Teaching the transition: A simulation-based approach to address threshold concepts encountered in the transition to clinical placements AUTHOR(S)

Abstract

Background: The transition from the preclinical to clinical years is an important liminal moment in the professional development of a medical student. Certain attitudes and behaviours have been observed as threshold concepts as part of this transformation. We proposed to address these threshold concepts using a simulation-based approach.

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#4Q Short Communications - Threshold Concepts
4Q2 (2977)
Date of Presentation: Monday, 26 August 2019
Time of Presentation: 1430-1445
Location of Presentation: Room 0.15, Level 0
Teaching the transition: A simulation-based approach to address threshold concepts
encountered in the transition to clinical placements
AUTHOR(S):
• • Claire Spiller, IMBE, St George's University of London, UK (Presenter)
• • Stella Ivaz, IMBE, St George’s University of London, UK
ABSTRACT
Background: The transition from the preclinical to clinical years is an important liminal moment in
the professional development of a medical student. Certain attitudes and behaviours have been
observed as threshold concepts as part of this transformation. We proposed to address these
threshold concepts using a simulation-based approach.
Summary of Work: Two simulation-based sessions were developed to prepare first year clinical
students for a medical ward placement: a medical ward round and an ‘on take’ scenario seeing
patients in A&E resus. These sessions were explicitly designed to incorporate the perceived
threshold concepts of diagnostic clinical reasoning and of learning how to learn in the clinical
environment. The sessions ran 6 times across the year to 328 medical students in their first clinical
year and were evaluated by anonymous questionnaire.
Summary of Results: 52 responses were received. 86.6% of students agreed or strongly agreed the
sessions helped prepare them for their Medicine placements. Amongst the reasons given for their
usefulness, themes of practicality and elements of the ‘hidden curriculum’ where most frequently
stated. 75% found the sessions helped them to negotiate the new learning environment. The 2
main themes reported by the students with respect to their performance in the clinical
environment were increased familiarity and proactivity. 82.7% reported that the sessions improved
their understanding of making a diagnosis. The most common articulation of this related to
cognition in terms of process, structure and meaning.
Discussion and Conclusions: Improvements were reported in the understanding of clinical
diagnostic thinking and in the ability to negotiate the clinical learning environment; the threshold
concepts these sessions were designed to address. Of the aspects reported as most useful by
students, it is the medium of simulation which permits these; the practical application of
knowledge and skills, but also aspects of the ‘hidden curriculum’ which contribute to professional
identity formation. Simulation can therefore provide a safe and ring-fenced space for developing
aspects of professional attitudes and behaviours.
Take-home Messages: Simulation allows a means of addressing development of attitudes and
behaviours contributing to professional identity formation.