Study reveals 'hidden' curriculum of humiliation in medical school

September 30, 2004

A 'hidden' curriculum of haphazard tuition and teaching by humiliation exists in undergraduate medical education, finds a study in this week's BMJ.

Researchers interviewed 36 students at one UK medical school about their experiences and perceptions of the quality of teaching received during their undergraduate training.

Students reported many examples of positive role models and effective, approachable teachers. However, students also described a hierarchical and competitive atmosphere in which haphazard tuition and teaching by humiliation continue to occur.

Twenty-five students described the haphazard nature of teaching, particularly by clinical staff, who often disregarded the formal timetable. Final year students were especially critical of what they perceived as a lack of commitment and poor teaching skills in some staff members.

Twenty-one students reported 29 incidents of humiliation, particularly during ward rounds in their clinical years. Almost all the reported perpetrators were male doctors and three quarters were senior medical staff. One student said: "I've found my first rotation was very stressful, humiliating, I worked and read because of fear, because of being targeted - and that was just miserable."

Overall, half of the students reported that competition rather than co-operation was the defining characteristic of medicine.

Although this study relies on interview accounts rather than observation of actual teaching and the data were collected from only one medical school, the reports suggest a worrying lack of accountability of medical teachers in overstretched clinical settings, say the authors.

Medical education has largely escaped from the quality control rigours imposed on clinical practice. Indeed, relatively few doctors have received formal training in teaching methods, educational theories, or modes of assessment.

Recognition and reform of the hidden curriculum is required to achieve the necessary fundamental changes to the culture of undergraduate medical education, they conclude.
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BMJ

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