Nurturing and Complexity – Threshold Concepts in Geriatric Medicine


  • Iain Wilkinson Consultant Physician at Surrey and Sussex Healthcare NHS Trust, Honorary Senior Lecturer Brighton and Sussex Medical School



care, complexity, geriatric medicine, medical training, threshold concepts


Older adults make up the largest proportion of patients in UK hospitals. This will increase further over the next twenty years. To manage unwell older adults requires specific skills – yet many are looked after by non-specialists (be they doctors, nursing staff or therapists). Threshold Concepts (TCs) represent a means of examining the changes which take place in doctors in becoming ‘a geriatrician’, and thus may identify the key concepts to focus education on about the care of older patients. This article presents a qualitative study of trainers (consultants, the educational supervisors of junior doctors) and trainees (the junior doctors themselves). Twelve semi-structured interviews were analysed using a concept mapping technique in combination with a traditional qualitative analysis to identify TCs, which were then explored in more detail with a structured questionnaire delivered to trainees. The study shows that whilst there are a number of troublesome areas in geriatric medicine training, two concepts stood out as TCs. Appreciation of the ‘complexity of medical care’ of older patients and what that entails, and a new concept of ‘nurturing-care’ (focused on the wider care issues for the patient) – are proposed as TCs in geriatric medicine. Both have large degrees of tacit knowledge, and rely on a networked model of thinking. Identification of these TCs in geriatric medicine can allow a focused analysis of postgraduate medical curriculums to ensure they are covered by doctors of all grades to improve the standard of care of older patients in the UK health service.

Author Biography

Iain Wilkinson, Consultant Physician at Surrey and Sussex Healthcare NHS Trust, Honorary Senior Lecturer Brighton and Sussex Medical School

Dr Iain Wilkinson is a Consultant Geriatrician with a special interest in Orthogeriatrics and movement disorders at Surrey and Sussex Healthcare NHS Trust. He is a fellow of the higher education academy and has a longstanding interest in medical education and educational research into the threshold concepts contained within higher specialist training in geriatric medicine. He is the cofounder and presenter of the MDTea podcasts and runs a number of education programmes both in care homes and the acute hospital setting. Clinically he is a clinical lead for the Kent, Surrey and Sussex Academic Health Science Network hip fracture programme and has led a number of local and regional quality improvement projects


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How to Cite

Wilkinson, I. (2018). Nurturing and Complexity – Threshold Concepts in Geriatric Medicine. International Journal of Practice-Based Learning in Health and Social Care, 6(1), 64–77.