{'fraction_non_alphanumeric': 0.02199528672427337, 'fraction_numerical': 0.009426551453260016, 'mean_word_length': 4.762443438914027, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The troublesome nature of intraprofessional collaboration: A threshold concept perspective

It is with great pleasure that we write this commentary to the paper by Looman et al which focused on intraprofessional collaboration (IntraPC) amongst health care providers (HCPs).1 As we read the paper, we thought about our own clinical experiences as an emergency medicine resident (author CB) working on off-service rotations and an internal medicine attending physician (author MG) who has worked with off-service residents on the wards for over two decades. As we discussed and reflected on our experiences, we could not help but agree with the study findings that, on the one hand, it is easy to acknowledge the importance of IntraPC, but on the other that it can be difficult to enact in practice. The study also had us wondering if IntraPC met the criteria for a threshold concept (TC) and, if so, what further implications this would have on the structure of clinical practice. [Correction added on 19 October 2020 after first publication. Details of Looman et al 2020 reference have been added and as a result all citation numbers have been renumbered in this version] Although many readers of this commentary may not be familiar with TC, they have all experienced them. Reflecting back on our own clinical experiences, we can all likely think of a situation where we had an epiphany or ‘aha’ moment; a moment where it felt like a switch had turned on and we saw something in a whole new light and, seeing it that way, we could never go back. For some, it may have to do with recognising that what we do in clinical practice really matters and that we have a burden of responsibility.2 For others, it was perhaps more subtle but at some point they recognised that it was ok to be uncertain and that uncertainty should be shared with patients and colleagues rather than hidden from them.3,4 These paradigm shifts that change how we fundamentally view and enact clinical practice are considered TC.5 First described by Meyer and Land in 2003, TC are transformative concepts that when crossed, ‘open up new and previously inaccessible ways of thinking’. 5 TC are also troublesome in that, at some point along the way, people usually struggle with the TC and find themselves in a liminal space—a no longer here but not crossed through the threshold yet space.5,6 Although there are other proposed components of a TC such as being irreversible, integrative and bounded, the fundamental core of TC is that they are transformative and troublesome.5,7