Threshold Concepts in Medical Physiology

Abstract

INTRODUCTIONThreshold concepts are those ideas that learners often find difficult, but must understand in order to master the discipline. In order for a concept to be defined as a threshold concept, it must meet at least three out of five characteristics: transformative, irreversible, integrative, bounded, and troublesome. In the realm of threshold concepts research, there has been very little conducted in regards to medical school curriculum specifically. Medical physiology has often been a challenging core topic for medical students. The goal of this study is to better understand what students considered to be threshold concepts in physiology so medical school curricula can better address the needs of students and ensure that they have a strong foundation.METHODSVolunteers from a medical school were recruited and three focus groups were conducted during the preclinical years. Each focus group consisted of 7–8 students. The focus groups began with a brief introduction of what threshold concepts are followed by the presentation of a brief clinical case. The students were given a case that integrated knowledge that had been taught in organ system courses prior to the focus groups. Students were asked to come up with a differential diagnosis and suggestions for underlying pathophysiology. After this, they were allowed to ask questions to gather a history and explain the underlying physiological concepts that led them to their differential diagnoses. A fourth focus group was conducted in the early weeks of the clinical years and after USMLE Step 1 examination. Following all focus groups, the audio was transcribed and thematic analysis was conducted.RESULTSBased on the four focus groups conducted, several potential candidate threshold concepts emerged including secondary messenger pathways, Starling forces, preload and afterload, and cell membrane potentials.CONCLUSIONThis study identified a set of candidate threshold concepts in medical physiology from the students’ perspective. Further characterization of these candidate threshold concepts can be used as a foundation for designing an effective and powerful physiology curriculum.Figure 1