Threshold Concepts and Troublesome Knowledge

Abstract

Threshold concepts, first defined in 2003, are fundamental disciplinary concepts which are transformative, integrative, and irreversible and usually involve troublesome knowledge. A significant body of literature has been published in diverse disciplines from photography to physics, identifying possible threshold concepts and exploring how best to teach, learn, and assess them. Threshold concept research has been undertaken in several health professions and, more recently, within medical education. In this chapter we introduce and define threshold concepts and examine their relationship to other pedagogic theories. We synthesize and critique current thinking and relevant literature from across the disciplines and discuss how the threshold concept framework can influence curriculum design, learning support, and teaching, including specific pedagogical strategies. We identify and review possible relevant threshold concepts drawing on research in nursing, the allied health professions, and medicine. We explore the relative lack of critical analysis of the threshold concept framework and acknowledge that further educational research to understand and test potential threshold concepts, particularly empirically based studies, would be valuable for the health profession education community. However, by demonstrating how experts across the disciplines have used the threshold concept framework to research and gain new insights into the learner experience, we aim to encourage readers to consider its relevance and possible application to their work. In addition, we propose that troublesome knowledge is itself an important concept for both educators and researchers in health professions education.