Using threshold concepts for the development of a guided approach to teaching, learning and assessment of pharmacology

Abstract

Background: Pharmacology is an integral part of healthcare curricula, encompassing ‘conceptual elements’ that are challenging and counterintuitive for learners to fully comprehend. Comprehending these conceptual elements is transformational to enhancing learner's ways of thinking and practising, enhancing their ability to offer safe and effective pharmacotherapeutic management and drug prescriptions. Considering the dearth of research on threshold concepts in pharmacology, our study aimed to explore this in depth by identifying threshold concepts and prioritising learning of these to enrich the medical curriculum and hence improve medical treatment and patient safety. Aim: This project aimed to identify and understand the threshold concepts of pharmacology knowledge and use them in the development of an educational framework that can support a task-centric approach to learning these concepts. Methods: A full systematic realist inquiry review was initiated to examine the impact of pedagogical interventions in shaping university-level learning of pharmacology. Next, virtual Nominal Group Technique (vNGT) groups were conducted with pharmacology experts and medical students to identify potential threshold concepts that promote epistemological and ontological shifts in student identity in pharmacology. Following an abductive analysis approach of the consensus-driven data, creative insights were gleaned while alternative theories and explanations were explored. The valuable insights gained through data analysis were used to inform the design and layout of an appropriate educational framework focusing on the identified threshold concepts. Results: The realist review illuminated how constructivism, cognitive load, and flow theory have been integrated to rationalise and optimise the operational aspects of various pedagogical interventions. Additionally, the review aided appreciation of the multi-layered, interactive nature of contexts. Discussion: Our research suggests acquisition of a web of threshold concepts in pharmacology affects a learner's understanding and performance but has cognitive load implications. Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. It is postulated that managing cognitive load effectively and aligning with cognitive schema development can enhance transformative learning for learners. To achieve this, the four components instructional design (4C/ID) model was used to create a blueprint that aims to reduce the impact of cognitive load and facilitate deep, significant learning by developing and automating schemas related to key troublesome pharmacology concepts.

Date of Award	2023
Original language	English