Posted in PGCAP Blogs

Reflection 5 Learning through play (Threshold concepts)

The reflections from this fifth blog are based on my experience from the challenge set in one of the PGCAP sessions, where we were asked to creatively purchase items in order to design a teaching session. The purpose of the teaching session was to explain a threshold concept. For my session, I was able to purchase, for free, three round pieces of lego. Using the pieces of lego I created a Venn diagram to help explain the threshold concept of occupation and its contribution to health and well-being. Although I was unable to use my learning material in a formal teaching session, I was able to use it during a one to one session with a level 4 student. This particular student was having difficulty defining occupation in an assignment. Despite my enthusiasm, I was disappointed that the student’s understanding of occupation did not improve with my method of teaching.

In occupational therapy, the relationship between occupation and health has been described as the only profession specific threshold concept (Fortune and Kennedy-Jones 2014). Fortune and Kennedy-Jones (2014) describes how understanding this threshold concept helps student ‘join the dots between theory and practice’. However, in order to join the dots Meyer and Land (2003) argue that student has to experience an uncomfortable and challenging process, whereby they ‘oscillate between old and emergent understandings’. Therefore, it is not surprising that the student I was working with did not experience an immediate change in his understanding of occupation and health.

Interestingly, Fortune and Kennedy-Jones (2014) suggest that occupational therapy educators in higher education tend to over simplify threshold concepts because they do not like to witness students being confused. From my own approach to the development of learning material (such as the lego venn diagram) I can see how I am guilty of this. For example, I tend to take a level 2 approach to teaching, where the design of learning materials is based on what I think students need to know (Biggs and Tang 2011). I tend to think that my role is to simplify the complexity of theory and practice, but by over simplifying it I am not providing an environment that supports the learning of threshold concepts. Tanner (2011) suggest that this approach then becomes a barrier for occupational therapy students going out into their practice placement because they cannot join the dots and see the relevance between the theory of practice taught at university and what they actually observe on practice.

Tanner (2011) recommends that to develop student learning around the threshold concept of occupation and health there needs to be closer co-operation between educators in higher education and occupational therapists in practice so that the links between theory and practice can be explored between the two parties. However, research exploring the use of theory in practice suggests that practitioner’s level of understanding of threshold concepts is poor (O’Neal 2007). Interestingly, I observe the above tension in my role as a lecturer. As part of my role I contact students while they are on placement and frequently, during conversation with students on placement they complain that their practice supervisor has said that they cannot see the relevance of the theory we have taught them at university to the realities of practice.

In the past, when students have raised the concern that they cannot see the relevance of the threshold concept whilst on practice, because it does not seem relevant to their practice supervisor, I have only provided reassurance. Cousin (2006) acknowledges reassurance is an important way the teacher can support the learner through the process of developing an understanding of a threshold concept. However, she also suggests the discussion is also an opportunity to provide an environment to listen to where the student is at in their learning journey. Cousin (2006) also describes how the teacher can also explore with the student why mastering the link between occupation and health is important. Finally, Cousin (2006) suggests the discussion can help the teacher to identify what other support or signposting the student needs in order to master their understanding of the threshold concept.

From this reflection I have begun to take the following action based on the reading material in this blogs – the letters in brackets demonstrates how this action relates to the descriptors in the UK Professional Standards Framework for teaching and supporting learning in higher education.

  • I will explain to students what threshold concepts are and how they are relevant to clinical and professional practice. (A2, V1, V3, K3)
  • Where appropriate, I will allow students to experience uncertainty to help in the process of developing their understanding of the threshold concepts. (A2, V1, V3, K3)
  • Where appropriate, I will avoid over simplifying threshold concepts to help in the process of developing their understanding of threshold concepts. (A2, V1, V3, K3)
  • In the programme development days, which occur each semester, I will discuss how we can support clinical supervisors to understand the relevance of threshold concepts to clinical and professional practice. (K6, V4)


Biggs, J.B., Tang, C., 2011. Teaching for quality learning at university. London: McGraw-Hill Education.

College of Occupational Therapists., 2017. Professional Standards for Occupational Therapy Practice. London: College of Occupational Therapists

Cousin, G., 2006. An introduction to threshold concepts. Planet. 17 (x).

Fortune, T. and Kennedy‐Jones, M., 2014. Occupation and its relationship with health and wellbeing: The threshold concept for occupational therapy. Australian occupational therapy journal61(5), pp.293-298.

Health and Care Professional Council., 2017. HCPC – Health and Care Professions Council – Standards of proficiency. [online] Available at: [Accessed 18 Jan. 2017].

Higher Education Academey,. 2011. UK Professional Standards Framework (UKPSF) | Higher Education Academy. [online] Available at: [Accessed 10 November 2016].

Meyer J H F and Land R 2003 ‘Threshold Concepts and Troublesome Knowledge 1 – Linkages to Ways of Thinking and Practising’ in Improving Student Learning – Ten Years On. C.Rust (Ed), OCSLD, Oxford

Tanner, B., 2011. Threshold concepts in practice education: Perceptions of practice educators. The British Journal of Occupational Therapy74(9), pp.427-434.








I am an Occupational Therapist and my main passion is the using the built environment to support people's occupational performance (basically ensuring people are able to do the things they want, need and have to do in their everyday lives without being hindered by the built environment). Having completed an MSc in Accessibility and Inclusive Design I was given an opportunity to complete a PhD, which I did in July 2016. Currently I am based in the School of Health Sciences at University of Salford. My research interest is in the process used by occupational therapists to modify home environments.

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