Threshold Concepts in Radiation Physics Underpinning Professional Practice in Radiation Therapy
Keywords:curriculum inquiry, radiation physics, radiation therapy, threshold concepts, transactional
This article identifies potential threshold concepts in radiation physics, and explains their relationship to professional practice in radiation therapy (that is,. the practice of radiation treatment and care of cancer patients). Concepts such as how the radiation beam spreads out (beam divergence), and how the distance from the ionising source affects the beam (inverse-square law), can be challenging for students entering higher education and experiencing their first clinical placements. Through observations of radiation therapy students in practice, mastery of these (and other concepts) appears essential for them to progress in their professional practice learning. The study used ‘transactional curriculum inquiry’ (Cousin 2009) in order to understand why particular concepts might be troublesome to students, and how mastery of these concepts could potentially lead to safe and accurate practice. While the study was conducted in a particular Bachelor of Science in Radiation Therapy programme, it has implications for how academic and clinical educators in other contexts might facilitate students’ acquisition of the threshold concepts that underpin professional practice. The findings suggest that the typical progression in professional education that assumes the application of theoretical concepts to practice, might not be the best way to acquire the threshold concepts that lead to transformed practice.
Barradell, S. and Peseta, T. (2016) ‘Promise and challenge of identifying threshold concepts: a cautionary account of using transactional curriculum inquiry’. Journal of Further and Higher Education, 40 (2), 262─275 http://dx.doi.org/10.1080/0309877X.2014.971105
Baumann, M., Krause, M., Overgaard, J., Debus, J., Bentzen, S.M., Daartz, J., Richter, C., Zips, D., and Bortfeld, T. (2016) ‘Radiation oncology in the era of precision medicine’. Nature Reviews Cancer, 16 (4), 234─250 http://doi.org/10.1038/nrc.2016.18
Bourland, J.D. (2016) ‘Radiation oncology physics’. in Clinical Radiation Oncology. 4th edn. ed. by Gunderson L.L. and Tepper J.S. Philadelphia: Elsevier, 93-143
Clouder, L. (2005) ‘Caring as a ‘threshold concept’: transforming students in higher education into health (care) professionals’. Teaching in Higher Education, 10 (4), 505─517 http://doi.org/10.1080/13562510500239141
Cousin, G. (2006) ‘An introduction to threshold concepts’. Planet, 17:1, 4─5 http://dx.doi.org/10.11120/plan.2006.00170004
Cousin, G. (2009) Researching Learning in Higher Education: An Introduction to Contemporary Methods and Approaches. London & New York: Routledge
Crane, G.D. and Abbott, P.V. (2016) ‘Radiation shielding in dentistry: An update’. Australian Dental Journal, 61 (3), 277─281 http://doi.org/10.1111/adj.12389
Ditkofsky, N., Shekhani, H.N., Cloutier, M., Chen, Z.N., Zhang, C., and Hanna, T.N. (2016) ‘Ionizing radiation knowledge among emergency department providers’. Journal of the American College of Radiology, 13 (9), 1044─1049 https://doi.org/10.1016/j.jacr.2016.03.011
Kinchin, I.M., Cabot, L.B., and Hay, D.B. (2010) ‘Visualizing expertise: Revealing the nature of a threshold concept in the development of an authentic pedagogy for clinical education’. in Threshold Concepts and Transformational Learning. ed. by Meyer, J.H., Land, R., and Baillie, C. Rotterdam: Sense, 81-96
Kong, F.M. and Wang, J. (2013) ‘Three-dimensional conformal radiation therapy’. In Encyclopaedia of Radiation Oncology. ed. by Brady, L.W., and Yaeger, T.E. Berlin Heidelberg: Springer, 893─893 https://doi.org/10.1007/978-3-540-85516-3_529
Körhasan, N.D. and Wang, L. (2016) ‘Students’ mental models of atomic spectra’. Chemistry Education Research and Practice, 17 (4), 743─755 http://doi.org/10.1039/C6RP00051G
Meyer, J.H.F. (2016) ‘Threshold concepts and pedagogic representation’. Education + Training, 58 (5), 463─475 https://doi.org/10.1108/ET-04-2016-0066
Meyer, J.H.F and Land, R. (2005) ‘Threshold concepts and troublesome knowledge (2): Epistemiological considerations and a conceptual framework for teaching and learning’. Higher Education, 49 (3), 373─388 http://doi.org/10.1007/s10734-004-6779-5
Miller, D.L., Vañó, E., Bartal, G., Balter, S., Dixon, R., Padovani, R., Schueler, B., Cardella, J.F., and De Baère, T. (2010) ‘Occupational radiation protection in interventional radiology: A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology’. Cardiovascular and Interventional Radiology, 33 (2), 230─239 https://doi.org/10.1007/s00270-009-9756-7
Muller, J. and Young, M. (2014) ‘Disciplines, skills and the university’. Higher Education, 67 (2), 127─140 https://doi.org/10.1007/s10734-013-9646-4
Neve, H., Lloyd, H., and Collett, T. (2017) ‘Understanding students’ experiences of professionalism learning: A ‘threshold’ approach’. Teaching in Higher Education, 22 (1), 92─108 https://doi.org/10.1080/13562517.2016.1221810
Noh, S.J., Lee, M.W., Jung, D.H., Lim, H.J., Kim, H., Kim, H.J., and Kang, Y.R. (2014) ‘A study on the development of quality assurance development and dose distribution for medical linear accelerator’. Proceedings of the Korean Nuclear Society, Daejeon 28-30 May 2014. [online] available from < https://inis.iaea.org/search/search.aspx?orig_q=RN:46050622. [08 March 2018]
Park E.J. and Light G. (2009) ‘Identifying atomic structure as a threshold concept: Student mental models and troublesomeness’. International Journal of Science Education, 31 (2), 233─258 https://doi.org/10.1080/09500690701675880
Podgorsak, E.B. (2005) Radiation Oncology Physics: A Handbook for Teachers and Students. Vienna: International Atomic Energy Agency, 657
Rosca, F., Lorenz, F., Hacker, F.L., Chin, L.M., Ramakrishna, N., and Zygmanski, P. (2006) ‘An MLC‐based Linac QA procedure for the characterization of radiation isocenter and room lasers’ position’. Medical Physics, 33 (6), 1780─1787 https://doi.org/10.1118/1.2198171
Royeen, C.B., Jensen, G.M., Chapman, T.A., and Ciccone, T. (2010) ‘Is interprofessionality a threshold concept for education and health care practice?’ Journal of Allied Health, 39 Supplement 1, 251─252. https://www.ncbi.nlm.nih.gov/pubmed/21174048
Saldana, J. (2013) The Coding Manual for Qualitative Researchers. New York: Sage
Tyler, A. and Hanna, L. (2015) ‘Radiotherapy planning 1: Fundamentals of external beam and brachytherapy’. in Practical Clinical Oncology. 2nd edition. ed. by Hanna, L., Crosby, T., and Macbeth, F. Cambridge: Cambridge University Press, 54─69
Verellen, D., De Ridder, M., Linthout, N., Tournel, K., Soete, G., and Storme, G. (2007) ‘Innovations in image-guided radiotherapy’. Nature Reviews Cancer, 7 (12), 949 https://doi.org/10.1038/nrc2288
Webb, S. (2015) Intensity-Modulated Radiation Therapy. Boca Raton, FL: CRC Press
Weurlander, M., Scheja, M., Hult, H., and Wernerson, A. (2016) ‘The struggle to understand: Exploring medical students' experiences of learning and understanding during a basic science course’. Studies in Higher Education, 41 (3), 462─477 http://dx.doi.org/10.1080/03075079.2014.930122
Wolfson, A.J., Rowland, S.L., Lawrie, G.A., and Wright, A.H. (2014) ‘Student conceptions about energy transformations: Progression from general chemistry to biochemistry’. Chemistry Education Research and Practice, 15 (2), 168─183 http://doi.org/10.1039/C3RP00132F
Young, M. and Muller, J. (eds) (2014) Knowledge, Expertise and the Professions. London: Routledge
Zhang, M. T., Zhou, S.-M., and Qu, T. X. (2015) ‘What do we mean when we talk about the linac isocenter?’ International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 4, 233─242 http://dx.doi.org/10.4236/ijmpcero.2015.43028
How to Cite
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons License "Attribution-NonCommercial No Derivs 4.0 International" (CC BY-NC-ND 4.0) which permits others to use the publication as long as the authors are appropriately cited.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- The Author grants to Coventry University an irrevocable, royalty-free, worldwide, non-exclusive licence to publish this article in this journal in addition to the licence granted at paragraph 1 of this copyright notice.