The disavowed curriculum
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
CONTEXT: Understanding students’ perceptions of and responses to lapses in professionalism is important to shaping students’ professional development.
OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students’ reasoning and motivations in “real time.”
DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why.
SETTING: University of Toronto.
PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous.
MAIN OUTCOME MEASURE: A model to explain students’ reasoning in the face of professional dilemmas.
RESULTS: Grounded theory analysis of interview transcripts revealed that students were motivated to consider specific actions by referencing a Principle (an abstract or idealized concept), an Affect (a feeling or emotion), or an Implication (a potential consequence of suggested actions). Principles were classified as “avowed” as ideals of four profession (e.g., honesty or disclosure), or “unavowed” (unacknowledged or undeclared, e.g., obedience or allegiance). Implications could also be avowed (e.g., concerning patients) or unavowed (e.g., concerning others); but students were predominantly motivated by considering “disavowed” implications: those pertaining to themselves (e.g., concern for grades, evaluations, or reputation), which are actively denied by the profession and discouraged as being inconsistent with altruism.
CONCLUSIONS: This “disavowed curriculum” has implications for education, feedback, and evaluation. Instead of denying their existence, we should teach students how to negotiate and balance these unavowed and disavowed implications and principles, in order to help them develop their own professional stance.
- Arnold, L (2002) Assessing professional behaviour: yesterday, today, and tomorrow. Acad Med 77: pp. 502-15 CrossRef
- Ginsburg, SR, Regehr, GR, Hatala, R (2000) Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med 75: pp. S6-11 CrossRef
- Christakis, DA, Feudtner, C (1993) Ethics in a short white coat: the ethical dilemmas that medical students confront. Acad Med 68: pp. 249-54 CrossRef
- Baldwin, DC, Daugherty, SR, Rowley, BD (1998) Unethical and unprofessional conduct observed by residents during their first year of training. Acad Med 73: pp. 1195-200 CrossRef
- Satterwhite, RC, Satterwhite, WM, Enarson, C (2000) An ethical paradox: the effect of unethical conduct on medical students’ values. J Med Ethics 26: pp. 462-5 CrossRef
- Hicks, L, Lin, Y, Robertson, DW, Robinson, DL, Woodward, SI (2001) Understanding the clinical dilemmas that shape medical students’ ethical development: a questionnaire survey and focus group study. BMJ 322: pp. 709-10 CrossRef
- Ginsburg, SR, Regehr, G, Lingard, L (2002) The anatomy of the professional lapse: bridging the gap between traditional frameworks and students’ perceptions. Acad Med 77: pp. 516-22 CrossRef
- Lingard, L, Garwood, K, Szauter, K, Stern, DT (2001) The rhetoric of rationalization: how students grapple with professional dilemmas. Acad Med 76: pp. S45-7 CrossRef
- Ginsburg, SR, Regehr, G, Lingard, L (2003) To be and not to be: the paradox of the emerging professional stance. Med Educ 37: pp. 350-7 CrossRef
- Creswell, JW (1998) Qualitative Inquiry and Research Design. Sage Publications, Thousand Oaks, CA
- Glaser, BG (1992) Basics of Grounded Theory Analysis. Sociology Press, Mill Valley, CA
- Kelle, U (1995) Computer-Aided Qualitative Data Analysis: Theory, Methods, and Practice. Sage Publications, Thousand Oaks, CA
- American Board of Internal Medicine. American Board of Internal Medicine, Philadelphia, PA
- Hafferty, FW, Franks, R (1994) The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 69: pp. 861-71 CrossRef
- Stern, DT (1998) Practicing what we preach? An analysis of the curriculum of values in medical education. Am J Med 104: pp. 569-75 CrossRef
- The disavowed curriculum
Journal of General Internal Medicine
Volume 18, Issue 12 , pp 1015-1022
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- undergraduate education
- medical education
- Industry Sectors
- Author Affiliations
- 1. Received from the Department of Medicine, Faculty of Medicine, Center for Research in Education, University of Toronto, Toronto, Canada
- 2. Department of Surgery, Faculty of Medicine, Center for Research in Education, University of Toronto, Toronto, Canada
- 3. Department of Pediatrics, Faculty of Medicine, Center for Research in Education, University of Toronto, Toronto, Canada