Two Threshold Concepts are identified in the initial course of a physical therapy doctoral program:
Patients who feel respected rather than judged have better clinical outcomes. Judgment is often unconscious, however, and difficult to examine. Language can be purposefully used to bring hidden judgments to light.
Course activities are designed to:
In particular, activities interweaving the two Threshold Concepts are designed to disrupt students’ habits of thinking and speaking and push them to create new ways of communicating. For example, students must go 24 hours without saying “should,” stripping their statements of implied judgment and restating their thoughts in purely informational terms. Similarly, students are directed to change judgment-laden “why” questions to factual “what” questions during patient interviews.
The concept of non-judgment and the revelatory nature of language are inherently troublesome. Although students initially agree that judging patients is inappropriate, knowing and being able to tell patients what they “should” do often represents the culmination of their educational goals. When their own everyday communications are challenged, students often fail to see judgments inherent in them. The idea that they may be expressing unconscious judgmental attitudes that are partially responsible for patients’ poor clinical outcomes is difficult to accept.
These Threshold Concepts are not unique to healthcare. Any professional education program must wrestle with the shift from a practitioner-centered to a client-centered approach and with the fundamental influence of language on their clients, all within the time constraints of mandatory content mastery.