Experience of applying threshold concepts in medical education

Background: Practical barriers exist in applying threshold-concept-based clinical teaching. We applied the practice model to the subject of acute liver failure and reported the experiences in teaching and learners' reactions.

Methods: The course comprised a 10-min online preclass video and a 1-h class with in-depth discussion. The video explained six extracted threshold concepts, which were labelled TC1-TC6. Three sets of feedback questionnaires were given to students. Questionnaires were provided after they watched the online video (Q1), after class (Q2), and before the end of the curriculum section (Q3). All the feedback questionnaires were analysed.

Results: Of the 136 attendees in the academic year 2018, 127 (93.4%), 69 (50.7%), and 112 (82.4%) completed the Q1, Q2, and Q3 questionnaires, respectively, and 48 (42.6%) provided comments. The degree of comprehension varied among threshold concepts and individual students. TC1 and TC2 were viewed as transformative for all three surveys. The threshold-concept-based learning process was satisfactory, and students could auto-reflect on the defining features of a threshold concept. Students became aware of their deficiencies in knowledge and acknowledged room for development with regard to their mindset for future patient management.

Conclusion: Threshold-concept-based clinical teaching is a feasible strategy. Students' reflections indicate that thresholds were crossed, which does not guarantee that students' mindsets are ready for future clinical practice.