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Vocational thresholds: developing expertise without certainty in general practice medicine.

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    Transformational learning in general practice occurs through workplace experiences that foster new ways of being. These "vocational thresholds" emphasize dispositional attributes and collegial relationships over solely clinical skills.

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    Area of Science:

    • Medical Education
    • Workplace Learning
    • Professional Development

    Background:

    • Workplace experiences can trigger transformational learning.
    • This learning may enable practitioners to cross 'vocational thresholds' into new professional identities.
    • Vocational thresholds are inspired by 'threshold concepts' that fundamentally alter understanding.

    Purpose of the Study:

    • To develop a concept of 'vocational thresholds'.
    • To understand the most powerful learning experiences for general practitioners (GPs).
    • To identify key developmental moments in GP careers.

    Main Methods:

    • Thematic analysis of 57 written accounts from GPs.
    • Accounts described powerful workplace learning experiences.
    • Data collected during a study on structured workplace learning.

    Main Results:

    • Most GPs highlighted the development of dispositional attributes, changing self-perception.
    • Collegial relationships within learning arrangements were pivotal for nearly two-thirds of GPs.
    • Direct patient experiences influenced perspective shifts for one-third of GPs.

    Conclusions:

    • 'Vocational thresholds' can frame significant GP learning experiences.
    • Development should prioritize dispositional capability ('being') alongside clinical skills ('knowing and doing').
    • This focus is crucial for navigating uncertainty in general practice.