Assessing the hidden curriculum in medical education: a scoping review and residency program’s reflection
DOI :
https://doi.org/10.36834/cmej.78841Résumé
Background: While the hidden curriculum (HC) is becoming recognized as an important component of medical education, ideal methods of assessing the HC are not well known. The aim of this study was to review the literature for methods of assessing the HC in the context of healthcare education.
Methods: We conducted a scoping review on methods to measure or assess the HC in accordance with the JBI Manual for Evidence Synthesis. Ovid MEDLINE, Ovid EMBASE, and ProQuest ERIC databases were searched from inception until August 2023. Studies which focused on healthcare education, including medicine, as well as other professions such as nursing, social work, pharmacy were included. We then obtained stakeholder feedback utilizing the results of this review to inform the ongoing HC assessment process within our own medical education program.
Results: Of 141 studies included for full text review, 41 were included for analysis and data extraction. Most studies were conducted in North America and qualitative in nature. Physician education was best represented with most studies set in undergraduate medical education (n = 21, 51%). Assessment techniques included interviews (n = 19, 46%), cross-sectional surveys (n = 14, 34%), written reflections (n = 7, 17%), and direct observation of the working environment (n = 2, 5%). While attempts to create standardized HC evaluation methods were identified, there were no examples of implementation into an educational program formally or longitudinally. No studies reported on actions taken based on evaluation results. Confidential stakeholder feedback was obtained from postgraduate medical learners in our program, and this feedback was then used to modify our longitudinal HC assessment process.
Conclusions: While the HC has as increasing presence in the medical education community, the ideal way to practically assess it within a healthcare education context remains unclear. We described the HC assessment process utilized at our program, which may be informative for other institutions attempting to implement a similar technique. Future attempts and studies would benefit from reporting longitudinal data and impacts of assessment results
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Références
Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: a scoping review. Acad Med J Assoc Am Med Coll. 2018 Apr;93(4):648–56. https://doi.org/10.1097/ACM.0000000000002004
Sarikhani Y, Shojaei P, Rafiee M, Delavari S. Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method. BMC Med Educ. 2020 Jun 1;20:176. https://doi.org/10.1186/s12909-020-02094-5
Zgheib NK, Dimassi Z, Arawi T, Badr KF, Sabra R. Effect of targeted curricular reform on the learning environment, student empathy, and hidden curriculum in a medical school: a 7-year longitudinal study. J Med Educ Curric Dev. 2020 Aug 27;7:2382120520953106. https://doi.org/10.1177/2382120520953106
Billings ME, Lazarus ME, Wenrich M, Curtis JR, Engelberg RA. The effect of the hidden curriculum on resident burnout and cynicism. J Grad Med Educ. 2011 Dec;3(4):503–10. https://doi.org/10.4300/JGME-D-11-00044.1
Brown MEL, Coker O, Heybourne A, Finn GM. Exploring the hidden curriculum’s impact on medical students: professionalism, identity formation and the need for transparency. Med Sci Educ. 2020 Jul 24;30(3):1107–21. https://doi.org/10.1007/s40670-020-01021-z
Canadian Residency Accreditation Consortium C. General Standards of Accreditation for Residency Programs. 2020. Available from: https://www.royalcollege.ca/content/dam/documents/accreditation/competence-by-design/non-resource-documents/canera/general-standards-accreditation-for-residency-programs-e.html#standard_9
Braund H, Patel V, Dalgarno N, Mann S. Exploring residents’ perceptions of competency-based medical education across Canada: a national survey study. MedEdPublish. 2024 Jan 8;14:2. https://doi.org/10.12688/mep.19247.1
Nidumolu A, Freedman D, Bosma M. From theory to practice: development and evaluation of a quality improvement curriculum for psychiatry residents. J Med Educ Curric Dev. 2024 Jan;11:23821205241228200. https://doi.org/10.1177/23821205241228200
Peters M, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11: scoping reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. https://doi.org/10.46658/JBIRM-20-01
George Li. A scoping review on measuring the hidden curriculum in medical education. 2022. Available from: https://osf.io/tbkaf [Accessed Apr 4, 2024].
Lee CA, Wilkinson TJ, Timmermans JA, Ali AN, Anakin MG. Revealing the impact of the hidden curriculum on faculty teaching: a qualitative study. Med Educ. 2023;57(8):761–9. https://doi.org/10.1111/medu.15026
Wear D, Skillicorn J. Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship. Acad Med J Assoc Am Med Coll. 2009;84(4):451–8. https://doi.org/10.1097/ACM.0b013e31819a80b7
Howard F, McKneally MF, Upshur REG, Levin AV. The formal and informal surgical ethics curriculum: views of resident and staff surgeons in Toronto. Am J Surg. 2012;203(2):258–65. https://doi.org/10.1016/j.amjsurg.2011.02.008
McKenna L, Williams B. The hidden curriculum in near-peer learning: an exploratory qualitative study. Nurse Educ Today. 2017;50(ned, 8511379):77–81. https://doi.org/10.1016/j.nedt.2016.12.010
Choo Hwee P, Hwee Sing K, Yong Hwang MK, Mei AHY. The informal curriculum: what do junior doctors learn from a palliative care rotation?. BMJ Support Palliat Care. 2020;10(1):114–7. https://doi.org/10.1136/bmjspcare-2018-001625
St-Amant O, Sutherland N. Unpacking the hidden curriculum in nursing education: clinical placements abroad. Int J Nurs Educ Scholarsh. 2020;17(1). https://doi.org/10.1515/ijnes-2019-0128
Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. Br Med J. 2004;329(7469):770–3. https://doi.org/10.1136/bmj.329.7469.770
Ozolins I, Hall H, Peterson R. The student voice: recognising the hidden and informal curriculum in medicine. Med Teach. 2008;30(6):606–11. https://doi.org/10.1080/01421590801949933
Lamiani G, Leone D, Meyer EC, Moja EA. How Italian students learn to become physicians: a qualitative study of the hidden curriculum. Med Teach. 2011;33(12):989–96. https://doi.org/10.3109/0142159X.2011.577467
Mossop L, Dennick R, Hammond R, Robbe I. Analysing the hidden curriculum: use of a cultural web. Med Educ. 2013;47(2):134–43. https://doi.org/10.1111/medu.12072
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(5):883–7. https://doi.org/10.1016/j.ejrad.2012.12.001
O’Brien BC, Hirsh D, Krupat E, et al. Learners, performers, caregivers, and team players: descriptions of the ideal medical student in longitudinal integrated and block clerkships. Med Teach. 2016;38(3):297–305.
Doja A, Bould MD, Clarkin C, Eady K, Sutherland S, Writer H. The hidden and informal curriculum across the continuum of training: a cross-sectional qualitative study. Med Teach. 2016;38(4):410–8. https://doi.org/10.3109/0142159X.2015.1073241
Gerjevic KA, Rosenbaum ME, Suneja M. Resident perceptions of the impact of duty hour restrictions on resident-attending interactions: an exploratory study. BMC Med Educ. 2017;17(1):124. https://doi.org/10.1186/s12909-017-0963-7
Roder CA, May SA. The hidden curriculum of veterinary education: mediators and moderators of its effects. J Vet Med Educ. 2017;44(3):542–51. https://doi.org/10.3138/jvme.0416-082
Gardeshi Z, Amini M, Nabeiei P. The perception of hidden curriculum among undergraduate medical students: a qualitative study. BMC Res Notes. 2018;11(1):271. https://doi.org/10.1186/s13104-018-3385-7
Bigdeli S, Koohestani HR, Soltani Arabshahi SK, Keshavarzi MH. Lived experiences of undergraduate medical students about hidden curriculum: a phenomenological study. Acta Med Iran. 2019;57(5):308–15. https://doi.org/10.18502/acta.v57i5.1867
Yahyavi ST, Hoobehfekr S, Tabatabaee M. Exploring the hidden curriculum of professionalism and medical ethics in a psychiatry emergency department. Asian J Psychiatry. 2021;66((Yahyavi, Hoobehfekr, Tabatabaee) Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of):102885. https://doi.org/10.1016/j.ajp.2021.102885
MacNeil KA, Regehr G, Holmes CL. Contributing to the hidden curriculum: exploring the role of residents and newly graduated physicians. Adv Health Sci Educ Theory Pract. 2022;27(1):201–13. https://doi.org/10.1007/s10459-021-10081-8
Cohen-Osher M, Lee AL, Erlich D. Revealing the hidden clerkship curriculum: a qualitative analysis. Fam Med. 2023;55(2):115–8. https://doi.org/10.22454/FamMed.2023.503671
Van Huyssteen M, Bheekie A. The hidden curriculum of work-based learning for pharmacy students in public sector pharmacies in South Africa. Pharm Educ. 2017;17(1):190–8.
Phillips CB. Student portfolios and the hidden curriculum on gender: Mapping exclusion. Med Educ. 2009;43(9):847–53. https://doi.org/10.1111/j.1365-2923.2009.03403.x
Karnieli-Miller O, Vu TR, Holtman MC, Clyman SG, Inui TS. Medical students’ professionalism narratives: a window on the informal and hidden curriculum. Acad Med. 2010;85(1):124–33. https://doi.org/10.1097/ACM.0b013e3181c42896
Cheng L-F, Yang H-C. Learning about gender on campus: an analysis of the hidden curriculum for medical students. Med Educ. 2015;49(3):321–31. https://doi.org/10.1111/medu.12628
Parekh R, Jones MM, Singh S, et al. Medical students’ experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries. BMJ Open. 2021;11(7):e049825. https://doi.org/10.1136/bmjopen-2021-049825
Balmer DF, Master CL, Richards B, Giardino AP. Implicit versus explicit curricula in general pediatrics education: is there a convergence? Pediatrics. 2009;124(2):e347-54. https://doi.org/10.1542/peds.2009-0170
Doja A, Bould MD, Clarkin C, Zucker M, Writer H. Observations of the hidden curriculum on a paediatrics tertiary care clinical teaching unit. Paediatr Child Health Can. 2018;23(7):435–40. https://doi.org/10.1093/pch/pxx206
Grady MD, Rich Glass V, Lechner E, Naylor SM. What do MSW students say matters in MSW Programs? Results from a qualitative study of the implicit curriculum. J Soc Work Educ. 2020;56(3):560–75. https://doi.org/10.1080/10437797.2019.1656585
Grady MD, Swick DC, Powers JD. The implicit curriculum survey: an examination of the psychometric properties. J Soc Work Educ. 2018;54(2):261–9. https://doi.org/10.1080/10437797.2017.1404527
Grady MD, Powers J, Despard M, Naylor S. Measuring the implicit curriculum: initial development and results of an msw survey. J Soc Work Educ. 2011;47(3):463–87. https://doi.org/10.5175/JSWE.2011.200900119
Peterson NA, Farmer AY, Donnelly L, Forenza B. Assessing the implicit curriculum in social work education: heterogeneity of students’ experiences and impact on professional empowerment. J Teach Soc Work. 2014;34(5):460–79. https://doi.org/10.1080/08841233.2014.955943
Afridi A, Sethi A, Ahmed F, Kashif L. Assessment of hidden curriculum during clinical rotations of year 4 mbbs students using hidden informal curriculum assessment tool (Hicat). J Med Sci Peshawar. 2020;28(4):352–5. https://doi.org/10.52764/jms.20.28.4.10
Haidet P, Kelly PA, Chou C, Communication C and culture study group. Characterizing the patient-centeredness of hidden curricula in medical schools: development and validation of a new measure. Acad Med J Assoc Am Med Coll. 2005;80(1):44–50. https://doi.org/10.1097/00001888-200501000-00012
Smith NA, Castanelli DJ. Measuring the clinical learning environment in anaesthesia. Anaesth Intensive Care. 2015;43(2):199–203. https://doi.org/10.1177/0310057X1504300209
Akcakoca B, Orgun F. Developing a measurement tool for evaluating the hidden curriculum in nursing education. Nurse Educ Today. 2021;97(ned, 8511379):104688. https://doi.org/10.1016/j.nedt.2020.104688
Al-Bawardy R, Blatt B, Al-Shohaib S, Simmens SJ. Cross-cultural comparison of the patient-centeredness of the hidden curriculum between a Saudi Arabian and 9 US medical schools. Med Educ Online. 2009;14((Al-Bawardy) Department of Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.):19. https://doi.org/10.3402/meo.v14i.4655
Green AR, Rosu C, Kenison T, Nze C. Assessing the hidden curriculum for the care of patients with limited English proficiency: an instrument development. Educ Health Abingdon Engl. 2018;31(1):17–24. https://doi.org/10.4103/1357-6283.239042
Ludwig B, Turk B, Seitz T, Klaus I, Loffler-Stastka H. The search for attitude-a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr. 2018;130(3–4):134–40. https://doi.org/10.1007/s00508-018-1312-5
Kaldjian LC, Shinkunas LA, Reisinger HS, Polacco MA, Perencevich EN. Attitudes about sickness presenteeism in medical training: is there a hidden curriculum? Antimicrob Resist Infect Control. 2019;8(1):149. https://doi.org/10.1186/s13756-019-0602-7
Butler J, Kassel L, Miesner AR, Grady S, Wall GC. Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: a nationwide survey. Curr Pharm Teach Learn. 2021;13(8):922–7. https://doi.org/10.1016/j.cptl.2021.06.001
Hafferty FW. Beyond curriculum reform: confronting medicineʼs hidden curriculum. Acad Med. 1998 Apr;73(4):403–7. https://doi.org/10.1097/00001888-199804000-00013
The Association of Faculties of Medicine of Canada A. The Future of Medical Education in Canada (FMEC). 2010. Available from: https://cou.ca/wp-content/uploads/2010/01/COU-Future-of-Medical-Education-in-Canada-A-Collective-Vision.pdf
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