Thread by @Megan_EL_Brown

It’s that time of the week again! #TheoryThursdays

The first #MedEd theory we’re going to cover is (drum roll pls) …

THE HIDDEN CURRICULUM

Many of us will know the term, but do we really know what it’s all about?

A thread 🧵

What is the hidden curriculum?

We don’t have a simple definition

Some argue that the hidden curriculum (HC) is the unwanted aspects of becoming a dr. Others argue it can be positive + we can exploit it for teaching.

IMO it’s more complex than either of these two extremes

The hidden curriculum (HC) is a concept (micro-level theory) that can be used as an entry point for thinking about + studying the space between formal and other-than-formal learning.

It’s ok that we don’t have a simple definition. A tight definition of the HC means we lose conceptual richness, which has been essential in creating a foundation for critical perspectives in the field – those that challenge political and social status quo.

In med ed, the foundational HC thinker is the insurmountable Prof Fred Hafferty

The HC is a popular concept within primary/secondary school education, but the term takes a different meaning in our field. Hafferty took the concept of the HC and spun it through a sociological lens

When I asked Fred about how he arrived at the meaning of HC for Med Ed, he shared this Peter Berger quote with me:

The first paper on the HC in MedEd by Hafferty + Franks was written after a conference where everyone was calling for more ethics teaching. This paper is a response – more teaching of something an institution thinks is unimportant will make no difference. That’s the HC in action

Broadly, then, the HC is a way of looking at and understanding social life (not just life in classrooms)

It is the set of influences acting on students because of their presence within an institution. These influences function at the level of organisational structure + culture

The HC is in action when THIS happens

…when there is divergence from the formal curriculum as a workaround to what people say gets things done/is the best way to do something

The HC is about potential disconnects between what students are told should happen + what does happen

I.e., Teaching does not equal learning

The “boring” bits:

-Explanatory power: Micro-level
-Ontology: Relativism
-Epistemology: knowledge is transmitted by the potential disconnect between what institutions say + what they do (do they talk the talk + walk the walk)? Knowledge is subjective + socioculturally bound

Where’s the evidence to support the presence + power of the HC? Well, you don’t have to look far in med ed for a wealth of papers exploring this concept.

2018 scoping review = 3747 articles on the HC in #MedEd! journals.lww.com/academicmedici…

Most HC research has focused on its negative impact – it can deter women from pursuing surgical careers for example, as there are fewer women surgeons, and male surgeons propagate harmful thinking regarding women’s “fit” with surgery

Some have argued that we have uncovered everything that is hidden in the field. That it’s time to stop exploring and start acting. No doubt, action to challenge harmful manifestations is key.

BUT we can never have uncovered all that is hidden

Figuring out what is not going on – what isn’t being spoken about, what divergences we are silent about – is exceptionally challenging.

And what is hidden evolves as social and political landscapes change.

This is important – insiders usually aren’t best placed to identify the many HC operating within their institutions.

You usually need fresh eyes.

Students can offer a wealth of insight – what doesn’t look right, sound right, or make sense to them as new to the profession?

In reviewing the #MedEd literature and in thinking of possible disconnects yourself, you’ll see that perhaps the HC isn’t all bad. Some argue we can use the HC to “teach by stealth” e.g., engage students in anatomical body painting to stealthily teach them about professionalism

This isn’t quite the HC – as we said before, teaching does not equal learning.

We can’t exploit the HC for teaching, but we can explore it with learners.

This is where the HC becomes critical in practice. Let’s take an example.

You are a doctor. There’s not enough time to spend as long with all of your patients as you’d like (sound familiar?).

How do you decide how much time each patient needs from you?

Exploring the hidden curriculum (e.g., the HC around patient worthiness and time prioritisation) is the first step in challenging negative, iniquitous, or oppressive practices.

At its best, studying the HC is a way of confronting power within medical education

And that has huge impact on both the experience of learners/professionals, but also on patient care – in our example, the just care of those who are unfairly deemed “less worthy”.

This brings us back to our cartoon…

…. to challenge power and inequality, we need to examine the gaps between what institutions say, and what happens in practice.

So that’s a quick review of what is meant by the concept of the hidden curriculum, its theoretical roots, evidence, and how it connects critically to the manifestation of power within #MedEd

A huge THANK YOU to Prof Hafferty for his comments + contributions to this thread

Next week we talk identity theory…

... stay tuned to find out which one (honestly, the amount of identity theory there is, you guess is as good as mine as to which I will choose!!)

Ciao for now xoxo Theory Girl