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Troublesome knowledge in pediatric surgical trainees: a qualitative study.

Simon C Blackburn1, Debra Nestel2

  • 1Imperial College, London, United Kingdom.

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|April 30, 2014
PubMed
Summary

Pediatric surgical trainees face "troublesome" knowledge, judgment, and skill challenges. Negative experiences can be catalysts for development, aiding the transition to a specialist identity.

Keywords:
Interpersonal and Communication SkillsMedical KnowledgePatient CarePractice-Based Learning and ImprovementProfessionalismpaediatric surgeryqualitative studyspecialist identitythreshold conceptstroublesome knowledge

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Area of Science:

  • Medical Education
  • Surgical Training
  • Psychology of Learning

Background:

  • Threshold concepts offer a new perspective on learning and professional identity.
  • Pediatric surgical training is a complex journey culminating in consultant status.
  • This study explores troublesome aspects of pediatric surgical training using threshold concept theory.

Purpose of the Study:

  • To apply threshold concept theory to pediatric surgical training.
  • To identify troublesome elements within the training curriculum.
  • To understand the transformative potential of these concepts on trainee identity.

Main Methods:

  • Conducted semistructured interviews with 8 pediatric surgical trainees.
  • Thematic analysis of interview transcripts using constant comparison.
  • Purposive recruitment across all training years; ethics approval obtained.

Main Results:

  • Identified troublesome areas: knowledge breadth/rarity, clinical judgment shifts, technical skill access, role transitions, trainer relationships, and negative experiences.
  • Overlap exists between identified themes.
  • Negative experiences acted as catalysts for developmental change.

Conclusions:

  • Threshold concepts provide a holistic view of surgical training curricula.
  • Negative experiences can trigger a 'meaning frame' rupture, fostering development.
  • Trainees navigate liminality towards a mature specialist identity in pediatric surgery.