning environment. In this small-scale qualitative study, data from an in-depth pair interview were triangulated with data from a questionnaire, to explore participants' experiences of self-regulated learning in the first year of a Dental Surgery course. Five threshold concepts relating to learning in transition emerged from the analysis of the data. These concepts were as follows: learning how to learn using a range of self-chosen sources instead of a single textbook, learning how to organise incoming information without guidance, distinguishing between main ideas and detail during revision, coping with a heavy workload, and knowing what to expect from examinations and coursework. Strong emotions (feeling confused, overwhelmed and scared) were associated with negotiating these threshold concepts. However, the study illustrates how the participants adopted new cognitive and metacognitive strategies to become more self-regulating over time. The findings of the study suggest that lecturers, tutors, study advisers and peers all have an important role to play in explicitly guiding first-year students as they grapple with troublesome threshold concepts relating to self-regulated learning. Furthermore, structural changes to the content-heavy, lecture-based curricula often associated with first-year Medical and Dental courses would help ease students' transition to independent learning, which may make an impact on student attainment.

Developing Confidence in Uncertainty: Conflicting Roles of Trainees as They Become Educators in Veterinary and Human Medicine

The important role of medical trainees (interns and residents) as teachers is increasingly recognized in veterinary and human medicine, but often is not supported through adult learning programs or other preparatory training methods. To develop appropriate teaching programs focused on effective clinical teaching, more understanding is needed about the support required for the trainee's teaching role. Following discussion among faculty members from education and veterinary and pediatric medicine, an experienced external observer and expert in higher education observed 28 incoming and outgoing veterinary and pediatric trainees in multiple clinical teaching settings over 10 weeks. Using an interpretative approach to analyze the data, we identified five dynamics that could serve as the foundation for a new program to support clinical teaching: (1) Novice-Expert, recognizing transitions between roles; (2) Collaboration-Individuality, recognizing the power of peer learning; (3) Confidence-Uncertainty, regarding the confidence to act; (4) Role-Interdisciplinarity, recognizing the ability to maintain a discrete role and yet synthesize knowledge and cope with complexity; and (5) Socialization-Identity, taking on different selves. Trainees in veterinary and human medicine appeared to have similar needs for support in teaching and would benefit from a variety of strategies: faculty should provide written guidelines and practical teaching tips; set clear expectations; establish sustained support strategies, including contact with an impartial educator; identify physical spaces in which to discuss teaching; provide continuous feedback; and facilitate peer observation across medical and veterinary clinical environments.

Junior doctor dementia champions in a district general hospital (innovative practice)

Dementia is a common condition in the UK with around 25% of patients in acute hospitals having dementia. In the UK, there is national guidance on the assessment of cognitive impairment in acute hospitals. This article is a qualitative study of junior doctors' experiences as part of a dementia and delirium team involved in changing the care of patients with dementia in a hospital in the UK. It draws on data from a focus group and follow-up questionnaire in two hospital trusts. We examine what drives doctors to become involved in such projects and the effects of this experience upon them. We suggest a typology for getting junior doctors involved in projects generating change when working with patients with dementia. Being more actively involved in caring for and developing services for patients with dementia may represent the crossing of an educational threshold for these junior doctors.

The ACRL framework for information literacy in higher education: implications for health sciences librarianship

The Association of College and Research Libraries is developing a new framework of information literacy concepts that will revise and replace the previously adopted standards. This framework consists of six threshold concepts that are more flexible than the original standards, and that work to identify both the function and the feelings behind information literacy education practices. This column outlines the new tentative framework with an eye toward its implications for health sciences libraries, and suggests ways the medical library community might work with this new document.

Troublesome knowledge in pediatric surgical trainees: a qualitative study

BACKGROUND

Meyer and Land (2003) describe threshold concepts as being "akin to a portal, opening up a new and previously inaccessible way of thinking about something." As a consequence, threshold concepts have a transformational potential and may lead to an associated change in identity. The successful completion of pediatric surgical training in the United Kingdom is a lengthy and complex professional journey in which trainees emerge as consultants with a professional identity. We sought to explore how "threshold concepts" applied to pediatric surgical training with a view to identifying elements that were "troublesome."

METHODS

Semistructured interviews were conducted. Transcripts were generated from audio recordings and thematically analyzed by the authors. Constant comparison was used to refine themes. Participants were purposively recruited across all years of training. A total of 8 pediatric surgical trainees participated in the study. Approval from obtained from the Human Research Ethics committee.

RESULTS

Although there is overlap between themes, analysis revealed "troublesome" areas of training related to knowledge (breadth and rarity of some conditions), clinical judgment (shifting expectation of independence), technical skills (accessing opportunities), transitions between roles (increasing responsibility and remoteness of support), relationships with trainers, and the effect of negative experiences.

CONCLUSIONS

Viewing trainees' experiences of surgical training through the lens of "threshold concepts" provides insight to the importance of viewing the curriculum in a holistic way. Negative experiences in training were an important catalyst for development, inducing a fundamental change in perception, which might be characterized as a rupture of a "meaning frame." Trainees in pediatric surgery can be viewed as moving to a mature specialist identity via a transitional state-liminality, from entry into specialist training.