Helping Learners Through Transitions: Threshold Concepts, Troublesome Knowledge and Threshold Capability Framework in Surgery

  • Simon BlackburnEmail author
  • Julian Smith
  • Debra Nestel
Part of the Innovation and Change in Professional Education book series (ICPE, volume 17)


This chapter explores a constructivist theory that can inform the design of surgical education and training programs, especially to address areas of particular challenge. Threshold concepts, troublesome knowledge and threshold capability are introduced and illustrated in paediatric surgical training and transition to cardiothoracic surgical practice. Like other theories in this section, threshold concepts involve transformation of individuals’ ways of thinking, movement through a liminal state. This transformation is often associated with the development of a professional identity and represents an ontological shift in how the individual sees themselves and may reflect how others see them too. Learners can, however, sometimes find themselves in a stuck place where they can move neither forwards nor backwards. The ideas explored in this chapter may provide insights with which educators can help learners to move beyond their current state, to anticipate and plan for troublesome areas in learning, so that they can successfully navigate transitions.


Threshold concepts Troublesome knowledge Liminal states Threshold capability theory Surgical trainees Surgical consultants Meaning frames Transitions Identity Ontology Uncertainty Epistemological shift Ontological shift 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
  2. 2.Department of Surgery (School of Clinical Sciences at Monash Health)Monash UniversityClaytonAustralia
  3. 3.Faculty of Medicine, Nursing & Health Sciences, Monash Institute for Health and Clinical EducationMonash UniversityClaytonAustralia
  4. 4.Faculty of Medicine Dentistry & Health Sciences, Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneParkvilleAustralia

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