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Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship

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Abstract

Changing the culture of medicine through the education of medical students has been proposed as a solution to the intractable problems of our profession. Yet few have explored the issues associated with making students partners in this change. There is a powerful hidden curriculum that perpetuates not only desired attitudes and behaviors but also those that are less than desirable. So, how do we educate medical students to resist adopting unprofessional practices they see modeled by supervisors and mentors in the clinical environment? This paper explores these issues and, informed by the literature, we propose a specific set of reflective competencies for medical students as they transition from classroom curricula to clinical practice in a four-step approach: (1) Priming—students about hidden curriculum in their clinical environment and their motivations to conform or comply with external pressures; (2) Noticing—educating students to be aware of their motivations and actions in situations where they experience pressures to conform to practices that they may view as unprofessional; (3) Processing—guiding students to analyze their experiences in collaborative reflective exercises and finally; (4) Choosing—supporting students in selecting behaviors that validate and reinforce their aspirations to develop their best professional identity.

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Authors and Affiliations

  1. UBC Department of Medicine and Center for Health Education Scholarship, UBC Southern Medical Program, Clinical Academic Campus, 2nd Floor, 2312 Pandosy Street, Kelowna, BC, V1Y 1T3, Canada

    Cheryl L. Holmes

  2. Department of Medical Education, College of Medicine at Chicago, University of Illinois, Chicago, IL, USA

    Ilene B. Harris & Alan J. Schwartz

  3. Department of Surgery and Center for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada

    Glenn Regehr

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  1. Cheryl L. Holmes
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  2. Ilene B. Harris
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  3. Alan J. Schwartz
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  4. Glenn Regehr
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Correspondence to Cheryl L. Holmes.

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Holmes, C.L., Harris, I.B., Schwartz, A.J. et al. Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship. Adv in Health Sci Educ 20, 1355–1370 (2015). https://doi.org/10.1007/s10459-014-9558-9

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