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Hosseini A, Ghasemi E, Nasrabadi AN, Sayadi L. Strategies to improve hidden curriculum in nursing and medical education: a scoping review. BMC MEDICAL EDUCATION 2023; 23:658. [PMID: 37691094 PMCID: PMC10494411 DOI: 10.1186/s12909-023-04652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The importance of hidden curriculum cannot be neglected in education. Despite much research in the field, there have been limited studies on HC improvement in nursing and medical education. This scoping review aimed to determine the scope of strategies to improve HC in nursing and medical education. METHOD PubMed, EBSCO/Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Web of Science, Proquest and Persian-language databases of Magiran and SID were searched in January 2023 without a time filter. According to the PRISMA flow diagram, two independent reviewers selected the records that fit the inclusion and exclusion criteria via title and abstract screening. Next, the reviewers studied the full texts of the related articles. The data extracted from the selected articles were tabulated and ultimately synthesized. FINDINGS Out of the eight examined studies, published from 2017 to 2022, only one was in the field of nursing and seven were in medicine. The central strategies were implementing new curricula to replace the previous ones, utilizing team-based clinical clerkship, proposing a HC improvement model, implementation a case-based faculty development workshop, implementation longitudinal and comprehensive educational courses, and incorporating an educational activity into a small group program. CONCLUSION Students and faculty members familiarization on the topic of HC, implementing new curricula, utilizing team-based clerkship, and using comprehensive models were among the HC improvement strategies. Focusing on upgrading the learning environment, particularly the clinical settings, can also be helpful in HC improvement.
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Affiliation(s)
- Amin Hosseini
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ghasemi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Sayadi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Shah A, Gasner A, Bracken K, Scott I, Kelly MA, Palombo A. Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis. MEDICAL EDUCATION 2021; 55:1242-1252. [PMID: 34075608 DOI: 10.1111/medu.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies. METHODS Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students. FINDINGS A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11 weeks) matched to FM at higher rates than short (25-40 hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n = 586). CONCLUSIONS Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Affiliation(s)
- Ajay Shah
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Adi Gasner
- Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Keyna Bracken
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian Scott
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Martina A Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alessandra Palombo
- Division of Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Herr KD, George E, Agarwal V, McKnight CD, Jiang L, Jawahar A, Pakkal M, Ulano A, Ganeshan D. Aligning the Implicit Curriculum with the Explicit Curriculum in Radiology. Acad Radiol 2020; 27:1268-1273. [PMID: 32061468 DOI: 10.1016/j.acra.2019.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Physician education occurs through two mechanisms that operate in tandem: the explicit and the implicit curriculum. The explicit, or formal, curriculum is the official version that is usually taken as the one-and-only curriculum and which is detailed in official documentation; however, an implicit curriculum exists, comprised of subtle messaging about professional norms, values, and beliefs that are tacitly communicated through both positive and negative role modeling. Both contribute to the overall education of the medical student and physician-in-training. Despite its well-documented influence in medical education, much of the teachings of the implicit curriculum occurs in the shadows, unspoken and unarticulated, and outside the awareness of both teacher and student. As panel members of the The Implicit Curriculum in Radiology Task Force of the Association of University Radiologists-Radiology Research Alliance (AUR-RRA), we present a review of the implicit curriculum, exploring its origin and impact on medical education, and on the overall professional development of medical students, post-graduate medical trainees and practicing physicians. Strategies for recognizing and contending with the implicit curriculum in radiology training are discussed, with a special emphasis on opportunities to leverage its potential through positive role modeling.
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Affiliation(s)
- Keith D Herr
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308.
| | - Elizabeth George
- Fellow in Neuroradiology, Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Colin D McKnight
- Vanderbilt University Medical Center, R-1302 MCN, South Nashville, Tennessee
| | - Liwei Jiang
- Integrated Interventional Radiology Resident, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anugayathri Jawahar
- Clinical Instructor in Radiology, Stanford University, Palo Alto, California
| | - Mini Pakkal
- Toronto General Hospital, Department of Medical Imaging, Toronto, Ontario
| | - Adam Ulano
- Department of Radiology, University of Vermont Medical Center, The Robert Larner MD College of Medicine at the University Of Vermont, Burlington, Vermont
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, Texas
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How can Artistic Paintings Broaden Medical Students' Understanding of the Radiology Profession? Acad Radiol 2019; 26:1718-1725. [PMID: 31080091 DOI: 10.1016/j.acra.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to explore how representational paintings of radiology encounters with patients may impact medical students' understanding and impression of both radiologists and the radiology profession. METHODS Participants included third year medical students at a single institution rotating through a one-week radiology elective. Three works of art were analyzed using the validated Visual Thinking Strategies technique. Data collected included a postsession questionnaire and transcriptions of audio-recorded sessions. Data analysis involved both qualitative and quantitative methodology. RESULTS Fifty students participated; all participants completed the postsession questionnaire and 10 participated in the audio recorded sessions. Total 82% found the experience "very enjoyable" and 86% agreed that the paintings positively affected their understanding of how radiologists provide care to patients; 96% would recommend this session to others. Exploring representational paintings of radiology encounters seemed to influence perception and understanding of radiology with students reporting "light bulb moments;" create a dissonance between the student experience and the experience depicted in the paintings; and address gaps in content specific knowledge. CONCLUSION The findings of this study suggest that analyzing paintings depicting radiology encounters with patients can challenge negative stereotypes that medical students have of the radiology profession and radiologists. This arts-based learning module employing a learning strategy such as Visual Thinking Strategies, should be considered by the radiology profession as a strategy to positively inform and educate trainees about the specialty.
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Designing a Comprehensive Undergraduate Medical Education Radiology Curriculum Using the 5C's of Radiology Education Framework. Can Assoc Radiol J 2018; 69:362-366. [PMID: 30318455 DOI: 10.1016/j.carj.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/02/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022] Open
Abstract
The 5C's of Radiology Education is a tool created from a recent qualitative study designed to explore how radiology exposures impact medical student opinions and perceptions of radiology and radiologists. It outlines the factors that the medical students identified as important for their radiology education. These factors are curriculum, coaching, collaborating, career, and commitment. The purpose of this paper is to provide a review of the literature of undergraduate medical education both broadly and more specifically to radiology education using the 5C's of Radiology Education framework.
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Aggarwal S, Kheriaty A. Same behavior, different provider: American medical students' attitudes toward reporting risky behaviors committed by doctors, nurses, and classmates. AJOB Empir Bioeth 2017; 9:12-18. [PMID: 28985136 DOI: 10.1080/23294515.2017.1377780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The bioethics literature lacks findings about medical students' attitudes toward reporting risky behaviors that can cause error or reduce the perceived quality of health care. A survey was administered to 159 medical students to assess their likelihood to directly approach and to report various providers-a physician, nurse, or medical student-for three behaviors (poor hand hygiene, intoxication, or disrespect of patients). For the same behavior, medical students were significantly more likely to approach a classmate, followed by a nurse and then a doctor (p < .0001), to ask for behavioral modification. Across all three health care provider types, medical students were most likely to report intoxication (p < .0001). Medical students' willingness to approach or report a provider for a risky or unprofessional behavior is influenced by the type of health care provider in question. Medical schools should implement patient safety curricula that alleviate fears about reporting superiors and create anonymous reporting systems to improve reporting rates.
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Little D, McCoubrie P. Learning whilst on-call: a vital part of radiology training? Clin Radiol 2016; 71:921-4. [DOI: 10.1016/j.crad.2016.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
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The Exposure Dilemma: Qualitative Study of Medical Student Opinions and Perceptions of Radiology. Can Assoc Radiol J 2015; 66:291-7. [DOI: 10.1016/j.carj.2014.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/20/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose According to a national survey of over 900 Canadian medical students, the stereotype of an isolated radiologist working in a dark room persists. The purpose of this study is to use qualitative methods to explore the ways exposure to radiology in medical school impacts students’ opinions and perceptions of radiology and radiologists. Methods After receiving ethics approval, 4 focus groups were conducted, 1 per year of undergraduate medical training at Western University. The transcribed audio recordings and accompanying field notes, together with the open-ended questions obtained from the national survey, were analyzed using thematic analysis. Results Five hundred sixty students in medical school years 1 and 2 (preclerkship) participated in the national survey and 18 in the focus groups; 336 students in years 3 and 4 [clerkship] participated in the national survey and 10 in the focus groups. Three major findings emerged from the analysis of the data. First, stereotypes are perpetuated mainly through informal interactions. Second, there is limited exposure to radiology and radiologists in medical school, especially in preclerkship. Third, students want to know what to expect if they choose a career in radiology. Conclusions Medical students, especially those in preclerkship, are seeking accurate information to modify or reinforce radiology stereotypes. Limited exposure makes interactions with students impactful and mentorship essential. Students want meaningful interactions with radiologists and radiology residents.
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Improving Psychiatry Residents' Attitudes Toward Individuals Diagnosed with Substance Use Disorders. Harv Rev Psychiatry 2015; 23:296-300. [PMID: 26146757 DOI: 10.1097/hrp.0000000000000047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Special attention needs to be paid to the attitudes of psychiatry residents toward individuals diagnosed with substance use disorders. The attitudes of trainees may be worse toward these individuals than toward individuals with other diagnoses, and these attitudes may worsen over time. While psychiatry residencies are increasingly teaching residents about how to diagnosis and treat individuals diagnosed with substance use disorders, more attention needs to be paid to educating residents about common attitudes toward these individuals. We recommend that psychiatry residency programs start with basic educational didactics and reflection exercises on attitudes toward individuals diagnosed with substance use disorders and that programs try to form a positive "hidden curriculum" in their institutions.
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Linhares JJ, Dutra BDAL, da Ponte MF, de Tofoli LFF, Távora PC, de Macedo FS, de Arruda GM. Construction of a competence-based curriculum for internship in obstetrics and gynecology within the medical course at the Federal University of Ceará (Sobral campus). SAO PAULO MED J 2015; 133:264-70. [PMID: 25885488 PMCID: PMC10876371 DOI: 10.1590/1516-3180.2014.0804872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/08/2014] [Accepted: 09/23/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE This research project arose from a proposal made to the teachers by the students of a medical course at a federal university in Brazil, from their personal experiences regarding the skills and competencies that should be developed during the obstetrics and gynecology (OBG) stage of the internship. The objective here was to develop the matrix of skills necessary for training good general physicians in the medical course. DESIGN AND SETTING Exploratory qualitative study conducted in a federal university in Brazil. METHODS The basis for developing these competencies among OBG interns was "The Competency Matrix for Medical Internship" developed by Bollela and Machado. The instrument was presented to, analyzed by and modified by a set of OBG specialists, at two sessions. RESULTS The specific competencies expected from students over the internship in OBG were framed within overall topics that had previously been determined and listed: healthcare, decision-making, communication and interpersonal relationships, management and organization of the Brazilian National Health System (Sistema Único de Saúde, SUS) and professionalism. CONCLUSIONS A competency matrix that standardizes the minimum requirements that interns should be capable of putting into practice after concluding the OBG stage is a valuable tool for ensuring student performance and a fair and rigorous assessment for them, thereby seeking to train good general physicians who meet the community's needs.
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Affiliation(s)
- José Juvenal Linhares
- MD, PhD. Assistant Professor, Discipline of Personal Development, Faculdade de Medicina da Universidade Federal do Ceará (FMUFC), Sobral, Ceará, Brazil.
| | | | | | - Luis Fernando Farah de Tofoli
- MD, PhD. Adjunct Professor, Discipline of Personal Development, Faculdade de Medicina da Universidade Federal do Ceará (FMUFC), Sobral, Ceará, Brazil.
| | | | | | - Guarany Mont’Alverne de Arruda
- MD. Assistant Professor, Discipline of Personal Development, Faculdade de Medicina da Universidade Federal do Ceará (FMUFC), Sobral, Ceará, Brazil.
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Van Deven T, Hibbert K, Faden L, Chhem RK. The hidden curriculum in radiology residency programs: a path to isolation or integration? Eur J Radiol 2013; 82:883-7. [PMID: 23305755 DOI: 10.1016/j.ejrad.2012.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE In this qualitative case study involving five academic Radiology centres across Canada, the authors seek to identify the hidden curriculum. METHODS A qualitative case study methodology was used for its potential to explore and provide rich descriptions and allow for the in-depth analysis of multiple data sources that include official institutional documents, surveys, observations and interviews (including undergraduate students, postgraduate, radiologists, imaging scientists, residents, faculty and administrators). This study relied on 48 interviews and involved primary data analysis by the core research team, and a secondary analysis by external examiners. RESULTS The results revealed that in four of the five major centres studied, a hidden curriculum of isolation prevailed, reinforcing an image of the radiologist as an independent operator within an organization dependent upon collaboration for optimal performance. The fifth site exhibited a hidden curriculum of collaboration and support, although the messages received were conflicting when addressing issues around teaching. CONCLUSIONS The authors conclude by noting two possibilities for medical imaging departments to consider that of isolation or that of integration. They examine the implications of each and propose a way forward that situates Radiology as the crossroads of medicine. As such, the need for a new, generative metaphor reasserts the importance of recognizing the role and function of scholarship in teaching and learning contexts across Canada.
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Affiliation(s)
- T Van Deven
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Canada
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Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, Kahn MJ, Hafferty FW. Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:440-4. [PMID: 21346498 DOI: 10.1097/acm.0b013e31820df8e2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Medical student literature has broadly established the importance of differentiating between formal-explicit and hidden-tacit dimensions of the physician education process. The hidden curriculum refers to cultural mores that are transmitted, but not openly acknowledged, through formal and informal educational endeavors. The authors extend the concept of the hidden curriculum from students to faculty, and in so doing, they frame the acquisition by faculty of knowledge, skills, and values as a more global process of identity formation. This process includes a subset of formal, formative activities labeled "faculty development programs" that target specific faculty skills such as teaching effectiveness or leadership; however, it also includes informal, tacit messages that faculty absorb. As faculty members are socialized into faculty life, they often encounter conflicting messages about their role. In this article, the authors examine how faculty development programs have functioned as a source of conflict, and they ask how these programs might be retooled to assist faculty in understanding the tacit institutional culture shaping effective socialization and in managing the inconsistencies that so often dominate faculty life.
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Affiliation(s)
- Janet P Hafler
- Yale School of Medicine, Yale University, New Haven, Connecticut 06510, USA.
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Chuang AW, Nuthalapaty FS, Casey PM, Kaczmarczyk JM, Cullimore AJ, Dalrymple JL, Dugoff L, Espey EL, Hammoud MM, Hueppchen NA, Katz NT, Peskin EG. To the point: reviews in medical education-taking control of the hidden curriculum. Am J Obstet Gynecol 2010; 203:316.e1-6. [PMID: 20541735 DOI: 10.1016/j.ajog.2010.04.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/22/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
This article, the ninth in the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the role of the "hidden curriculum" in shaping the professional identity of doctors in training. The characteristics that distinguish the formal curriculum and hidden curriculum are defined. Specific examples of hidden curricula in clinical environments and the positive and negative impacts that may result are highlighted. Techniques to evaluate clinical training environments and to identify the hidden curriculum are provided and are followed by methods to promote its positive messages and lessen its negative ones.
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Pinney SJ, Mehta S, Pratt DD, Sarwark JF, Campion E, Blakemore L, Black KP. Orthopaedic surgeons as educators. Applying the principles of adult education to teaching orthopaedic residents. J Bone Joint Surg Am 2007; 89:1385-92. [PMID: 17545442 DOI: 10.2106/jbjs.f.01487] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Stephen J Pinney
- Department of Orthopaedic Surgery, University of California--San Francisco, 1701 Divisadero Street, Suite 280, San Francisco, CA 94115, USA.
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Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. BMJ 2004; 329:770-3. [PMID: 15459051 PMCID: PMC520997 DOI: 10.1136/bmj.329.7469.770] [Citation(s) in RCA: 436] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum. DESIGN Semistructured interviews with individual students. SETTING One medical school in the United Kingdom. PARTICIPANTS 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame. MAIN OUTCOME MEASURES Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training. RESULTS Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years. CONCLUSIONS Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.
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Affiliation(s)
- Heidi Lempp
- Academic Rheumatology, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE5 9RJ.
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Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. MEDICAL EDUCATION 2004; 38:522-34. [PMID: 15107086 DOI: 10.1046/j.1365-2929.2004.01820.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Attitudes influence behaviour. Developing and maintaining proper attitudes by medical students can impact on the quality of health care delivered to their patients as they assume the role of doctors. There is a paucity of longitudinal research reports on the extent to which students' attitude scores shift as they progress through medical school. OBJECTIVE This study examined the change in attitude scores of a large student cohort as they progressed through medical school. Whether student gender is related to attitude change was also investigated. METHOD Medical students from 3 consecutive classes (1999-2001) participated in this study. Students completed 2 instruments that included the Attitudes Toward Social Issues in Medicine and an in-house tool referred to as the Medical Skills Questionnaire. The instruments were administered at 3 milestones during the course of medical school training (entry, end of preclinical training and end of clerkship). RESULTS Reliability estimates for total (0.82-0.91) and subscale (0.41-0.81) attitudinal scores were in the acceptable range. Multivariate analyses of variance of mean attitudinal scores indicated a persistent decline in several attitude scores as students progressed through the medical educational programme. Females demonstrated higher attitude scores than males. CONCLUSIONS As students progress through medical school their attitude scores decline. The reasons for the shift in attitude scores are not clear but they may relate to a ceiling of high attitude scores at entry, loss of idealism and the impact of the unintended curriculum. Further study of the impact of medical education on student attitudes is warranted.
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Affiliation(s)
- Wayne Woloschuk
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Abstract
BACKGROUND The use of pejorative terms for patients is well documented. Reasons include frustration and anger in managing certain patients, fostering group solidarity among caregivers under stress, and the alleged "dehumanization" of medical training. Medical students were surveyed to document and understand the phenomenon. METHODS The 1988, 1989, 1990, and 1996 Johns Hopkins University Medical School graduating seniors were asked about their attitudes towards such use and about the nature of medical school. RESULTS Class response rates varied from 75% to 95%, with 8% to 13% of respondents recording having heard no pejorative terms. The reported number of different terms declined during the period from 75 to 55, as did use of "dirtball" and "gomer." Only 2% to 13% of particular classes considered such usage to be helpful, whereas 30% to 50% considered it harmful. Pejorative terms were used most frequently for self-destructive or abusive patients. From 12% to 24% of students thought medical school to be humanizing; 10% to 24%, dehumanizing; and 38% to 59%, both. CONCLUSION Most students had heard pejorative references to patients, but few thought the practice useful. Monitoring such usage may help identify individual or institutional problems and lead to better management strategies for certain subgroups of patients.
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Affiliation(s)
- Peter E Dans
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
Pre-clinical medical students are often unconvinced that the basic sciences are clinically valuable. Also, they are hesitant about formulating ideas on their own from non-textbook sources. First-year medical students taking histology or neurobiology were persuaded to consult articles from the current biomedical literature. I set brief short-answer and labeled-sketch questions well before the course theoretical examinations, where the answers counted toward the score. The answers could only be found by reading in articles made available in the laboratory. The articles were chosen to display basic-science knowledge in action in clinical contexts. The questions offer an additional curriculum that can be steered toward, for example, concerns of family practice, mechanisms of common diseases, and topics of fast-increasing clinical importance.
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Affiliation(s)
- W A Beresford
- Department of Anatomy, School of Medicine, West Virginia University, Morgantown 26506-9128, USA
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