Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula.

Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development.

BACKGROUND: Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration. METHODS: This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis. RESULTS: Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential. CONCLUSION: LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices.

CONTEXTE: La formation professorale longitudinale (FPL) peut faciliter l'acquisition d'habiletés pédagogiques, surtout dans le cadre d'un forum où les enseignants peuvent réfléchir individuellement et collectivement à ces nouvelles habiletés. Cependant, les processus exacts qui rendent ces interventions efficaces doivent être explorés davantage. MÉTHODES: Cette étude qualitative examine une initiative de FPL qui comprend l'enseignement d'une nouvelle approche de rétroaction à laquelle ont participé cinq médecins de famille. L'initiative a commencé avec la tenue de deux ateliers d'une heure et demie, le premier sur la rétroaction axée sur les objectifs (l'habileté d'enseignement à développer) et le deuxième sur la réflexion narrative (comme outil pour soutenir la réflexion personnelle sur cette habileté en apprentissage). Au cours des six mois suivants, les cinq participants ont appliqué de manière itérative l'approche de la rétroaction dans leur enseignement et se sont livrés à une réflexion narrative lors de quatre séances de groupe d'une heure. Des transcriptions des discussions de groupe et des entretiens de clôture ont fait l'objet d'une analyse thématique. RÉSULTATS: L'expérimentation itérative, la réflexion individuelle et l'exploration collective des efforts de mise en œuvre de la nouvelle approche de rétroaction ont permis de développer une communauté d'apprentissage au sein du groupe. Ce sentiment de communauté a créé un environnement sûr pour la réflexion, tout en motivant les efforts continus pour apprendre l'habileté. La préréflexion individuelle préparait les participants à la co-réflexion de groupe; cependant, les récits écrits n'étaient pas essentiels. CONCLUSION: Les initiatives de FPL devraient mettre l'emphase sur les occasions de mise en application itérative des habiletés d'enseignement, d'autoréflexion guidée et de réflexion et d'apprentissage collaboratifs en groupe pour assurer un changement durable des pratiques d'enseignement.