This research program studies the process whereby students entering medical school become transformed into physicians with three goals: to understand the development of professionalism and professional identity formation as students move through their educational career from laypersons to physician-hood and military medical officers; to inform and shape the medical education curriculum at USU and other universities. This improves the quality of medical education, not only for future pediatricians, but for future physicians of all specialties.

Threshold concepts in medical education is one approach to studying the transformation from lay person to physician. Threshold concepts are ways of thinking and reasoning that are crucial to the completion of personal identity formation and to internalizing the values and beliefs of a competent, committed military medical officer. Threshold concepts are those that, once understood, transform the individual and their sense of self; are organizing in that they allow integration of what were once poorly understood ideas (an A-ha moment); and cannot be cast aside once fully understood. The medical education literature is just beginning to discuss threshold concepts and importantly, our studies may be among the first to look at this issue systematically.

As students struggle with threshold knowledge they may become "stuck" and find themselves regressing, wondering about their vocational decision, and becoming depressed and withdrawn. Faculty can better counsel students if the faculty can appreciate the concepts with which the student is wrestling. From our current research with 3rd year students, threshold concepts include "Medicine isn’t black and white but mostly grey," "You can’t save everyone, no matter how worthy and no matter how hard you try," and "Being smart isn’t enough."

We will be working with students to understand the threshold concepts that they encounter during Bushmaster, where we suspect substantial shifts in personal identity occur. Articulating these concepts will allow the faculty to engage with the students at a deeper level that facts and skills.

We produce young physicians with the medical knowledge and skills needed and the appropriate values, attitudes, and behaviors of a military medical professional. Understanding the concepts that are necessary for a military medical officer to acquire will ensure that appropriate curricular activities including field exercises and small group learning are carried out. A frank discussion of the explicit concepts can assist the student in this critical transformation. Threshold concepts help the student "make sense of it all" and become comfortable in their new role as military medical officer.