Easy to Use Active Community Supportive Instructors

Continuing education for clinicians who refuse to leave gaps in care.

Experienced healthcare professionals using methods that prioritize mentorship, normalize ongoing skill-building, and embrace evidence-based educational strategies in an active, well supported community.

Healthcare providers at a continuing education conference

Photo caption here as needed

75+
Combined Years in Practice
12
CE Credit Hours, Module #1
3
Clinical Disciplines
∞
Lifetime Forum Access
— Our Premise —

By making specialized gynecological education accessible, practical, and current: we empower healthcare professionals to show up fully informed and ready to deliver the quality care their patients deserve.

— A founding principle of Threshold & Practice

— The Team —

Three clinicians.
One shared conviction.

We met across hospital systems, private practices, and community clinics throughout the Pacific Northwest. What we shared — beyond decades of bedside experience — was a deep frustration with how much essential patient care lives outside the standard medical curriculum. So we built the curriculum we wished existed for the patients and providers alike.

Lori Swain, DNP, CNM, MSCP, FACNM

Lori Swain

DNP, CNM, MSCP, FACNM

Lori is a CNM in full-time clinical practice, bringing the midwifery model of care to patients across the lifespan - with a specific focus on midlife and gynecologic care. She is a Menopause Society Certified Practitioner (MSCP) and is committed to partnering with patients as they navigate the transitions and complexities of midlife and beyond.

Jennifer Ham, DNP, CNM, MSCP, FACNM

Jennifer Ham

DNP, CNM, MSCP, FACNM

Jennifer has served as a CNM to families from a variety of organizational models throughout the United States since 2011 and she served as a registered nurse in hospital birth for a decade preceding in midwifery training. She is currently working as a clinician with interest in longitudinal care and she has expertise as clinical faculty, in systems quality improvement and she is a published author on the topic of mentorship. She earned her Menopause Society Certified Practitioner (MSCP) in 2015 and she is a fellow of the American College of Nurse-Midwives, one of the highest honors in the profession.

Heather Carrion, CNM, MSCP, RNFA

Heather Carrion

CNM, MSCP, RNFA

Heather began practicing midwifery in 2010, first in a Philly area practice, where she gained invaluable GYN experience mentored by the physician-owner, then she moved back to Oregon in 2015 to join the practice she currently works in. In January 2024, she began practicing GYN-only care and in October 2024 earned her designation as a Menopause Society Certified Practitioner. In August 2025, she completed her training as an RN First Assist (RNFA) for gynecologic surgery alongside her long-time GYN colleagues. Throughout all of this, she has provided patient-centered care and would now like to use these experiences to help other clinicians become comfortable with GYN care

— What We Offer —

Three ways
to practice deeper.

g

Our focus for online learning centers on positioning the midwife as an expert in gynecology and longitudinal care, expanding access, strengthening confidence and scope among NPs, PAs, and midwives, and grounding gynecologic care in a midwifery philosophical construct.

I.

Practice toolkits

Professional resources, EMR sample templates, sample after visit summaries for patient education, pertinent billing and coding information that pertains to that kind of visit

Browse the catalog →
II.

Knowledge

Accessibility in mind, asynchronous, as the clinician is able

See what's inside →
III.

Practical application of knowledge through Case Based Learning (CBL) Sessions

Synchronous and recorded facilitated case reviews with the owners and within a group of diverse clinicians with integrated polls and questions. Low stakes involvement that encourages participation over “right answers”

Apply for the next cohort →
IV.

Community of Practice (CoP)

Opportunity to join in and participate in online communities until the expiration of the CE (2 years) where clinicians can try implementation of knowledge in local contexts and participate in communities by bringing back wins and failures of new approaches, workflows, application of knowledge and continue to troubleshoot pain points.

Apply for the next cohort →

Built for the clinicians who have the will but not the time.g

  • Family Medicine Physicians
  • Internal Medicine Physicians
  • OB/GYNs
  • Nurse Practitioners
  • Physician Associates
  • Clinical Pharmacists
  • Registered Nurses in primary care
  • Mental health clinicians
  • Physical & pelvic floor therapists
  • Naturopathic physicians
— Start Here, Today —

Begin where the textbook left off.

Join our email newsletter list for early access to new modules, monthly clinical letters from our founders, and get notified when registration is about to open. No noise. We only send when we have something to say.