Transformative learning opportunities for students and educators during interprofessional healthcare practice experiences in higher education: Viewed through the lens of Threshold Concepts Theory
Introduction: The transformative nature of collaborative interprofessional learning experiences, for both students and educators, signals the importance of learning opportunities that transcend professional or disciplinary boundaries. Specifically, real-time clinical practice experiences where students and educators from a number of health professions learn with, from and about eachother, while working with patients, enables authentic interprofessional learning opportunities.
Methods: This paper reports the qualitative interpretive findings from a mixed methods study on the learning experiences of students and educators from several undergraduate health and allied health programmes engaged in collaborative interprofessional practice in a university context. Interpretive thematic analysis of student and educator focus group transcripts revealed a number of transformational learning thresholds that students and educators transitioned through, over time.
Findings: Transformative learning occurred through cumulative collaborative learning experiences. Interprofessional thresholds were identified as: broadening perspectives on health practice; navigating collaborative roles through interprofessional practice (IPP); interprofessional team practice through active learning/learning by doing; integrative professional practice for actioning holistic, patient-centred healthcare.
Conclusion: Threshold Concepts Theory (TCT) provided both an interpretive lens for viewing the experiential learning processes that occurred during the student-led interprofessional programme and a theoretical perspective into the transformative nature of knowledge and skills acquisition and integration during interprofessional learning opportunities.
Argyris, C., & Schön, D. A. (1974). Theory in practice: Increasing professional effectiveness. San Francisco, CA: Jossey-Bass.
Bandura, A. (1977). Social learning theory. New Jersey, NJ: Prentice-Hall.
Barr, H. (2013). Towards a theoretical framework for interprofessional education. Journal of Interprofessional Care 27: 4–9. http://dx.doi.org/10.3109/13561820.2012.698328
Barr, H., Gray, R., Helme, M., Low, H., & Reeves, S. (2016). Steering the development of interprofessional education. Journal of Interprofessional Care 30 (5): 549–552. doi: http://dx.doi.org/10.1080/13561820.2016.1217686
Black, D. A., Taggart, J., Jayasinghe, U. W., Proudfoot, J., Crookes, P., Beilby, J., Powell-Davis, G., Wilson, L.A., & Harris, M. F. (2013). The teamwork study: Enhancing the role of non-GP staff in chronic disease management in general practice. Australian Journal of Primary Health 19(3), 184–189. http://dx.doi.org/10.1071/PY11071
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77–101. http://dx.doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. London, England: SAGE.
Bryman, A. (2012). Social research methods. Oxford, England: Oxford University Press.
Craddock, D., O’Halloran, C., McPherson, K., Hean, S., & Hammick, M. (2013). A top-down approach impedes the use of theory? Interprofessional educational leaders’ approaches to curriculum development and the use of learning theory. Journal of Interprofessional Care 27(1), 65–72. http://dx.doi.org10.3109/13561820.2012.736888
Davies, J. 2016. ‘Threshold Guardians’: Threshold concepts as guardians of the discipline. In R. Land, J. H. F. Meyer, & M. T. Flanagan (Eds.), Threshold concepts in practice (pp.121–134). Rotterdam, Netherlands: Sense.
Denzin, N., & Lincoln, Y. (2011). The sage handbook of qualitative research. California, CA: SAGE.
Durning, S. J., & Artino, A. R. (2011). Situativity theory: A new perspective on how participants and the environment can interact: AMEE Guide no. 52. Medical Teacher 33(3), 188–199. http://dx.doi.org/10.3109/0142159X.2011.550965
Eraut, M. (1994). Developing professional knowledge and competence. London, England: Routledge-Falmer.
Fallow, J. L., Goodwin, C., & Sevilla, J. (2015). Interprofessional education through service-learning: Lessons from a student-led free clinic. Journal of Interprofessional Care 29(3), 263–264. http:/dx.doi.org/10.3109/13561820.2014.936372
Frenk, J., Chen, L., Bhutta, Z., Cohen, J., Crisp, N., Evans, T., …Zurayk, H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet Commissions 376(9757), 1923–1958. http://dx.doi.org/10.1590 /S1726-46342011000200023
Grant, A., Mackenzie, L., & Clemson, L. (2015). How do general practitioners engage with allied health practitioners to prevent falls in older people? An exploratory qualitative study. Australasian Journal on Aging 34(3), 149–154. http://dx.doi.org/ 10.1111/ajag.12157
Green, C. (2013). Relative distancing: A grounded theory of how learners negotiate the interprofessional. Journal of Interprofessional Care 27(1), 34–42. http://dx.doi.org/10.3109/13561820.2012.720313
Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(Supp1), 188–196. http://dx.doi.org/ 10.1080/13561820500081745
Hall, P., Weaver, L., & Grassau, P. A. (2013). Theories, relationships and interprofessionalism: Learning to weave. Journal of Interprofessional Care, 27(1), 73–80. http://dx.doi.org/10.3109/13561820.2012.736889
Hammick, M., Freeth, D., Copperman, J., & Goodsman, D. (2009). Being interprofessional. Cambridge, England. Polity Press.
Hean, S., Anderson, E., Bainbridge, L., Clark, P. G., Craddock, D., Doucet, S., … Oandasan, I. (2013). IN-2-THEORY – Interprofessional theory, scholarship and collaboration: A community of practice. Journal of Interprofessional Care 27(1), 88–90. http://dx.doi.org/10.3109/13561820.2012.743979
Hean, S., Anderson, E., Green, C., Pitt, J. R., & O’Halloran, C. (2016). Reviews of theoretical frameworks: Challenges and judging the quality of theory application. Medical Teacher 38(6), 613–620. http://dx.doi.org/10.3109/014259X.2015.1075648
Kemmis, S. (2009). Understanding professional practice: A synoptic framework. In B. Green (Ed.), Understanding and researching professional practice (pp.19-39). Rotterdam, Netherlands. Sense.
Land, R., Meyer, J. H. F., & Smith, J. (Eds.). (2008). Threshold concepts within the disciplines. Rotterdam, Netherlands: Sense.
Land, R., Meyer, J. H. F., & Flanagan, M. T. (Eds.). (2016). Threshold concepts in practice. Rotterdam, Netherlands: Sense.
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, UK: University Press.
Lee, A., & Dunston, R. (2011). Practice, learning and change: Towards reauthorization of professional practice. Teaching in Higher Education, 16(5), 483–494. http://dx.doi.org: 10.1080/13562517.2011.580840
Lie, D. A., Forest, C. P., Walsh, A., Banzali, Y., & Lohenry, K. (2016). What and how do students learn in an interprofessional student-run clinic? An educational framework for team-based care. Medical Education Online 21: 31900. http://dx.doi.org/10.3402/meo.v21.31900
Meyer, J. H. F., & Land, R. (2003). Threshold concepts and troublesome knowledge: Linkages to ways of thinking and practising within the disciplines. In C. Rust (Ed.), Improving student learning – 10 years on (pp. 412-424). Oxford, England: OCSLD.
Meyer, J. H. F., & R. Land, R. (2006). Threshold concepts and troublesome knowledge: Issues of liminality. In J. H. F. Meyer & R. Land (Eds.), Overcoming barriers to student learning: Threshold concepts and troublesome knowledge (pp. 19-33). London, England: Rutledge.
Meyer, J. H. F., Land, R., & Baillie, C. (Eds.). (2010). Threshold concepts and transformational learning. Rotterdam, Netherlands: Sense.
Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco, CA: Jossey-Bass.
Ministry of Health (2016a). Health of the Health Workforce 2015. Wellington, Ministry of Health. Retrieved from www.health.govt.nz (publications)
Ministry of Health (2016b). New Zealand Health Strategy: Future Direction. Wellington, Ministry of Health. Retrieved from www.health.govt.nz (publications)
Morgan, C. J. (2017). Graduates’ development of interprofessional practice capability during their early socialisation into professional roles. Journal of Interprofessional Care, 31(4), 438–445. http://dx.doi.org/10.1080/13561820.2017.1295029
O’Brien, D., Swann, J., & Heap, N. (2015). Can the communities of practice model explain the complex organization of an interprofessional student-led health clinic? Journal of Allied Health 44(1), e11–16.
O’Brien, D., McNaughton, S. M., Flood, B., Morgan, C. J., & Bowmar, A. (2016). Piloting an integrated, interprofessional programme for people living with Type 11 diabetes: Outcomes and experiences. Australian Journal of Clinical Education 1(1), 1–16. Available at: http://epublications.bond.edu.au/ajce/vol1/iss1/1
Olson, R., & Bialocerkowski, A. (2014). Interprofessional education in allied health: A systematic review. Medical Education e48(3), 236–246. http://dx.doi.org/10.1111/medu.12290
Payler, J., Meyer, E., & Humphris, D. (2007). Theorizing interprofessional pedagogic evaluation: Framework for evaluating the impact of interprofessional continuing professional development on practice change. Learning in Health and Social Care 6(3), 156–169. http://dx.doi.org/10.1111/j.1473-6861.2007.00156.x
Perkins, D. (2006). Constructivism and troublesome knowledge. In J. H. F. Meyer & R. Land. (Eds.), Overcoming barriers to student understanding: Threshold concepts and troublesome knowledge (pp.33–48). London, England: Routledge.
Reeves, S. (2016). Ideas for the development of the interprofessional education and practice field: An update. Journal of Interprofessional Care 30(4), 405–407. http://dx.doi.org/ 10.1080/13561820.2016.1197735
Reeves, S., & Hean, S. (2013). Why we need theory to help us better understand the nature of interprofessional education, practice and care. Journal of Interprofessional Care 27(1), 1–3. http://dx.doi.org/10.3109/13561820.2013.751293
Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: Effects on professional practice and healthcare outcomes (update). http://dx.doi.org/10.1002/14651858.CD002213.pub3
Reeves, S., Boet, S., Zierler, B., & Kitto, S. (2015). Interprofessional education and practice guide No.3: Evaluating interprofessional education. Journal of Interprofessional Care 29(4), 305–312. http://dx.doi.org/10.3109/13561820.2014.1003637
Rodger, S., & Hoffman, S. J. (2010). Where in the world is interprofessional education? A global environmental scan. Journal of Interprofessional Care, 24(5), 479–491. http://dx.doi.org/doi:10.3109/13561821003721329
Shulman, L. S. (2005). Signature pedagogies in the professions. Daedalus 52–60. Retrieved from http://www.mitpressjournals.org/loi/daed
Thistlethwaite, J. (2012). Interprofessional education: A review of context, learning and the research agenda. Medical Education 46(1), 58–70. http://dx.doi.org/10.1111/j.1365-2923.2011.04143.x
Timmermans, J. A. (2010). Changing our minds: The developmental potential of threshold concepts. In J. H. F. Meyer, R. Land., & C. Baillie (Eds.), Threshold concepts and transformational learning (pp.3–19). Rotterdam, Netherlands: Sense.
Watkins, K. D. (2016). Faculty development to support interprofessional education in healthcare professions: A realist synthesis. Journal of Interprofessional Care 30(6): 695–701. http://dx.doi.org/1080/13561820.2016.1209466.
Weller, J., Thwaites, J., Bhoopatkar, H., & Hazell, W. (2010). Are doctors team players, and do they need to be? The New Zealand Medical Journal 123(1310), 109–117. http://www.nzma.org.nz/journal/123-1310/4013/
Wenger, E. (1998). Communities of practice. Learning, meaning and identity. Cambridge, England: University Press.
Wenger, E. (2010). Communities of practice and social learning systems: The career of a concept. In C. Blackmore (Ed.), Social learning systems and communities of practice (pp.179-199). London, England: Springer.
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Retrieved from
World Health Organization. (2013). Transforming and scaling up health professionals’ education and training. Geneva, Switzerland. Retrieved from http://www.who.int/hrh/resources/transf_scaling_hpet/en/
World Health Organization. (2016, April 15). Framework on integrated, people-centred health services. Report by the Secretariat. Report No. A69/39. Retrieved from http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/
Zepke, N. (2013). Threshold concepts and student engagement: Revisiting pedagogical content knowledge. Active learning in Higher Education 14(2), 97-107. http://dx.doi.org/10.1177/1469787413481127
- There are currently no refbacks.