Observations of the hidden curriculum on a paediatrics tertiary care clinical teaching unit

Abstract

Objective: The hidden curriculum is a set of influences that function at the level of organizational structure and culture which fall outside the formal curriculum, and are often unarticulated or unexplored. Learning associated with the hidden curriculum may have negative consequences on trainee educational development. The study goal was to examine how aspects of the hidden curriculum were enacted during ward rounds on a tertiary care general paediatrics clinical teaching unit (CTU). Methods: We conducted an ethnographic case study on a CTU of a tertiary care paediatric hospital and observed interactions between medical students, residents and attending staff on rounds. Detailed field notes were collected and inductive analysis was used to inform descriptions and identify themes regarding the hidden curriculum. Results: Twenty-two hours of observation were performed. Two major themes emerged: the hierarchical nature of team dynamics and engagement mediated by perceptions of relevance of the rotation. The hierarchical nature of team dynamics reflected the reinforcement of the rules of rank and 'who to respect'; it contained three subthemes including 'rules of the game', positioning and questioning order. Engagement mediated by perceptions of relevance of the rotation concerned the finding that active participation and attentiveness during rounds varied by home discipline. Conclusions: We were able to identify representations of the hidden curriculum during observations on a tertiary care paediatric CTU. Interest appears to be a determinant in student level of engagement and observed hierarchies have the potential to impact this engagement either positively or negatively.

Hidden, Informal, and Formal Curricula in Health Professions Education

“…Teamwork, too, emerges in discussions around the hidden curriculum. In a study exploring ward rounds in a pediatric clinical teaching unit, Doja et al (2018) described observing rules around the medical team. They reported the nature of the team dynamics as occurring in a hierarchy with students knowing when they could speak up and ask questions.…”

“…Using an ethnographic approach, Doja et al (2018) conducted observations of interactions between medical students, residents, and attending staff during clinical rounds in a tertiary pediatric unit to explore how aspects of the hidden curriculum were enacted. They reported observing clear hierarchy within the team, whereby there were particular "rules" about who spoke and how each responded, and that physical positioning of the team reinforced a person's place in the hierarchy.…”

Witnessing the Ward: On the Emotional Labor of Doing Hospital Ethnography

“…Studies have shown that there is a steep and implicit hierarchy in medical teams (see for example Bould et al, 2015; Doja et al, 2018), and in the process of managing relations with my collaborator and hospital officers, the negotiated order of the hospital became evident. I also learned the implicit hospital “feeling rules” (Bellas, 1999), i.e.…”

The Secreted Curriculum and Youth Education to Become the Professionals the World Craves for

“…According to Lempp and Seale (2004), some of the secreted curriculum consequences include "loss of idealism, adoption of a 'ritualized' professional identity, emotional neutralization, change of ethical integrity and acceptance of hierarchy" (p. 770). Other negative consequences of the secreted curriculum included weakening of moral reasoning among young people (Patenaude et al, 2003;Doja et al, 2018).…”