158 - Using the Theory of Threshold Concepts to Identify “Troublesome Knowledge” in Becoming a Master Clinical Teacher

Poster Number: 158
Publication Number: 158.218

Stephanie R. Hale, Baylor College of Medicine, Houston, TX, United States; Melissa M. Carbajal, Baylor College of Medicine, Houston, TX, United States; Audrea Burns, Texas Children's Hospital, Houston, TX, United States; Lisa Noll, Baylor College of Medicine, Houston, TX, United States; Linessa Zuniga, Baylor College of Medicine, Houston, TX, United States; Matei Petrescu, Baylor College of Medicine, San Antonio, TX, United States; Satid Thammasitboon, Baylor College of Medicine, HOUSTON, TX, United States

Background: A master clinical teacher (MCT) has been described as a clinician who “transcends ordinary teaching though inspiring, supporting, actively involving, and communicating with students.” This is a lofty goal that many clinical teachers aspire to, but few achieve. The literature is ripe with information on the competencies of clinical teachers, but there is nothing available that describes the essence and critical barriers that individuals face when aspiring to become an MCT. The theory of Threshold Concepts (TC) described ways of knowing central to the mastery of a subject that, once understood, transform an individual’s way of thinking and accept an alternative version of self. TC is a contemporary analytical framework used to investigate the areas of Troublesome Knowledge (TK) in many academic fields.

Objective: To identify the Troublesome Knowledge (knowledge, skills and attitudes) that one must overcome to become a master clinical teacher.

Design/Methods: This was a sequential mixed-methods research integrating findings from a survey, semi-structured interviews and focus groups. We developed, piloted and administered a survey to pediatric faculty and trainees. The quantitative findings and insights gained from survey responses were used to inform the qualitative interview procedures with purposive sampling of trainees, early career clinicians and pre-identified MCTs. We used descriptive statistics for quantitative analysis. Two authors conducted a thematic analysis on the qualitative data using the TC as a sensitizing concept.  Member checking and triangulation supported themes trustworthiness.

Results: We analyzed and interpreted 143 survey responses with 303 narrative comments. We held 3 focus groups of 4-6 participants and interviewed 11 MCTs. We identified themes that conceptualized as areas of TK including: Navigating risk inherent to learner-teacher interaction, Adjusting to various learner needs, Constructing an engaged learning environment, and Seamlessly integrating learning within workflow (Table). Conclusion(s): Informed by the theory of TCs, we identified critical areas (Troublesome Knowledge) that clinical teachers must encounter and comprehend to transform themselves towards becoming an MCT. These findings can be used to inform faculty development effort or the individual career development of clinical teachers.
Hale CVHale CV 2021.pdf