Student Perspectives of Threshold Concepts in Undergraduate Medical Education for Understanding the Structure and Function of the Human Body
Authors: Ferriby Andrew C. , Schaefer Audra F. 
Published: May 2022

The purpose of a curriculum is to produce individuals with proficiency in content knowledge, ability to apply knowledge, and eventually become experts in a given field. One theory of how students transition into thinking like an expert is through the acquisition of threshold concepts. Threshold concepts are pieces of knowledge in a field that, once understood, produce a qualitative shift in a student’s thinking and increases their potential to become an expert in that field. There is sparse research in threshold concepts in medical education, and most of the current literature either focuses on aspects of clinical practice or serves as a discussion piece with no empirical evidence. There are even fewer studies that attempt to identify the threshold concepts for understanding the scientific principles that underlie medicine as a field, and these studies often rely only on expert opinions. This is a shortcoming since experts in undergraduate medical education, often Ph.D. researchers, have a very different perspective than the medical student currently grappling with the scientific concepts for the first time. This study aims to address this gap in the literature by conducting focus groups with medical students in all four years of undergraduate medical education (M1‐M4) at a large allopathic medical school to examine which concepts students identify as threshold concepts in medical education for understanding the human biology. All curricular years were included determine the student perspectives at each stage of undergraduate medical education and capture any potential shifts throughout the medical curriculum in the clinical and pre‐clinical years. Sessions were semi‐structured and asked questions that inquired about the threshold concepts for understanding the human biology for medical practice. Focus group sessions were recorded, transcribed and analyzed using thematic analysis. Three M4 students, ten M3 students, nine M2 students and four M1 students participated in focus groups. At the present time, data are still undergoing thematic analysis. Thus far, the major codes emerging pertain to cardiovascular, pulmonary, renal physiology and neurobiology as potential threshold concepts. Students also identified as pathology as a potential threshold concept since it integrates the knowledge they have previously learned and applies it to medical practice. A theme that appears to be emerging is the importance of hands‐on patient/clinical experience to push students through the threshold into understanding a particular scientific concept. As the analysis of the data is completed, the results of this study will offer insight for medical educators on how to adapt their curricula to better suit the needs of their students. This may include further integration of basic science and clinical education, providing students opportunities to work with patients earlier in their education and/or shifting the emphasis to the most clinically relevant systems.