Abstract
The hidden curriculum within medical education has been a topic of recent debate. Consensus opinion regarding the continued relevance of this term, what constitutes the hidden curriculum, and the nature of its impact do not exist. Further research is required to contribute to this debate. This work sets out to investigate which factors beyond taught cognitive knowledge influence medical students in clinical and educational environments and examine how this occurs. Semi-structured focus group interviews were conducted with 39 students from one UK medical school. Fourteen faculty were interviewed individually to triangulate data. Data were analysed using constructivist thematic analysis, informed by grounded theory convention. The presence of the hidden curriculum was clearly demonstrated, acting through role modelling, organizational culture, stereotyping and professional dress. Mentioned frequently were the influences of the hidden curriculum on student professionalism and identity development. Professionalism was perceived as being negatively impacted by the hidden curriculum and seen as an imposition from senior faculty to control students. Students believe medical identity formation begins prior to medical school, in a process known as “anticipatory socialization”, a previously unstudied identity transition. Students felt covert institutional agendas negatively impacted their identity, pushing them further from the identity their institution was encouraging them to acquire. Key messages for educators include the need to explore the hidden curriculum through discussion with students. Improving transparency of organizational culture may allow students to interpret institutional agendas in the way institutions formally intend, reducing orthogonal interpretations of organizational culture and subsequent impact upon identity formation.
Highlights
Medical school is designed to equip students with the knowledge and skills required to become a doctor
The hidden curriculum “deals with the tacit ways in which knowledge and behaviour are constructed”, operating outwith of a medical school’s specified formal curriculum [2]. It consists of a set of influences acting upon students as a result of their presence within a specific organization [3]. These multifaceted influences operate within a student’s social environment and include “corridor conversations”, role modelling behaviour and assessment regimes [4].There is contemporary debate surrounding the definition of the hidden curriculum, with some viewing the term as the unwanted aspects of becoming a doctor [5] and others asserting the hidden curriculum includes positive interactions [6] and can offer benefits to both students and faculty
For the purpose of this research, the definition of the hidden curriculum will be taken as it has been described at the start of this paragraph
Summary
Medical school is designed to equip students with the knowledge and skills required to become a doctor. The hidden curriculum “deals with the tacit ways in which knowledge and behaviour are constructed”, operating outwith of a medical school’s specified formal curriculum [2]. It consists of a set of influences acting upon students as a result of their presence within a specific organization [3]. These multifaceted influences operate within a student’s social environment and include “corridor conversations”, role modelling behaviour and assessment regimes [4].There is contemporary debate surrounding the definition of the hidden curriculum, with some viewing the term as the unwanted aspects of becoming a doctor [5] and others asserting the hidden curriculum includes positive interactions [6] and can offer benefits to both students and faculty. This definition is without positive or negative connotations, in order to ensure findings are grounded in participant experience
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