Introduction: Threshold concepts (TCs) as an educational theory were first described in 2003. They describe the potential educational portals to be passed through in order to become proficient in a given area. As such within each area of education these ‘core’ concepts will need to be learnt in order to be become ‘expert’.
The Mental Capacity Act highlights the importance of being able to assess capacity and thus relates to the work of being a Geriatrician. The assessment of capacity is included in the learning objectives for higher training in Geriatric Medicine.
Methods: A qualitative study was performed to look for the existence of potential threshold concepts in Geriatric Medicine. Fourteen semi-structured interviews were conducted with trainers (consultants) in the South-East region. The interviews were transcribed and then with a method rooted in grounded-theory a discourse analysis was performed. Capacity was identified as a potential TC and was then assessed against the proposed characteristics of threshold concepts (they are: transformative, irreversible, integrative, bounded and troublesome).
Results: Trainers feel that capacity assessment is ‘troublesome’ to learn. The assessment may at first appear counter intuitive and it seems that to fully understand capacity an ontological change to some degree is needed.
While not specific to Geriatrics there is a feeling that, within hospital medicine, Geriatricians often take the lead on capacity assessment. Once learnt there is little evidence that trainees can unlearn the concept (irreversible). Finally capacity once understood integrates a number of different areas of the speciality.
Conclusions: The assessment of capacity is highly likely to be a threshold concept for trainees in Geriatric Medicine. Full understanding of this concept may prove difficult for some trainees and trainers should be aware of this. Once understood, capacity assessment involves all areas of the patient pathway through hospital.