Insights into teaching a complex skill: Threshold concepts and troublesome knowledge in electroencephalography (EEG)

Abstract

Background: Threshold concepts (TCs) are defined as ideas within a discipline that are often conceptually difficult (“troublesome”), but when learned, transform a learner’s understanding. Electroencephalography (EEG) has been recognized as a conceptually difficult field in neurology, and a study of threshold concepts in EEG may provide insights into how it is taught and learned.

Methods: Semi-structured interviews were performed with 12 EEG experts in the US and Canada. Experts identified potential TCs and troublesome knowledge, and explored how these concepts were taught and learned. Interview transcripts were coded and analyzed using a general thematic analysis approach, based on the core elements of the threshold concepts framework.

Results: One concept (polarity) emerged most clearly as a threshold concept. Other troublesome areas included pattern interpretation and clinical significance, but these lacked some of the characteristics of TCs. Several themes emerged, including the role of TCs and troublesome knowledge in determining expertise and the role of prior experience.

Conclusions: We have used the threshold concepts framework to explore potential barriers to learning, suggest ways to support learners, and identify potential points of emphasis for teaching and learning EEG. A similar approach could be applied to the study of teaching and learning in other conceptually difficult areas of medical education.

Acknowledgements

The authors wish to acknowledge the EEG experts who were interviewed for the purposes of this work. Dr. Moeller would also like to thank the faculty and staff in the MSc Clinical Education Programme at the University of Edinburgh.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Threshold concepts: Concepts within a discipline that are conceptually difficult (“troublesome”), but when learned, transform a learner’s understanding of the field, opening up new ways of thinking (Meyer, J. H. F., & Land, R. 2003. Threshold Concepts and Troublesome Knowledge: linkages to ways of thinking and practising within the disciplines. In C. Rust (Ed.), Improving Student Learning – Ten Years On. Oxford: Oxford Centre for Staff and Learning Development).

Additional information

Notes on contributors

Jeremy J. Moeller

Jeremy J. Moeller, MD, MSc, is Assistant Professor of Neurology and Neurology Residency Program Director at Yale School of Medicine.

Tim Fawns

Tim Fawns, PhD, is an Academic Coordinator in the MSc Clinical Education Programme and Fellow in Clinical Education at the University of Edinburgh.