Providing a liminal space: Threshold concepts for learning in palliative medicine

Abstract

Introduction: Experience in palliative medicine provides a beneficial learning opportunity for doctors-in-training. There is, however, a gap in understanding which aspects of learning are most useful, which are problematic and how learning can best be facilitated. This study addresses that gap using the ‘threshold concepts’ framework. Threshold concepts are critical points of learning, often unique to a discipline. The learning occurs within a transitional or ‘liminal’ space and has specific characteristics including being ‘troublesome’ and ‘transformative.’

Methods: A qualitative, exploratory study was carried using the threshold concept framework. Semi-structured focus group interviews were held with doctors-in-training who had undertaken a 6-month palliative medicine attachment. Data were analysed using a content analysis approach with deductive and inductive phases, in order to identify threshold concepts.

Results: Five threshold concepts were identified. Two of these, ‘emotional engagement’ and ‘communication management,’ displayed all the typical characteristics of threshold concepts. This learning was highly valued by participants, had not occurred elsewhere in training and continued to influence practice.

Conclusions: Specific threshold concepts were identified for doctors undertaking a palliative medicine placement. These highlights where specific supports are required for learning and can be used to inform curriculum design.

Ethical approval

Ethical approval was obtained from the University of Auckland Human Participants Ethics Committee, (UAHPEC8356). Written consent was obtained from all participants.

Acknowledgements

The authors wish to acknowledge the contribution of Dr. Miriam Nataksuji, MBChB, FRNZCGP, a Professional Teaching Fellow at the Clinical Skills Centre, FMHS, the University of Auckland. Miriam was a co-interviewer in one of the interviews.

Disclosure statement

The lead author had a professional relationship with one of the participants at the time of the study and previous professional relationships with the other participants. The lead author was not involved in approaching the participants or carrying out the focus group interviews. The other two authors report no declarations of interest.

Glossary

Liminal space: ‘A transformative state in the process of learning in which there is a reformulation of the learner’s meaning frame and an accompanying shift in the learner’s ontology or subjectivity’ (Land et al. 2014).

Data availability

Data is stored on the University of Auckland server. Data sharing is available subject to ethics committee approval.

Note

Notes

1 A brand of highlighter pen.

Additional information

Notes on contributors

Anne O’Callaghan

Anne O’Callaghan, MBBS, MRCP (UK), FAChPM, EdD, is a Palliative Medicine Specialist at Auckland City Hospital and Senior Lecturer in the Department of Psychological Medicine, the University of Auckland. Her interests include medical education, clinical communication and the way in which teams influence wellbeing and practice in healthcare settings.

Andy Wearn

Andy Wearn, MBCHB, MMedSc, MRCGP, FRNZCGP, is Head of the Medical Programme at the University of Auckland, and also works part-time as a general practitioner. His interests are in clinical skills, professionalism, curriculum, assessment and small group learning. He has an eclectic mix of publications in health professional education and primary care.

Mark Barrow

Mark Barrow, MSc, EdD, is the Dean of the Faculty of Education and Social Work at the University of Auckland. He has research interests in the development of professional and academic identity, and interprofessional education in health care settings.