The Hidden Curriculum: What Can We Learn From Third-Year Medical Student Narrative Reflections?

Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts 02139, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 3.47). 09/2010; 85(11):1709-16. DOI: 10.1097/ACM.0b013e3181f57899
Source: PubMed

ABSTRACT To probe medical students' narrative essays as a rich source of data on the hidden curriculum, a powerful influence shaping the values, roles, and identity of medical trainees.
In 2008, the authors used grounded theory to conduct a thematic analysis of third-year Harvard Medical School students' reflection papers on the hidden curriculum.
Four overarching concepts were apparent in almost all of the papers: medicine as culture (with distinct subcultures, rules, vocabulary, and customs); the importance of haphazard interactions to learning; role modeling; and the tension between real medicine and prior idealized notions. The authors identified nine discrete "core themes" and coded each paper with up to four core themes based on predominant content. Of the 30 students (91% of essay writers, 20% of class) who consented to the study, 50% focused on power-hierarchy issues in training and patient care; 30% described patient dehumanization; 27%, respectively, detailed some "hidden assessment" of their performance, discussed the suppression of normal emotional responses, mentioned struggling with the limits of medicine, and recognized personal emerging accountability in their medical training; 23% wrote about the elusive search for personal/professional balance and contemplated the sense of "faking it" as a young doctor; and 20% relayed experiences derived from the positive power of human connection.
Students' reflections on the hidden curriculum are a rich resource for gaining a deeper understanding of how the hidden curriculum shapes medical trainees. Ultimately, medical educators may use these results to inform, revise, and humanize clinical medical education.

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    • "Thus, students are personally driven to emulate the behaviors of strong clinical mentors who may or may not model desired professional behaviors (Brainard and Brislen 2007; Cohen et al. 2009). Borrowing the language of educators (Jackson 1968), Hafferty (1998) described this transmission of the culture of medicine as the ''hidden curriculum'' which is now recognized by many as a more powerful determinant of medical student behavior than the formal curriculum (Gaufberg et al. 2010; Ginsburg et al. 2003; Hafferty 1998). A formal curriculum, therefore, must include content and instructional methods other than just teaching appropriate professional behaviors to students (Graber 2009). "
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    Advances in Health Sciences Education 10/2014; DOI:10.1007/s10459-014-9558-9 · 2.71 Impact Factor
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    • "Adelman et al., 2007; Eskildsen & Flacker, 2009). While efforts are ongoing to revise medical school formal curricula to improve students' perceptions of and approach to geriatric care, the " hidden " or informal curriculum remains a powerful influence on how physicians-in-training learn to practice medicine and form opinions about different types of patients (e.g., Cribb & Bignold, 1999; Gaufberg et al., 2010; Hafferty & Franks, 1994; Lempp & Seale, 2004). Research has shown the importance of the attitudes and behaviors of senior physicians on shaping how physicians-in-training perceive certain tasks, types of patients, or goals; for example, Diachun et al. found that " teachers' biases regarding the importance of geriatric education can negatively affect students' interest in geriatric course content " (2010: 1222). "
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