Currently, the UK are seeking to recruit a greatly increased number of healthcare professionals into the NHS, including medical doctors. Many students study medical science, biomedical science, and physician assistant degrees, for example, at university and some of these aspire to take a further medical degree to become doctors. An apprenticeship of these graduates could increase the clinical workforce very rapidly.
Identifying the thresholds between perceptions and clinical skills that need to be acquired, in order for a medical science student to become a clinician is important. This information may enable the increased recruitment of medical doctors by recruiting medical scientists as doctor apprentices. These conceptual differences between the scientific destination compared to the medical one should be recognised and postgraduate apprentice-style study could be implemented with initial orientation and induction into the workplace, followed by weekly programmes of study and tutor support.
Some of the suggested features of this liminal space include, patient history taking, basic clinical skills and case-based learning in a patient centred way.
Establishing training for the trainers will be important to provide the core of trainers, facilitators, mentors and coaches within each training centre. Universities that currently provide medical training degrees could develop the curriculum for the apprentice training. Many universities already provide 'doctors as teachers' training within the hospital staff. for practicing healthcare professionals, which could further facilitate this core of trainers.
Could some of the concepts adopted in the development of this type of apprenticeship training, as demonstrated in school teaching professions in 'Teach First' programmes, be translated into doctor training.
Although this approach may be resisted by the current clinical establishment as diluting the academic excellence of the profession, the adoption of this type of training could greatly enhance the current diversity and knowledge of the hospital inter-professional environment in a very positive way.
Some further incentives to encourage this type of recruitment may be required in terms of remuneration and support in some of the further training fee costs.
Liminal spaces refer to the spaces between two different states or conditions. In the context of medical science and medical training, liminal spaces refer to the spaces between the two fields. Bridging the liminal spaces between medical science and medical training means finding ways to connect these two fields .
Thank you, Chuck, for this insight.
Just to confirm that the word limen comes from the Latin for threshold.
In medical education, gaps or spaces (liminal spaces, present between threshold concepts, can apply to different spaces between learning concepts that may be different between academic disciplines. ‘Threshold concept theory’ provides a framework to navigate the student through these spaces providing a scaffold of support through this area of proximal difficulty, am educational concept originally described by the educationalist, Vigotski.
The learning in these spaces can be transformative but can also be troublesome.
The identification of threshold concepts, to build bridges between the space, will enable the design of the curricula and how best to support the learners in their transformation from scientists to clinicians. It may also enlighten us in how to approach the most effective type of teaching.
An example of a threshold concept that is transformative is professional identity, using medical science for making clinical decisions in a patient centred way.
- ‘A transformative state in the process of learning in which there is a reformulation of the learner’s meaning frame and an accompanying shift in the learner’s ontology or subjectivity’ (Land et al. 2014).
- Liminality is viewed as a transformative state in the process of learning in which there is a reformulation of the learner's meaning frame. (Schwartzman 2010)
- Threshold concepts in medical education: A scoping review (Jones H, Hammond L. 2022)