The perception of hidden curriculum among undergraduate medical students: a qualitative study

Professional values at the beginning of medical school: a quasi-experimental study

BACKGROUND

Teaching professionalism in medical schools is central to medical education and society. We evaluated how medical students view the values of the medical profession on their first day of medical school and the influence of a conference about the competences of this profession on these students' levels of reflection.

METHODS

We studied two groups of medical students who wrote narratives about the values of the medical profession and the influence of the COVID-19 pandemic on these values. The first group wrote the narratives after a conference about the competences of the medical profession (intervention group), and the second group wrote the same narratives after a biochemistry conference (control group). We also compared the levels of reflection of these two groups of students.

RESULTS

Among the 175 medical students entering in the 2022 academic year, 159 agreed to participate in the study (response rate = 90.8%). There were more references to positive than negative models of doctor‒patient relationships experienced by the students (58.5% and 41.5% of responses, respectively). The intervention group referred to a more significant number of values than the control group did. The most cited values were empathy, humility, and ethics; the main competences were technical competence, communication/active listening, and resilience. The students' perspectives of the values of their future profession were strongly and positively influenced by the pandemic experience. The students realized the need for constant updating, basing medical practice on scientific evidence, and employing skills/attitudes such as resilience, flexibility, and collaboration for teamwork. Analysis of the levels of reflection in the narratives showed a predominance of reflections with a higher level in the intervention group and of those with a lower level in the control group.

CONCLUSIONS

Our study showed that medical students, upon entering medical school, already have a view of medical professionalism, although they still need to present a deeper level of self-reflection. A single, planned intervention in medical professionalism can promote self-reflection. The vision of medical professional identity was strongly influenced by the COVID-19 pandemic, positively impacting the formation of a professional identity among the students who decided to enter medical school.

‘I left feeling different about myself’: What students learn on their first practice placement

Introduction:

With the inclusion of 40 hours of simulated practice education for UK occupational therapy students and the subsequent impact of the COVID-19 pandemic, universities have been exploring simulated placement opportunities. However, the evidence available to guide the development of such placements is sparse. This article presents the first stage of a grounded theory study that seeks to understand what students learn during the course of their first practice placement, with the intention of informing simulated placement development.

Method:

Grounded theory methodology was used to guide semi-structured individual interviews with 15 participants – seven undergraduate students, three practice educators and five postgraduate pre-registration students. Interviews occurred close to the end of the first practice placement. Concurrent data collection and analysis led to the development of categories of learning.

Findings:

Four core categories of learning were identified: learning about oneself, learning about the occupational therapy profession, learning about practices and learning about service users.

Conclusion:

Understanding of these four categories of learning may enable educators to consider learning which occurs that may not be anticipated, particularly in regard to personal development. This can enable educators to consider how learning can be targeted within simulation for an authentic simulated placement.

Critical appraisal skills training to undergraduate medical students: A Randomized Control Study

INTRODUCTION

Critical appraisal skills are presumed to perform a principal part in evidence-based health education and practice methods. This study aimed to design an educational intervention around critical appraisal in this context, evaluate the efficacy of the teaching methods, and investigate critical appraisal skills training to undergraduate medical students.

METHODS

In this prospective Randomized Control Trial (RCT), 256 sixth-year undergraduate medical students from Shiraz University of Medical Science, Shiraz, Iran, participated. 124 of the students were not taught critical thinking methods as a control group, and 132 participants were taught critical thinking methods by multi-media and attended an online Critical Appraisal Skills (CAS) training workshop as an intervention group. We used the Critical Appraisal Skills Programme (CASP) questionnaire to evaluate students' knowledge, attitude, confidence, and appraisal skills. This questionnaire was translated into Persian for the first time in Iran by Shokooh Varai, et al. They investigated its validity and reliability, the reliability of the questionnaire being obtained by the Richardson Index (0.75), and the validity being confirmed by some faculty members of Tehran Nursing and Midwifery School. To compare both control and intervention groups, we used an independent t-test and a Chi-Square test at a significance level of 5%, and to analyze the demographic information, we applied some descriptive statistics: frequency, frequency percentage, mean and standard deviation. All of the statistical approaches were analyzed, using SPSS 22.

RESULTS

In all dimensions of the critical appraisal skills, medical students who completed the critical appraisal multi-media training and workshop performed better than those who did not (control group), and this difference was statistically significant (p<0.05). Moreover, the Chi-Square test results showed no statistical relationship between the groups regarding the demographic variables (p>0.05). Also, the Cohen's D effect size values in the knowledge and confidence dimensions were greater than 0.5; this meant a large effect. Regarding the attitude and appraises Skill dimensions, the effect size was between 0.2 and 0.5, which meant a medium effect.

CONCLUSIONS

Teaching critical appraisal skills through multi-media and CAS online workshops to medical students effectively improves the students' knowledge and confidence in appraising articles. This teaching also indicated a medium effect on students' attitudes and behavior. Our findings can justify implementing critical appraisal skills teaching modules in the undergraduate medical education curriculum.

Exploring the hidden curriculum of professionalism and medical ethics in a psychiatry emergency department

PURPOSE

To investigate the hidden curriculum of professionalism in the emergency department.

DESIGN AND METHODS

This is a qualitative study that consisted of six in-depth semi-structured interviews and a focus group with psychiatry residents of a teaching hospital program about their perception of professionalism in emergency department. A simple content analysis method has been conducted for the extraction of findings.

FINDINGS

Common themes that were detected in the hidden curriculum were "Disregarding the priority of the patients"; "Overriding patient autonomy"; "Non-empathetic care"; "Breaching Confidentiality"; "Injustice in providing care"; and "Dishonesty" PRACTICE IMPLICATIONS: Professional behaviors are mostly learned through the hidden curriculum. The hidden and formal curricula of professionalism are different in several domains. Paying attention to organizational culture and social environment is critical for promoting professionalism.

Application of community-based nutrition education needs assessment in reviewing the course plan of medical and nursing students

Background: Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.

Methods: The study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.

Results: The priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.

Conclusion: The use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.

Can doctors be taught virtue?

Medical schools and residency programs have become very adept at teaching medical students and residents an enormous amount of information. However, it is much less clear whether they are effective at fostering virtuous qualities like empathy or professionalism in trainees. This would come as no surprise to Plato, who famously argued in the Meno that virtue cannot be taught. This pedagogical challenge threatens to stymie medical educators, who increasingly recognize the importance of professionalism, compassion, and empathy in the practice of good medicine. As medical educators, we are motivated to demonstrate that virtue is teachable and to find a way to do so, as this is how we will be able to improve the conduct of physicians and the quality of their care of patients. As such, we address the question of the teachability of virtue in the realm of medicine, analysing Plato's contradictory analyses in the Meno and Protagoras, and drawing upon modern neuroscience to turn an empirical lens on the question. We explore the ways in which Noddings' Ethic of Care may offer a way forward for medical educators keen to foster virtue in trainees. We conclude by demonstrating how, by harnessing the power of caring relationships, the principles of Noddings' Ethic of Care have already been applied to medical education at a university in Israel.

Surveys in Surgical Education: A Systematic Review and Reporting Guideline

OBJECTIVES

Survey studies are a commonly used method for data collection in surgical education research. Nevertheless, studies investigating survey design and response rates in surgical education research are lacking. The aim of this study was to gain an insight into survey response rates among surgical residents and medical students, and provide an initial reporting guideline for future survey studies in this field.

DESIGN

PubMed (MEDLINE) was systematically searched for survey studies in surgical education from January 2007 until February 2020, according to the PRISMA statements checklist. Study selection was conducted by 2 authors, independently. Surveys directed at surgical residents and/or medical students were included if data on response rates was available. Studies reporting solely from nonsurgical fields of medicine, paramedicine, or nursing were excluded. Subgroup analyses were performed, comparing response rates for varying modes of survey, per country, and for the 10 journals with the most identified surveys.

RESULTS

From the 5,693 records screened for a larger surgical survey database, a total of 312 surveys were included; 173 studies focused on surgical residents and 139 on medical students. The mean (SD) response rate was 55.7% (24.7%) for surgical residents and 69.0% (20.8%) for medical students. The number of published surveys increased yearly, mostly driven by an increase in surgical resident surveys. Although most surveys were Web-based (n = 166, 53.2%), this survey mode resulted in the lowest response rates (mean 52.6%). The highest response rates, with a mean of 79.8% (13.1%), were seen in in-person surveys (n = 89, 28.5%). Wide variations in response rates were seen between different countries and journals.

CONCLUSIONS

Web-based surveys are gaining popularity for medical research in general and for surgical education specifically; however, this mode results in lower response rates than those of in-person surveys. The response rate of in-person surveys is especially high when focusing on medical students. To improve reporting of survey studies, we present the first step towards a reporting guideline.

Students' and Faculty Perspectives Toward the Role and Value of the Hidden Curriculum in Undergraduate Medical Education: a Qualitative Study from Saudi Arabia

A hidden medical curriculum is defined as the unwritten, unofficial, and unintended learning that students experience in medical school along with more formal aspects of education. This term describes the behaviours, attitudes, assumptions and beliefs conveyed by teachers, peers and the surrounding environment. However, more research is needed to evaluate its impact on student and faculty interactions in this context. We conducted this qualitative study utilizing focus group and semi-structured interviews of students and faculty to evaluate the perspectives of medical students and faculty toward the role and impact of the hidden medical curriculum in medical education at Alfaisal University, Riyadh, Saudi Arabia. Data was analysed using open-, axial- and selective-coding using thematic framework analysis. Interviewees consisted of 24 students in years 1-3 during the spring semester 2018-2019, 8 faculty members and 4 teaching assistants. We identified six core themes of hidden curriculum at Alfaisal University (Appendix). Role and behavioural modelling, value-based teaching, interpersonal faculty-student interactions, effects of diversity and socialization, teaching methodologies and hidden curriculum, mentoring and student support systems. Although some of the themes identified in these focus group interviews were similar to previously published studies, the novel themes that we identified were diversity, socialization and interpersonal faculty-student interactions. We conclude that identifying the issues pertaining to hidden curriculum is important for the development of medical students and for nurturing and upholding the values that we want to instil in our future physicians.

Cultivation of humanistic values in medical education through anatomy pedagogy and gratitude ceremony for body donors

BACKGROUND

One of the most important objectives of modern medical education is to empower medical students to become humanistic clinicians. Human anatomy plays a crucial role in this mission by using cadavers to cause reflections on death, dying, illness, and the role of medical practitioners in humanistic care. The objective of this study was to introduce, describe, and evaluate the impact of a ceremony in honor of the body donors on ethical and humanistic attitudes of medical students.

METHODS

We used a phenomenological research approach to explore and understand the lived experiences of the anatomy teachers as they teach anatomy in the context of humanism and ethics. A separate survey of third-year medical students was carried out to understand their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. Data were collected in two phases: a desktop review of teaching materials followed by in-depth interviews of the main anatomy teachers followed by a self-administered, 5-item Likert scaled questionnaire given to students.

RESULTS

In the present article, we describe the rituals conducted in honor of body donors at our School of Medicine. We also describe the lived experiences of anatomy teachers as they work on improving humanistic education quality through the introduction of the concept of "silent mentor" which refers to a cadaver that quietly allows medical students to learn from it. In turn, a ceremony in honor of body donors who have altruistically donated their bodies so that learning anatomy through dissection would be possible is also introduced. A survey of the impact of the ceremony in honor of body donors on medical students revealed positive responses in terms of promoting studying anatomy (3.96 Vs 3.95) as well as reflections on own death (4.44 Vs 4.35), the life of body donors (4.07 Vs 4.04), and how to humanely view future patients and their significant others (4.32 Vs 4.24) relative to those that did not attend the ceremony (5-item Likert scale). The majority of the students that attended the ceremony also indicated that it had a positive impact on their future doctor-patient relationship, thinking about the possibility of donating their body for teaching as well as about medical ethics. Most of them also think that attending the ceremony helped reduce their anxiety, fear, and disgust of seeing corpses or dissecting and 90% insisted that memorial ceremonies should continue being conducted at Zhongshan Medical School.

CONCLUSION

The combination of the anatomy component of the basic medical curriculum and gratitude ceremonies as well as activities to promote body bequeathal programs might help to accomplish the goal of cultivating high-quality medical students and professionals for the future. The long-term benefits would be a medical graduate who exudes empathy, relates well with patients and their significant others, leading to a productive doctor-patient relationship.

The Hidden Curriculum Challenges in Learning Professional Ethics Among Iranian Medical Students: A Qualitative Study

BACKGROUND

Medical ethics is a vital quality for the doctors which has been seriously taken into consideration in recent years. Identifying the factors affecting medical ethics may help to develop more effective ways to promote this quality in medical education. This study was aimed to explain the challenges of hidden curriculum in learning the professional ethics among Iranian medical students.

MATERIALS AND METHODS

This qualitative study was performed on 15 medical interns of Kermanshah University of Medical Sciences in 2019 using grounded theory (GT). Sampling was started by purposive sampling and continued through theoretical sampling until complete data saturation. Data collection and analysis were done simultaneously. Data were interpreted by the constant comparative method according to Strauss and Corbin's approach.

RESULTS

The results showed that the challenges of hidden curriculum for learning the professional ethics by medical students included a number of key concepts. Analyzing these concepts and taking into account the commonalities, we obtained six subthemes using a reduction inductive method, the main theme of which was "the challenge of hidden curriculum in learning the professional medical ethics". The subthemes included "decreased interest in medicine", "false beliefs", "curriculum weakness", "materialism and economic problems", "avoidance of responsibility", and "underlying problems of the medical profession".

CONCLUSION

The findings indicated six challenges in the hidden curriculum for learning the professional medical ethics. These challenges can be considered a threat or an obstacle to achieving the goals of professional ethics. Therefore, curriculum planners, education policymakers, and teachers should plan and implement the professional ethics curriculum based on these factors.

#OrthoTwitter: social media as an educational tool

Aims

The increased use of social media creates opportunity for new, effective methods of delivering medical and clinical education. Twitter is a popular social media platform where users can post frequent updates and create threads containing related content using hashtags. This study aims to investigate and analyse the type of content relating to orthopaedic surgery that is being posted on the platform of Twitter.

Methods

A retrospective search was performed for tweets containing the words ‘orthopaedic surgery’ or ‘orthopedic surgery’ or the use of the hashtag ‘#OrthoTwitter’ between November 2018 to November 2019. A total of 5243 tweets were included.

Results

Tweets containing ‘orthopaedic surgery’ or ‘orthopedic surgery’ most frequently contained promotional or marketing content (30% promotional, 21% marketing), and private organisations were the category of author to which the greatest number of tweets belonged (30%). Tweets containing educational or research content were the least common among all tweets containing ‘orthopaedic surgery’ or ‘orthopedic surgery’ (11%). In contrast, of the tweets containing the hashtag ‘#OrthoTwitter’, 44% contained educational or research content, 15% contained promotional content and no tweets containing marketing content. Furthermore, 87% of all tweets using the hashtag ‘#OrthoTwitter’ were from orthopaedic surgeons, and the least number of tweets were from private organisations (2%).

Conclusion

Twitter is a widely used social media platform regarding orthopaedic surgery. We propose that the hashtag ‘#OrthoTwitter’ can be used to create an online community of orthopaedic surgeons where members can assist one another through sharing reliable and educational content.

Assessing the Impact of a Ceremony in Honor of the Body Donors in the Development of Ethical and Humanistic Attitudes among Medical Students

Activities related to body donation programs, such as donor memorial ceremonies, provide the opportunity to complement student training, especially with regard to the ethical and humanistic elements involved in medical training. This study sought to assess the impact of a ceremony in honor of the body donors has on ethical and humanistic attitudes in medical students. Medical students were surveyed about their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. The effect of the students' contact with the family of the donor was analyzed in students who had contact with the cadaver in the dissection room and had either participated or not participated in the donor memorial ceremony. A total of 370 questionnaires were answered by first-, second-, and third-year medical students at the Federal University of Health Sciences of Porto Alegre in 2017. The students who participated in the ceremony presented more positive responses in relation to commitment to their studies, reflection on death, and positive development of empathy when compared to those who did not attend the ceremony. Most of the students that attended the ceremony suggested the event led to an improvement in the doctor-patient relationship. These results suggest that cadaver dissection with accompanied memorial ceremony involving contact with donor families is an effective means of fostering ethical and humanistic attitudes among medical students from the beginning of the course.

Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method

BACKGROUND

Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME.

OBJECTIVES

This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them.

METHODS

In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM).

RESULTS

Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components.

CONCLUSION

The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.

Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices

The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a "hidden curriculum." Evidence suggests a strong association between "hidden curriculum" delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the "hidden curriculum" within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the "hidden curriculum" within the evolving gross anatomy education model.