The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate (...) specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)

In a penetrating analysis of student unrest, the Dean for Institute Relations at M.I.T (and former chief of the psychiatric services both there and at Wellesley College) isolates a major cause of campus conflict: the overwhelming, nonproductive mass of unstated academic and social norms that divert the student from creative intellectual effort and from the attempt to define and reach his goals as independently as he is able.

Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the (...) class='Hi'>hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach. (shrink)

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper‐focus on “figuring out” the (...) teacher with minimal focus on the act of writing. Students used a form of behavioral “code‐switching” to maximize their grade while considering how their “valuing” of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment. (shrink)

The so-called ‘hidden curriculum’ is often presented as a counterproductive element in education, and many scholars argue that it should be eliminated, by being made explicit, in education in general and specifically in higher education. The problem of the HC has not been solved by the transition from a teacher-centered education to a student-centered educational model that takes the student’s experience as the starting point of learning. In this article we turn to several philosophers of education to propose (...) that HC can be made explicit in HE when the teacher recognizes and lives his/her teaching as a personal issue, not merely a technical one; and that the students’ experience of the learning process is not merely individual but emerges through their interpersonal relationship with the teacher. We suggest ways in which this interpersonal relationship can be strengthened despite current challenges in HE. (shrink)

First-generation college students, typically defined as those whose parents have not completed a Bachelor’s degree, have increasingly captured the attention of higher education researchers over the...

The so-called ‘hidden curriculum’ is often presented as a counterproductive element in education, and many scholars argue that it should be eliminated, by being made explicit, in education in general and specifically in higher education. The problem of the HC has not been solved by the transition from a teacher-centered education to a student-centered educational model that takes the student’s experience as the starting point of learning. In this article we turn to several philosophers of education to propose (...) that HC can be made explicit in HE when the teacher recognizes and lives his/her teaching as a personal issue, not merely a technical one; and that the students’ experience of the learning process is not merely individual but emerges through their interpersonal relationship with the teacher. We suggest ways in which this interpersonal relationship can be strengthened despite current challenges in HE. (shrink)

We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This (...) orientation, combined with a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training. (shrink)

David Gordon; The Concept of the Hidden Curriculum, Journal of Philosophy of Education, Volume 16, Issue 2, 30 May 2006, Pages 187–198, https://doi.org/10.1111/.

David Gordon; The Concept of the Hidden Curriculum, Journal of Philosophy of Education, Volume 16, Issue 2, 30 May 2006, Pages 187–198, https://doi.org/10.1111/.

Today’s medical training environment exposes medical trainees to many aspects of what has been called “the hidden curriculum.” In this article, we examine the relationship between two aspects of the hidden curriculum, the performance of emotional labor and the characterization of patients and proxies as “bad,” by analyzing clinical ethics discussions with resident trainees at an academic medical center. We argue that clinicians’ characterization of certain patients and proxies as “bad,” when they are not, can take (...) an unnecessary toll on trainees’ emotions. We conclude with a discussion of how training in ethics may help uncover and examine these aspects of the hidden curriculum. (shrink)

The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other (...) practitioners. (shrink)

In this paper we want to briefly illustrate the ways in which technical, ethical and political judgements of various kinds are interwoven in the processes of healthcare decision-making in the UK. Drawing upon the research for the “Choices in Health Care” project we will borrow the notion of the hidden curriculum from education to illuminate the nature of resource allocation decision processes. In particular we will indicate some of the fundamental but largely hidden political factors in play (...) in these processes and the importance of the inchoate and implicit notion of “NHS values” in shaping UK resource allocation policies. We suggest that these more diffuse, holistic and system level value judgements are both central to understanding priority setting and at the same time difficult to reduce or abstract out into lists of single values/principles. (shrink)

Medical students’ concerns during clinical clerkships may not always be addressed with mentors who work under significant time constraints. This study examined 3rd year students’ survey responses regarding patient encounters to elucidate what may be hidden aspects of their learning environment. We analyzed results to an 18-item survey completed during a required ethics and professionalism course in third-year medicine clerkships over a period of 18 months. The survey covered types of concerns elicited by patient encounters, interactions with mentors about (...) concerns, perceptions of mentors, and level of moral distress. We also examined results of a 7-item evaluation of small group discussions during the study period. 1210 surveys and 195 evaluations constituted the study samples. Students’ concerns related primarily to ethics (36.4%, n = 441) and quality of care (34.5%, n = 418). Concerns had not been raised with a mentor in 535 (44.2%) instances. Students experienced moral distress in connection with 35.4% (n = 324) of cases; this was particularly common when a concern applied to a mentor. Higher levels of moral distress were associated with a lower likelihood of wishing to emulate the mentor (r = -0.27, p <.001). Two thirds of students, 66.9% (n = 107), stated that small group discussions where concerns were discussed lowered their stress levels. We suggest that clinical mentors be made aware of students’ learning needs and that structured discussions be available for students to articulate concerns with peers and facilitators in efforts to uncover elements of the hidden curriculum with the goal of optimizing students’ well-being, learning and professional development. (shrink)

David Gordon; Rules and the Effectiveness of the Hidden Curriculum, Journal of Philosophy of Education, Volume 17, Issue 2, 30 May 2006, Pages 207–218, https://.

David Gordon; Rules and the Effectiveness of the Hidden Curriculum, Journal of Philosophy of Education, Volume 17, Issue 2, 30 May 2006, Pages 207–218, https://.

This exploratory study analyzes the extent of alignment between the formal and hidden curricula in responsible management education. Based on case study evidence of a school that has signed the United Nations Principles for Responsible Management Education, we found poor alignment between the school’s explicit RME claims and students’ lived experiences. While the formal curriculum signaled to students that RME was important, the school’s hidden curriculum sent a number of tacit messages that led students to question (...) the relevance and applicability of responsible management. The tacit messages that students received occurred along three “message sites” related to how the formal curriculum was delivered, how students and lecturers interacted, and how the school was governed. On the basis of these findings we develop a proposition that can guide further research in this area, i.e., the connotative level of language use is an important site of misalignments between what lecturers say in relation to RME and how students interpret the meaning of their lecturers’ words. We also discuss further implications of our findings for strengthening the alignment between schools’ formal RME claims and their hidden curriculum. (shrink)

Macau, as a society, is a crossroads where East–West encounters have been taking place for centuries. This paper examines some of the contemporary issues and implications for moral education. After a brief introduction to the social background of Macau, the paper describes the characteristics of Macau's education in general and the development of its moral education in particular. This has taken place in the context of the strong influences on morality of both Catholicism and Confucianism. An outline of the current (...) curriculum of moral and civic education is followed by a critical appraisal of its implementation over the last few years. By means of this case study of Macau, the paper argues that a communitarian‐oriented morality in Macau is justified, and it also suggests how, by turning attention to its history, a minimal set of values can be constructed for Macau's particular social setting. Finally, some further educational challenges for Macau's future moral and civic education are reviewed. (shrink)

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students’ levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects (...) of the “hidden curriculum,” teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors’ right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. (shrink)

In medical education, where law and ethics are often taught simultaneously, a hidden or silent curriculum emerges strongly from research-based and descriptive reviews of practice experienced by students and qualified practitioners. In social work education, where law and ethics are more commonly taught separately, specific reference to such a curriculum does not emerge from the literature. However, evidence from reviews of social work practice points to instances of ethical and legal erosion in the context of a profession (...) which asserts its location as a moral activity and its commitment to human rights and social justice. The purpose of this article is not to systematically compare what students may be learning in and about medicine and social work. Rather, prompted by concerns expressed in medical education research, it reviews the social work evidence and why it achieves a lower profile than parallel experiences in medicine. It explores the problems encountered in practice by students and qualified social workers when drawing on their legal and ethical knowledge. It reviews the impacts of legal and values education on social work programmes. It concludes by questioning whether the initiatives to improve social work, in England specifically, by the Social Work Task Force and Social Work Reform Board are appropriately configured to address the tensions that divide recommended from actual practice. (shrink)

Context: Cognitive science, as an interdisciplinary research endeavour, poses challenges for teaching and learning insofar as the integration of various participating disciplines requires a reflective approach, considering and making explicit different epistemological attitudes and hidden assumptions and premises. Only few curricula in cognitive science face this integrative challenge. Problem: The lack of integrative activities might result from different challenges for people involved in truly interdisciplinary efforts, such as discussing issues on a conceptual level, negotiating colliding frameworks or sets of (...) premises, asking profound questions challenging one’s own paradigm, and differences in terminologies, as well as from the “personal” challenge of realising one’s own limits of knowledge and, hence, the need to trust in another person’s expertise. This implies that the proposed curriculum structure provides an “epistemic laboratory”: a space for experiencing and negotiating, as well as constructing different viewpoints in a trustful setting. Approach: A newly-designed interdisciplinary cognitive science curriculum is presented that is based on a constructivist epistemology. We suggest that a careful construction of the learning space is a necessary requirement. The MEi:CogSci curriculum is designed and structured in such a way that enables didactical measures that allow for collaborative construction of meaning by discussing concepts, methods and terminologies and also hidden assumptions. Findings: The experience with four cohorts of students has shown that a truly interdisciplinary approach to cognitive science demands a different attitude towards knowledge as well as towards teaching and learning on both sides: the teacher and the student. The research orientation promotes an understanding of knowledge as something that is actively constructed, rendering the role of the teacher that of a co-learner rather than a transmitter of knowledge, thereby also changing the responsibility of students. (shrink)

Abstract“Your patient just died; do you mind pronouncing her?” It was six‐thirty in the morning three months after I had graduated from medical school, and I had just relieved the covering nighttime intern. I must have looked horrified. Pronouncing a death is one of the last things we do for a patient, but it's a ritual that doctors learn outside of formal training. If, as the data suggests, young physicians do not have any training on death pronouncement in medical school (...) and do not receive any direct observation from faculty during their postgraduate years, pronouncing a death remains deeply buried in the informal curriculum, or “hidden curriculum,” a term that has been used to describe the massive body of tacit cultural education that takes place in medical school and residency. (shrink)

The neglect of issues related to the economic status of minorities and women in introductory economics textbooks widely used in the United States is a problem rooted in the most fundamental theoretical propositions of mainstream economics. Despite the fact that the claims of both mainstream methodology and general equilibrium theory have been seriously questioned in recent years, introductory economics textbooks fail to incorporate into the principles curriculum those critical findings which would allow analysis of the economic problems of women (...) and minorities in the United States. This article compares mainstream and radical textbooks' treatments of race and gender issues to show how the radical approach to these economic questions overcomes many of the deficiencies of the mainstream approach. (shrink)

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person (...) session, the participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty. (shrink)

The article surveys some of the more potent aspects of the moral dimension of educational institutions, with particular reference to their hidden curriculum of moral formation, the place of passion in teaching, and the many elements that are required for a balanced and realistic moral education. It concludes with some comments on commodification and respect in education.

In approximately the last 20 years, the self-protection capacity of many American Indian tribes has significantly increased to include the review of research requests by a tribally based IRB. While these tribal IRBs are trained using a curriculum derived from the Belmont Report, there is need to recognize the cultural specificity of the Belmont Report and its potential for conflict or inappropriateness when applied to populations with deep differences in cultural constructs compared to the majority population. However, recognition of (...) the sometimes paradigmatically different culture of American Indian tribes compared to the U.S. culture at large seldom occurs. Moreover, significant and subtle factors of researchers' professional, organizational, and personal cultures that relate to the research enterprise are essentially never addressed by themselves or the tribal IRB. Nonetheless, tribal IRBs continue and serve as a procedural guide for investigators intending to conduct respectful research with American Indian populations. (shrink)

Service-learning has received a great deal of attention in the management education literature over the past decade, as a method by which students can acquire moral and civic values as well as gain academic knowledge and practice real-world skills. Scholars focus on student and community impact, curricular design, and rationale. However, the educational environment (“context”) in which service-learning occurs has been given less attention, although experienced educators know that the classroom is hardly a vacuum and that students learn a great (...) deal from the non-curricular aspects of their educational experience. Moral values in particular are conveyed by what is not said. Given this, I argue that the contexts in which service-learning takes place are as important as the activity itself. Three perspectives on context will be described and assessed: the “hidden” curriculum, the educational atmosphere, and the university’s orientation towards social responsibility. (shrink)