Abstract
Introduction and aim
The Rural Medical Immersion Programme (RMIP) educates a selected group of University of Otago medical students for the duration of their Fifth year. The RMIP aspires to help redress the maldistribution of the rural medical workforce and deliver excellent medical education. Little is currently known about what students feel they learn in the RMIP, and little is known about what students learn that engenders a disposition to seek rural work in the future following the RMIP. This thesis aimed to explore threshold concepts that students learnt during their year on RMIP, with the objectives to identify the nature of threshold concepts and consider their impact on students, including any possible effect on vocational intention.
Methods
A qualitative study was undertaken to achieve this aim. Former RMIP students who had completed the RMIP within the previous 5 years and who were no longer in any educational relationship with RMIP faculty were recruited. A total of 24 participants were interviewed in either a focus group or individual semi-structure interview. Data from these interviews was transcribed and then analysed using reflexive thematic analysis. Reflexive thematic analysis was chosen for several reasons, including the ability to create new theory in an unknown area and acknowledge reflexivity and the research team as part of this process.
Results
The results of this study produce a novel model that describes and explains the learning journey students undertake when becoming a rural doctor through the lens of threshold concepts. Fifteen threshold concepts were identiHied, and two novel threshold concepts were related directly to vocational intent. Threshold concepts were learnt through exposure to a rural context via experiential learning. Threshold concepts describe Hive main domains of profound learning and change within the students. These domains describe not only cognitive but also affective transformation. Together, these transformations culminate in students becoming different people. They are no longer students, but begin to see themselves, the world around them, and their future through the altered gaze of someone on their way to understand what it is to be a rural doctor. Becoming a rural doctor is the central unifying concept of all the threshold concepts identified in this research.