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

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Abstract

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.

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References

  1. Gardeshi Z, Amini M, Nabeiei P. The perception of hidden curriculum among undergraduate medical students: A qualitative study. BMC Res Notes [Internet]. 2018 May 4 [cited 2020 Dec 23];11(1):271. Available from: https://bmcresnotes.biomedcentral.com/articles/ https://doi.org/10.1186/s13104-018-3385-7.

  2. Balboni MJ, Bandini J, Mitchell C, Epstein-Peterson ZD, Amobi A, Cahill J, et al. Religion, Spirituality, and the Hidden Curriculum: Medical Student and Faculty Reflections. J Pain Symptom Manage [Internet]. 2015 Oct 1 [cited 2020 Dec 23];50(4):507–15. Available from: https://pubmed.ncbi.nlm.nih.gov/26025271/.

  3. Dent J, Harden R. A Practical Guide for Medical Teachers. undefined. 2017.

  4. Whitcomb TL. Raising awareness of the hidden curriculum in veterinary medical education: A review and call for research [Internet]. Vol. 41, Journal of Veterinary Medical Education. University of Toronto Press Inc.; 2014 [cited 2020 Dec 23]. p. 344–9. Available from: https://pubmed.ncbi.nlm.nih.gov/25335646/.

  5. Neve H, Collett T. Empowering students with the hidden curriculum. Clin Teach. 2018.

  6. Treadway K, Chatterjee N. Into the Water — The Clinical Clerkships. N Engl J Med [Internet]. 2011 Mar 31 [cited 2020 Dec 23];364(13):1190–3. Available from: https://www.nejm.org/doi/full/https://doi.org/10.1056/NEJMp1100674.

  7. Bandini J, Mitchell C, Epstein-Peterson ZD, Amobi A, Cahill J, Peteet J, et al. Student and Faculty Reflections of the Hidden Curriculum: How Does the Hidden Curriculum Shape Students’ Medical Training and Professionalization? Am J Hosp Palliat Med. 2017.

  8. Ludwig B, Turk B, Seitz T, Klaus I, Löffler-Stastka H. The search for attitude—a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr [Internet]. 2018 Feb 1 [cited 2020 Dec 23];130(3–4):134–40. Available from: /pmc/articles/PMC5816099/?report=abstract.

  9. Silveira GL, Campos LKS, Schweller M, Turato ER, Helmich E, de Carvalho-Filho MA. “Speed up”! The influences of the hidden curriculum on the professional identity development of medical students. Heal Prof Educ. 2019;5(3):198–209.

    Google Scholar 

  10. Hopkins L, Saciragic L, Kim J, Posner G. The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education. Cureus [Internet]. 2016 Oct 25 [cited 2020 Dec 23];8(10). Available from: /pmc/articles/PMC5120972/?report=abstract.

  11. Williams M, Moser T. The Art of Coding and Thematic Exploration in Qualitative Research. Vol. 15, International Management Review. 2019.

  12. Yazdani S, Momeni S, Afshar L, Abdolmaleki M. A comprehensive model of hidden curriculum management in medical education. J Adv Med Educ Prof [Internet]. 2019 Jul [cited 2020 Dec 23];7(3):123–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31528646.

  13. Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, et al. Decoding the learning environment of medical education: A hidden curriculum perspective for faculty development. Acad Med [Internet]. 2011 [cited 2020 Dec 23];86(4):440–4. Available from: https://pubmed.ncbi.nlm.nih.gov/21346498/.

  14. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. Br Med J [Internet]. 2004 Oct 2 [cited 2020 Dec 23];329(7469):770–3. Available from: http://www.bmj.com/.

  15. 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 [Internet]. 2010 [cited 2020 Dec 23];85(1):124–33. Available from: https://pubmed.ncbi.nlm.nih.gov/20042838/.

  16. Passi V, Johnson N. The impact of positive doctor role modeling. Med Teach [Internet]. 2016 Nov 1 [cited 2020 Dec 23];38(11):1139–45. Available from: https://pubmed.ncbi.nlm.nih.gov/27089216/.

  17. Plaut SM, Baker D. Teacher-student relationships in medical education: Boundary considerations. Med Teach [Internet]. 2011 Oct [cited 2020 Dec 23];33(10):828–33. Available from: https://pubmed.ncbi.nlm.nih.gov/21355699/.

  18. Witman Y. What do we transfer in case discussions? The hidden curriculum in medicine…. Perspect Med Educ [Internet]. 2014 Apr 1 [cited 2020 Dec 23];3(2):113–23. Available from: https://link.springer.com/article/10.1007/s40037-013-0101-0.

  19. Karnieli-Miller O, Vu TR, Frankel RM, Holtman MC, Clyman SG, Hui SL, et al. Which Experiences in the Hidden Curriculum Teach Students About Professionalism? Acad Med [Internet]. 2011 Mar [cited 2020 Dec 23];86(3):369–77. Available from: http://journals.lww.com/00001888-201103000-00028.

  20. Al-Bishri J. Evaluation of biomedical research in Saudi Arabia. Saudi Med J. 2013.

  21. Hendelman W, Byszewski A. Formation of medical student professional identity: Categorizing lapses of professionalism, and the learning environment. BMC Med Educ [Internet]. 2014 Jul 9 [cited 2020 Dec 23];14(1). Available from: https://pubmed.ncbi.nlm.nih.gov/25004924/.

  22. Mulder H, ter Braak E, Chen HC, ten Cate O. Addressing the hidden curriculum in the clinical workplace: A practical tool for trainees and faculty. Med Teach [Internet]. 2019 Jan 2 [cited 2020 Dec 23];41(1):36–43. Available from: https://pubmed.ncbi.nlm.nih.gov/29490529/.

  23. Murakami M, Kawabata H, Maezawa M. The perception of the hidden curriculum on medical education: an exploratory study. Asia Pac Fam Med [Internet]. 2009 Dec 15 [cited 2020 Dec 23];8(1):9. Available from: http://www.apfmj.com/content/8/1/9.

  24. Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum: What can we learn from third-year medical student narrative reflections? Acad Med [Internet]. 2010 [cited 2020 Dec 23];85(11):1709–16. Available from: https://pubmed.ncbi.nlm.nih.gov/20881818/.

  25. 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 [Internet]. 2016 Apr 2 [cited 2020 Dec 23];38(4):410–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26274359/.

  26. Hawick L, Cleland J, Kitto S. Sending messages: How faculty influence professionalism teaching and learning. Med Teach [Internet]. 2017 Sep 2 [cited 2020 Dec 23];39(9):987–94. Available from: https://pubmed.ncbi.nlm.nih.gov/28622057/.

  27. Paice E, Heard S, Moss F. How important are role models in making good doctors? [Internet]. Vol. 325, British Medical Journal. BMJ Publishing Group; 2002 [cited 2020 Dec 23]. p. 707–10. Available from: www.bbc.co.uk/radio4/.

  28. Herman BK. Teaching Professionalism in Medical Residency Programs: Exemplary Educators, Role Modeling, and the Influence of the Hidden Curriculum. A Dissertation in Adult Education. 2019.

  29. Weissmann PF, Branch WT, Gracey CF, Haidet P, Frankel RM. Role modeling humanistic behavior: Learning bedside manner from the experts. Acad Med [Internet]. 2006 [cited 2020 Dec 23];81(7):661–7. Available from: https://pubmed.ncbi.nlm.nih.gov/16799294/.

  30. Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: A scoping review. Acad Med [Internet]. 2018 Apr 1 [cited 2020 Dec 23];93(4):648–56. Available from: https://pubmed.ncbi.nlm.nih.gov/29116981/.

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Acknowledgements

The authors would like to sincerely thank Dr. Abdul Ahad Shaikh, senior lecturer of Neurophysiology, for the time he spent conducting student focus group interviews. The authors also wish to thank all participants who generously gave their time and insights and shared their experiences; this study would not have been possible without them.

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This research was not funded.

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Correspondence to Muhammad Raihan Sajid.

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This study was approved by Alfaisal Institutional review board vide IRB approval number 18083.

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Appendix. Selected participants’ comments regarding the hidden curriculum and its six identified themes

Appendix. Selected participants’ comments regarding the hidden curriculum and its six identified themes

Theme 1

Role and Behavioural Modelling Faculty and Student quotes:

 

“Like the physicians … especially the female physicians.. clinicians that usually come in really inspire me in the way they hold themselves, the way they talk about their subjects, how much they love their profession, I really enjoy it.” A Student

 

“I think… of course, we can teach by being an example… we can teach by being a role model.” A faculty

 

“There are doctors that come and they were talking in such a way that will motivate you to be like this person

[…] Although family medicine is not something I'm thinking of doing but still, the way he (a family physician) carries himself and the way he talks about patients and the way he talks to the students speaks volumes. And other professors that are really respectful to students, like it is a mutual thing.” From a student in Focus group interview

 

“Most of our doctors are like trying to push us forward by telling us indirectly that all of us here are smart all of us can do it we just need to put in the effort.” From a student in Focus group interview

 

“I also agree … when female clinicians come and show up and they are very enthusiastic they are really giving us a good impact.” From a student in Focus group interview

 

“Sometimes, the presence of teachers or anyone that teaches us and gives us knowledge can be quite insensitive because they're so used to being in this Environment. so sometimes I would be shocked in forensics how they talk about cases and other subjects I'll be shocked how they like they are talking normally this is how they are it's just how the profession is. it makes me alarm like: I don't want to become like that, I don't talk to people that are not exposed to this new information in such a way.” From a student in Focus group interview

 

“I think all teachers need to be trained to watch and observe because all teachers for me are role models they will imprint their effect on the student one way or another, so maybe teachers all through all levels of education needs to be aware of their influence other than the education the learning process.” A faculty perspective

 

“I always try to come on time and I always like respect everybody's.. viewpoint okay? I never.. whether somebody is saying right or wrong.. I never interrupt them in between … like the punctuality.. it should be.. like.. it should be.. practiced by every everybody.. like the.. like for the PBL facilitators ok? timing is very important.. it should be.. followed by all whether they are junior faculty or senior faculty … and they should not be humiliating.. the.. the low achieving.. achievers in the class in front of them.. they should not give feedback in front of others.” A faculty perspective

 

“When I talk to students who have difficulties you know whether it's you know difficulties academic or personal I think we're always trying to be a role model and giving them.. a lesson in life” A faculty perspective

 

“You could use role model but make that role model thing more explicit.. make it come from.. the.. from the value system of the students.” A student quote

Theme 2

Value Based Teaching

 

“Things like… you know… morality and ethical treatment of your patient … that is all you know … something that everybody does … you know in terms of … you know respect and confidentiality … and … and the kind of behaviour you have with a patient is something that's taken as given.. okay? … and then you add on to all of that … this other bit that I'm talking about in terms of you know having a sympathetic ear … being empathetic … and making sure you are up to date.” From a student

 

“I think …that the best way.. one of the ways would be to role model … another thing that can be done is.. where we actually expect the students in other words.. you don't necessarily teach them to do something but you put them into the situation where they need to be more empathetic.. all right? and then look at how they cope with this particular situation.” From a faculty

 

“As a university I think we need to focus on the professional values, values of professionalism … we need to pay attention to the values of being a professional person in terms of acknowledging your weaknesses and acknowledging your strengths in terms of knowing vulnerability whether it's your vulnerability or another person vulnerability and not abusing it.. I think also common sense judgment.” A faculty perspective

 

“I tried my best like at least they should know.. number one they should know how to respect their peers their teachers their faculty their friends they should know that they should respect the others opinions this is something and as you said it's a multicultural multi opinion of course either it is a faculty or either the student themselves they should I think this is what I always try to do that they should learn how to be respectful how to approach correctly.” Student

 

“I think that.. what students need to see and.. which in terms of the formal curriculum is.. is not necessarily taught.. but that value for me is.. is empathy.” A faculty perspective

Theme 3

Interpersonal Interactions

 

“As far as students are concerned, it shaped my values 180 degrees because you'd come and see people go through the same challenges … but from a different perspective and that would add to your values because, you know, this is your mind once you start talking to people you have now two minds and three minds, so your perspectives grow and you start seeing the world differently.” A student

 

“One of the things that I really like is that most of our doctors when you look at their resumes you'll find a long list of achievements yet when you try to talk to them you feel like they're normal people and that helps a lot … most.. most of our doctors are really laid back they don't really care and they really try to help you as much as possible most of the time.” A student

 

“The.. huge bulk of the hidden curriculum we learn from interacting with other colleagues.” A student

 

“The skills that I learned in clubs bleed into the skills that I need in order to succeed in my formal Alfaisal education.. I learned how to communicate effectively.” student

 

“But we're here the competition level is really high you have something that's called Dean's List. So, no matter what everyone wants to be on it and feels capable of being on it … so that competition is there.” A student

Theme 4

Culture and Socialization

 

“we are exposed to a different array of religion in people.. and yes I was.. if you were to ask me to argue with these people before I entered University yes I would have been like really harsh really.. like you know aggressive about it, but now my values remain the same.. I mean my thoughts on the matter is the same but the way to communicate with them as a result of learning to communicate in general will result in me being.. slightly more.. civil whilst communicating with them” A student

 

“Alfaisal has people from different nationalities and different backgrounds both on student and faculty level, and I think interacting with different people from all over the world… this adds to you.” A student

 

“The culture of the students is very diverse and despite these massive differences in culture… I believe that the academic environment in Alfaisal brings us together and gives us one common purpose and helps us remain focused and prevents any form of disunity from erupting. A student

 

“The environment at Alfaisal.. the poster day they are.. having poster day in one of the weeks is actually you know.. they are implementing the fact that research is important and I did not realize that.. the.. the importance of research until I entered Alfaisal university. It really teaches you that research is an important tool in the development of any nation.” A student

 

“The support they give for the clubs they allow us to work together so in a way they help us improve our social skills or team management skills.” Student quote

 

“I feel like I've changed and became more diverse when I entered University compared to my high school years.” A student

 

“I'm coming from a high school.. I'm the top 99 percentile or whatever.. I have this feeling that I'm the best and I don't need them.. going into university you get much more calm and you learn how to ask for help.. I think that's very valuable both in university life and clinically later on.” A student quote

 

“I appreciate the time that I do spend with my family more than I used to.” A student

 

“I think after studying medicine I'm even more passionate about that… I feel like just being in this environment surrounded by clinicians and people who share the same interest has developed this passion even more and more I'm even more reading research papers and taking part in that type of academic stuff just so I can be on the same level as them.” Student quote

Theme 5

Teaching Methodologies and Hidden Curriculum

 

“Indirectly the TBL thing the whole thing about having to work with other people and teammates that does force you in situations where you have to be examined how you treat other people and that does change your values” Student quote

 

“It gives the students chance to like… show off… and that's a good thing because it's going to motivate other students to be like them… and to motivate them to study. Personally, I see…like for instance I see this person who is … who is giving out answers in TBL or speaking out in PBLs or explaining the case in TBRs or giving out answers in TBRs and I inspire to be like that person and this motivates me to study.” Student quote

 

“In TBLs.. we used to have this.. if you don't if you don't think that this answer should be accepted you make an appeal.. I think this is very very good because this teaches the student that yes if you think you're right you can raise your voice but you have to provide certain and.. certain and reliable evidence” Student quote

 

“Sometimes I don’t feel it is implemented very well… TBR are implemented well enough to potentially force the behavioural outcomes we should expect out of them.” Student quote

 

“As a system..we.. the learning is not very much tied up with the learning objectives.. it is now mainly based on the teaching faculty and that's why it is.. it it.. it varies from subject to subject discipline to discipline and discipline and for the students it becomes difficult sometimes.” Student quote

 

“The main objective of PBL [problem-based learning] is.. the main is self-learning.. we want you to take.. take responsibility of your learning […] to some extent it is fulfilled but in large.. the concept is vanished.. because of the lack of training of faculty and training of the students more importantly.. students don't know what to expect from PBL … the second part is your communication with the peers and your faculty members and your seniors.. I think that part is working very well.. you learn how to communicate.. you learn how to respect others’ opinion.. and you know how to express your opinion” Student quote

Theme 6

Challenges and Student Support Systems

 

“It is to large extent.. it is.. it is really student-centered and because.. as a faculty as an institution and we try to engage students in their own learning that is student-centered and it is working.” Faculty quote

 

“Because we need an analytic analysis, we need to think out of the box and some of the students that are not used to it so they need a little bit of work.” Faculty

 

“It's plus point as well because you have so many versatile.. versatile faculty from different areas so they can actually share their own experiences. … it's good for the.. for the growing and for the students as well.” Faculty

 

“The mentorship.. the mentor program is really strong, especially the students are coming to their mentors and they're talking about it so definitely they're helping them.” Student quote

 

“The other thing that I think Alfaisal has is that hidden you know motivation for students to do activities and to develop other skills outside you know the usual curriculum.” Student quote

 

“It is to large extent.. it is.. it is really student-centered and because.. as a faculty as an institution and we try to engage students in their own learning that is student-centered and it is working.” Faculty

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Almairi, S.O.A., Sajid, M.R., Azouz, R. et al. Students’ and Faculty Perspectives Toward the Role and Value of the Hidden Curriculum in Undergraduate Medical Education: a Qualitative Study from Saudi Arabia. Med.Sci.Educ. 31, 753–764 (2021). https://doi.org/10.1007/s40670-021-01247-5

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