The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education.

INTRODUCTION:  The hidden curriculum is a set of ethical, moral, and value-based teachings communicated to doctors-in-training, providing a basis for their future interactions with patients, peers, and colleagues. The aim of our study is to introduce the concept of the hidden curriculum to a cohort of third-year medical students and to subsequently evaluate their understanding. In particular, we sought to measure and benchmark the degree of hidden curriculum recognition within a Canadian medical education context. With the help of student feedback, we elicited ideas for future directions.

METHODS: One hundred and fifty-four third-year medical students completing their obstetrics and gynaecology core clinical rotation attended a workshop on the hidden curriculum. Students completed two sets of evaluations; a voluntary anonymous pre- and post-workshop questionnaire evaluating their knowledge and opinions regarding the hidden curriculum, and a mandatory workshop evaluation. Answers to pre- and post-workshop questionnaires were compared using Mann-Whitney U test, and thematic analysis was used to code the students' comments to identify common themes.

RESULTS:  A standardized workshop on the hidden curriculum significantly improved students' understanding and highlighted the importance of the hidden curriculum. Voluntary student comments (N = 108) were categorized according to five themes:  1) Students who were not sensitized to the hidden curriculum (8; 7.4%); 2) students who were sensitized but unaware of the hidden curriculum (12; 11.1%); 3) students who were sensitized and aware of the hidden curriculum (34; 31.5%); 4) comments on teaching methodologies/environment (43; 39.8%); and 5) suggestions for enhancement (11; 10.2%).

CONCLUSIONS:  A simple, cost-effective intervention, such as a workshop, can effectively assess and address the hidden curriculum. Many students are highly sensitized to and are aware of the positive and negative effects of role modeling on their development.  The students are calling for similar interventions to be directed at the postgraduate and faculty level.