| Summary: | Background - The theory of Threshold Concepts (TC) proposes that there are ideas necessary for a student to learn which enable them to think like a professional. Studies of TC in higher education have appeared since 2003. Studies in medical education are more recent.
Method - We studied TC using a qualitative analysis approach (grounded theory and constant comparison) to produce a thematic analysis of 135 de-identified reflective practice essays from students in the pediatric clerkship at our medical school.
Summary of results - Seven themes met our criteria for a threshold concept; transformative (ontological shift) and troublesome (causes angst). 2 TC in our students' work were identical with those found by authors from the UK ("Medicine isn't black and white," and "Sometimes there isn't a right answer,") 4 TC were similar and 2 were distinct.
Discussion - Our findings suggest that there are some TC inherent (maybe essential) in personal and professional identify formation for a student moving from layperson to physician-hood, regardless of the setting of the medical school.
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