Exploring the hidden curriculum’s impact on medical students: professionalism, identity formation and the need for transparency
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Published version
Author(s)
Brown, Megan EL
Coker, Oluwafemi
Heybourne, Annabel
Finn, Gabrielle M
Type
Journal Article
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.
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.
Date Issued
2020-09
Date Acceptance
2020-07-24
Citation
Medical Science Educator, 2020, 30 (3), pp.1107-1121
ISSN
2156-8650
Publisher
Springer
Start Page
1107
End Page
1121
Journal / Book Title
Medical Science Educator
Volume
30
Issue
3
Copyright Statement
© The Author(s) 2020. This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as
long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article
are included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in the
article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as
long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article
are included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in the
article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://doi.org/10.1007/s40670-020-01021-z
Publication Status
Published
Date Publish Online
2020-07-24