Medicine Medical Student Reflections of Newborn: Looking Back for Threshold Concepts

Setting: Almost 9000 babies are born annually at CUMH where 4th-year Medical students spend a week of their Paediatric clerkship.Learning Environment: The focus is on Situational learning and a Cognitive Apprenticeship model in a Family Centered Care Unit. Students are immersed into the interdisciplinary team. Potential learning opportunities occur in the NICU, Delivery-Suite, Postnatal Wards and Outpatients.Objective: At the end of the rotation, students are asked to write a reflection: “one thing that struck you during your rotation”. I decided to examine a selection of student reflections for evidence of transformative insights and integrative learning that might show what new or troublesome knowledge the students are grappling with, and perhaps unlock potential T.C’s of clinical practice. Emerging Threshold Concepts: Student perceptions of transformative observations (epiphanies) and new understandings included: Empathy (for parents and their sick baby), Admiration and respect for the Interprofessional Partnership of Care and multi-layered Communication, including the breaking of bad news. They are seeing real-life difficult Ethical challenges. They are excited about the Privilege of Medicine and the Challenges of Clinical practice, bur worried about dealing with Uncertainty, concerning certain babies’ prognoses, but also about their own potential to progress from Novice doctors to Wise Practitioners (Praxis). Insights into their own learning styles included the importance of a sound knowledge base and learning through role-modelling and the potential to Transfer of their learning to other Medical specialties,Conclusions: As they tentatively approach the Portal of Medical Practice, these students are becoming aware of what they don’t know, and realise that the answers to many of theseessential knowledge gaps are not in the books. They are battling between often misleading and incorrect intuitive knowledge (common sense) and newly-observed uncertainties. They may leave the rotation unsettled, but perhaps excited, curious, and eager to pursue their journey.