Threshold Concepts in a Literary Magazine Produced by Health Care Students

This article was migrated. The article was marked as recommended. Introduction: Progress Notes is a literary magazine featuring works from health care students in the USA. It is edited by medical students at the Uniformed Services University of the Health Sciences (USUHS) to provide a space for their creative works. Since the magazine's inception in 2016, four volumes have been published, containing 130 works of poetry, fiction, reflection, and artwork. Goal: To understand the themes and perspectives of the published works. Methods: After Institutional Review Board approval, two researchers used qualitative thematic analysis to examine the texts, coding independently and resolving differences by discussion. They arranged the codes into themes which were discussed until consensus. A third researcher read the texts, codes and themes and verified that they were an accurate reflection of the published works. Artwork was assigned themes by the same two researchers who analyzed the written works, and a sample selection was verified by the third researcher. Results: Researchers identified eight themes across poetry, fiction, and reflective essays: vocation, death, failure/resilience, emotional restraint, personhood of the patient, approach to the patient, military physicians, and moments of personal realization. Four themes were identified in the artwork: death; comradeship/aloneness; vocation/quest; and competence. Discussion: Students submitted creative works in which they grapple with what it means to be a physician. Analyzed through the lens of the threshold concepts, researchers identified: "I am a healer;" "I can deal with ambiguity;" "The patient is the focus;" "As a military medical officer, I serve two masters;" and "As a physician, I have a unique and complex relationship with death." These threshold concepts represent an ontological shift in the students' professional identity. Conclusion: A literary magazine edited, and featuring works by, health care students provides a forum in which health care students wrestle with the elusive and enigmatic fundamental principles of being a physician.