Using the theory of Threshold Concepts to identify troublesome knowledge in becoming a Master Clinical Teacher

Purpose: There is a wealth of literature describing the characteristics and proficiencies of clinical teachers, but no description exists of the obstacles that clinical teachers face when aspiring to become a Master Clinical Teacher (MCT). Using Threshold Concepts (TC) theory as an analytical framework can help investigate those potential challenges.

Methods: This is a mixed-methods research integrating an exploratory survey and semi-structured interviews. The authors used a systematic approach to develop the survey and administered it to physicians in a large pediatrics department, using the results to inform the interview process. In the interview phase, the authors used purposive sampling of trainees, early-career clinical teachers, and departmentally recognized MCTs. The authors conducted reflexive thematic analysis on the qualitative data using TC as a framework, deriving areas of Troublesome Knowledge (TK) and subsequently conceptualizing TCs.

Results: The survey phase yielded 143 responses with 303 narrative comments. The interview phase comprised three focus groups and eleven individual interviews with MCTs. Four themes were identified that conceptualize as TCs with associated areas of TK, including: Embracing continual personal and professional evolution; Cultivating shared vulnerability for authentic engagement and learning; Empowering learners for self-discovery and transformation; and Navigating the complexities of clinical teaching.

Conclusions: The identified TCs and associated TKs provide insights into clinical teachers' experience in becoming MCTs. These findings can inform faculty development efforts and the individual career development of clinical teachers and also underscore the dynamic and multi-faceted nature of clinical teaching and the ongoing evolution required to excel in it.