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Lookup NU author(s): Professor Clare GuildingORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
We read with interest the paper titled “Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning” by Faraz Khurshid and colleagues, published in “Teaching and Learning in Medicine”.1 We thank the authors for this paper; their identification of key threshold concepts (TCs) within pharmacology contributes to the ongoing efforts to enhance the pedagogical approaches in this challenging field.Khurshid et al.'s work aligns well with the broader initiative undertaken by the International Union of Basic and Clinical Pharmacology (IUPHAR) Education Section Core Concepts in Pharmacology project (CCP2). Core Concepts (CCs) and TCs are educational research and innovation fields that have emerged over the past half-century and share the common feature of considering student learning through the lens of concepts. There are different views regarding the relationship between CCs and TCs. The founders of TCs, Jan Meyer & Ray Land, posit that TCs stem from a different theory of learning than CCs, in that they require students to develop an “interim understanding” before internalizing the TC opens up a new perspective on the subject.3 Meyer and Land therefore argue that TCs, unlike CCs, cannot be simplified for novice learners.4 Those who have developed CCs often view these “big ideas” as the cognitive tools of a discipline that allow students to solve problems or predict outcomes,5-7 and therefore suggest that TCs are likely to be a subset of CCs. For example, homeostasis is a well-established CC of physiology5, 6 and has been suggested to be a TC.8 An extension of this concept, pharmacological homeostasis—the end result of perturbation and resolution of homeostasis by medicines, has been suggested to be a TC at the boundary of physiology and pharmacology. Since Khurshid's recent paper provides pharmacology TCs, we were interested to compare these with the CCs provided by the IUPHAR CCP team.The Core Concepts in Pharmacology project emphasizes the importance of a concept-based curriculum for improving pharmacology education globally. This initiative, involving over 300 educators from 23 countries, focuses on identifying,9 defining, unpacking,10 and developing methods to teach and assess the essential concepts in pharmacology education.Khurshid et al.'s identification of TCs such as Pharmacokinetics, Drug Mechanism of Action and Drug Receptor Interactions, and the emphasis on cognitive schematic themes and stages of learning resonates with our recent findings on student misconceptions and cognitive challenges. Notably, Khurshid et al.'s research highlights the troublesome and transformative nature of these concepts,4 which is consistent with our observations. For example, our studies on pharmacodynamic understanding in medical, biomedical, and pharmacy students reveal common misconceptions around drug efficacy, drug-target interaction, and structure–activity relationships.11 Students often confused drug efficacy with drug potency or affinity and misunderstood the nature of drug-target interactions, often focusing solely on receptors as targets. Interestingly, in a pilot study to determine the most challenging core concepts for pharmacy students, drug mechanism of action was not in the most difficult 16 of the 24 core concepts,12 which challenges the notion of this as a troublesome threshold concept in pharmacology.Similarly, our research on pharmacokinetic misconceptions identified significant gaps in understanding core concepts such as drug bioavailability, drug clearance, volume of distribution, and steady-state concentration.12 These misconceptions can hinder students' ability to apply pharmacological principles effectively, underscoring the need for a concept-based curriculum that addresses these foundational issues.The criteria used to assess TCs in Khurshid et al.'s study—transformative, irreversible, integrative, bounded, and inherently troublesome, as defined by Meyer and Land,4 highlight their complex nature and the impact they have on students' understanding. These attributes ensure that TCs represent significant shifts in perception that are essential for mastering pharmacology. It will be of interest to see how these TCs compare with those produced by The Veterinary Educators in Pharmacology Special Interest Group, who are undertaking an international study to identify pharmacology threshold concepts and threshold capabilities from the perspective of veterinary medicine students.13In contrast, our criteria for evaluating core concepts—fundamental, useful, enduring, complex, and challenging, developed9 and validated14 focus on their foundational importance and practical application, ensuring that core concepts provide a robust framework for students to build upon as they advance in their studies and professional practice. Notably, both sets of criteria emphasize the complexity and challenging nature of these concepts, underscoring the need for instructional strategies that support deep learning and integration.In conclusion, Khurshid et al.'s work enhances our understanding of the cognitive nature of TCs in pharmacology but also supports the broader goal of improving pharmacology education through a concept-based approach. As both TCs and CC play essential roles in shaping students' learning experiences, ongoing research and international collaboration will be vital in refining educational strategies that support deep learning and effective application in professional practice.
Author(s): Guilding C, White PJ
Publication type: Article
Publication status: Published
Journal: Pharmacology Research and Perspectives
Year: 2024
Volume: 12
Issue: 6
Print publication date: 01/12/2024
Online publication date: 12/11/2024
Acceptance date: 31/10/2024
Date deposited: 12/11/2024
ISSN (print): 2052-1707
ISSN (electronic): 2052-1707
Publisher: Wiley
URL: https://doi.org/10.1002/prp2.70035
DOI: 10.1002/prp2.70035
ePrints DOI: 10.57711/39zv-8172
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