Medical students’ experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives Primary healthcare internationally is facing a workforce crisis with fewer junior doctors choosing general practice (GP) as a career. In the UK, a national report on GP careers highlighted adverse influences during medical school on students’ career choices. The authors explored these influences in two urban UK medical schools, both with relatively low numbers of students entering GP training.
Design Using a phenomenological approach, the authors thematically analysed the reflective diaries of four medical students who were recruited as ‘participant researchers’ over a period of 10 months. These students made regular reflexive notes about their experiences related to GP career perceptions in their academic and personal environments, aiming to capture both positive and negative perceptions of GP careers. The research team discussed emerging data and iteratively explored and developed themes.
Setting Two UK medical schools
Participants Undergraduate medical students
Results Seven key themes were identified: the lack of visibility and physicality of GP work, the lack of aspirational GP role models, students’ perceptions of a GP career as default, the performativity of student career choice with the perceptions of success linked to specialism, societal perceptions of GP careers, gender stereotyping of career choices and the student perception of life as a GP.
Conclusions Students overwhelmingly reflected on negative cues to GP careers, particularly through their experience of the hidden curriculum. Three recommendations are made: the need for increased representation of GP role models in clinical curricula content delivery and senior leadership; ensuring GP clerkships involve an active and authentic student role with patients, enabling students to experience GP’s ‘work’ including managing complexity, uncertainty and risk. Finally, institutions need to consider students’ experiences of the hidden curriculum and the effect this can have on students’ perception of careers, alongside the challenges of rankings and perceived hierarchical positioning of disciplines.
Design Using a phenomenological approach, the authors thematically analysed the reflective diaries of four medical students who were recruited as ‘participant researchers’ over a period of 10 months. These students made regular reflexive notes about their experiences related to GP career perceptions in their academic and personal environments, aiming to capture both positive and negative perceptions of GP careers. The research team discussed emerging data and iteratively explored and developed themes.
Setting Two UK medical schools
Participants Undergraduate medical students
Results Seven key themes were identified: the lack of visibility and physicality of GP work, the lack of aspirational GP role models, students’ perceptions of a GP career as default, the performativity of student career choice with the perceptions of success linked to specialism, societal perceptions of GP careers, gender stereotyping of career choices and the student perception of life as a GP.
Conclusions Students overwhelmingly reflected on negative cues to GP careers, particularly through their experience of the hidden curriculum. Three recommendations are made: the need for increased representation of GP role models in clinical curricula content delivery and senior leadership; ensuring GP clerkships involve an active and authentic student role with patients, enabling students to experience GP’s ‘work’ including managing complexity, uncertainty and risk. Finally, institutions need to consider students’ experiences of the hidden curriculum and the effect this can have on students’ perception of careers, alongside the challenges of rankings and perceived hierarchical positioning of disciplines.
Date Issued
2021-07-29
Date Acceptance
2021-07-06
Citation
BMJ Open, 2021, 11 (7)
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
11
Issue
7
Copyright Statement
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
License URL
Identifier
10.1136/bmjopen-2021-049825
Subjects
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status
Published
Article Number
ARTN e049825
Date Publish Online
2021-07-29