Exploring the Hidden Curriculum's Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency

How medical students learn about the social: Opportunities and limitations in service learning and volunteering

Medical education's integration of social determinants of health (SDOH) is essential for fostering equitable and comprehensive patient care. Despite this need, many medical schools struggle to effectively teach SDOH due in part to the hidden curriculum-subtle, institutional norms and values that implicitly shape student learning and, in this case, undermine an appreciation of SDOH. This article examines the potential and limitations of service learning (SL) as an experiential learning modality to address these challenges. Traditional didactic methods often fail to capture the complex, relational aspects of modern medical practice, necessitating a more interactive and community-engaged approach. When grounded in principles of justice and community partnership, SL can help transform medical students from passive recipients of knowledge into active, critical thinkers. We identify four key outcomes of SL in medical education: 1) development of empathic and reflective practices, 2) explicit engagement with social injustices, 3) promotion of diverse perspectives, and 4) cultivation of advocacy skills. To explore these possibilities, we present a case study of an urban medical school's SL program focused on prison health and mass incarceration, using it as a heuristic tool to illustrate both the strengths and challenges of SL in medical education. Through this analysis, we demonstrate how SL can disrupt the hidden curriculum, deepen students' understanding of SDOH, and enhance their ability to provide compassionate, equitable care while highlighting the need for future empirical research that systematically assess SL's long-term impact on medical education and health equity.

Transforming Professionalism Education in Clerkships: A Student-Driven Approach Utilizing The Hidden Curriculum

Introduction

Professionalism, influenced by regional context and societal values, is essential in doctor-patient relationships, patient experiences, and clinical outcomes. However, formal education alone fails to cultivate professionalism effectively. Research highlights the hidden curriculum's detrimental impact on medical students' professionalism. Nonetheless, strategies to teach professionalism in specific curriculum areas and to counteract hidden curricula, particularly for clinical clerkships, remain underexplored. This study evaluates a structured, student-led professionalism training program in a clerkship.

Methods

Over one year, we implemented and replicated an educational intervention on professionalism in four emergency medicine clerkship groups. Grounded in constructivist and transformative learning theories, the intervention aimed to enhance students' reflective capacities by addressing the hidden curriculum. It included briefing sessions on professionalism models and student-led discussions on clinical cases encountered to uncover implicit lessons. Students' understanding was reinforced through anonymous self- and peer assessments of professionalism traits. The impact was evaluated qualitatively through inductive thematic analysis of student reflections and quantitatively through student feedback based on the Kirkpatrick model.

Results

The training received highly positive evaluations from students. Quantitative analysis showed significant score increases in knowledge and ability (using the Wilcoxon Signed Rank Test). Students demonstrated the ability to reflect on the hidden curriculum and highlighted three key themes: professional attributes, sociocultural context, and system-level factors. Subthemes included communication, empathy, learning commitment, cultural competence, hierarchy, and family engagement.

Discussion

This study presents a practical clerkship professionalism training model demonstrating that regular case-based discussions and anonymous self- and peer assessments help students identify and reflect on professional behaviors within the hidden curriculum.

How Preceptor Behaviour Shapes the Future of Medical Professionals

Preceptors play an indispensable role in shaping the future of healthcare. They bridge theoretical learning and practical clinical expertise in a rapidly evolving medical education landscape. Their influence extends beyond knowledge transfer, embodying the values, attitudes, and professionalism essential to competent medical practice. Bandura's Social Learning Theory posits that individuals learn through observation and modelling. Applying this theory supports the assumption that trainees acquire skills and professional norms by observing preceptor behaviour, a process known as vicarious learning. They transmit clinical competencies, ethical standards, and interpersonal skills critical for patient-centred care. Despite their significance, challenges such as increasing workloads, diverse trainee needs, and the complexities of modern healthcare often impede their ability to mentor effectively. Preceptors shape trainees' professional identities and ethical standards, which are significantly influenced by the hidden curriculum, the set of unspoken or implicit lessons conveyed outside the formal curriculum. Globally, there is growing recognition of the need to support and enhance the role of preceptors in medical education. Due to several challenges, some factors might prevent preceptors from maintaining their role model status, including the need for experience, continuous learning, and adaptation to diverse trainee needs. Strategies such as engaging in reflective practices and implementing effective stress management techniques are crucial for preceptors to navigate these barriers and uphold their status. However, few studies have synthesised the various dimensions of preceptor influence, including role modelling, communication skills, and the hidden curriculum. This review aims to fill this gap by exploring the variable role of preceptors in shaping medical trainees' professional development. It highlights the theoretical underpinnings of preceptorship, discusses the challenges preceptors face, and proposes evidence-based strategies to enhance their impact on future healthcare professionals.

The experiences of unprofessionalism among students in dental education: a qualitative study

AIM

The present study aimed to explore the unprofessional behavior of educators, senior students, and peers in the education process of dental and oral health services.

METHOD

This qualitative study employed a conventional content analysis approach. The undergraduate students (n = 21) were recruited to participate in the study through purposive sampling. Data were collected through in-depth semi-structured interviews. The qualitative data was analyzed using a five-step conventional content analysis method, as delineated by Graneheim and Lundman. The process involved five steps, including identifying meaning units, condensing them, assigning codes, establishing categories and subcategories, and identifying overarching themes.

RESULTS

The students' experiences were explored in a theme "formation of unprofessional subcultures" that includes categories of "multifaceted disrespect", "dishonesty in professional responsibility", and "neglecting the professional accountability."

CONCLUSION

According to the findings, educators and students exhibited unprofessional conduct in accountability, respect, and honesty. The results indicate that disrespectful behavior, dishonesty, irresponsibility, and a lack of accountability have become normal within the dental education system. This normalization occurs through the hidden curriculum, which inadvertently educates students on these unprofessional behaviors alongside the formal curriculum. The subcultures of unprofessionalism were explained as a trigger that significantly influences students' professional development and future behaviors in the dental field.

Medical students' perception of a unique humanistic mentoring program in a religious university: a convergent parallel mixed methods study

BACKGROUND

The medical school of Tzu Chi University in Taiwan offers a unique, group-based, humanistic mentoring program as a complement to the programs mentored by faculty members and school counselors. The humanistic mentors are senior volunteers who are subject-matter experts in various fields and who embody the spirit of humanism in their lives. The average mentee-to-mentor ratio is around 3. This study explored medical students' perceptions of this unique program and focused on three major themes: guidance/support, mentor-mentee interaction/relationship, and cultivation of humanistic literacy.

METHODS

During the 2018-2019 academic year, we conducted a mixed methods study with a convergent parallel design targeting clerks and graduates undertaking post-graduate year training as the study population. The content validity index and Cronbach's alpha were used to assess the validity and reliability of the questionnaires. Data comparisons between two subgroups were assessed using the Chi-square test. Quantitative data from 86 respondents based upon convenience sampling were collected by using a validated self-administered questionnaire (20 items each utilizing a Likert scale). Qualitative data from 20 interviewees based upon purposive sampling were collected through one-to-one interviews based on a semi-structured interview guide. Data were analyzed in parallel using thematic analysis and merged at the point of interpretation, allowing for triangulation and validation of results.

RESULTS

Regarding the functional roles of three focused themes both quantitative and qualitative data revealed that participants viewed the program positively. The three quantitative items with the highest percentages of positive responses were related to mentors' endeavors to provide support (72%), to stay connected (69%), and to share their career and life experiences (72%). Interviewees perceived that their mentors provided timely guidance and support in response to their physical or mental needs and empowered them to cultivate humanistic literacy, both of which were mediated through a trusting, caring mentor-mentee relationship.

CONCLUSION

The participants had positive perceptions regarding this unique humanistic mentoring program. As an educational strategy for medical students this type of humanistic mentoring holds great potential.

"Busting the hidden curriculum" a realist and innovative perspective to foster professional behaviors

Contemporary health professions education has long delineated the desired attributes of medical professionalism in the form of standard curricula and their role in forming professional behaviors (PBs) among aspiring doctors. However, existing research has shown the contradictory and powerful role of hidden curriculum (HC) in negatively influencing medical students' PBs through unspoken or implicit academic, cultural, or social standards and practices. These contrasting messages of formal curricula and HC lead to discordance and incongruence in future healthcare professionals developing professional identity formation. There is little research on PB modifying educational strategies and their determinants that medical schools adopt to bust the impact of HC. Consequently, it is unclear how the right PBs can be influenced, entrenched, and inculcated in undergraduate medical students, especially in their early clinical placements. The lack of such insight highlights a critical gap in the literature, nudging educators to take a realist stance to deal with this problem. Behavior psychology stresses shaping medical students' values and beliefs as salient mediators that influence intentions to pursue future PBs. Curiosity prevails about what would guide the educational interventions to target this behavior change. To help understand this concept, we present our design-based innovative perspective about PROfessionalism in Partnership for Education Research (PROPER) shaped by pluralistic theoretical models in the context of two European medical schools with diverse medical students, highlighting its non-parochial and transferable nature.

Shut up, or Set Free: Poetic Inquiry into Disabled Students' Experiences of Differential Attainment

Introduction

Differential attainment (DA) - systematic differences in training and assessment outcomes when grouping individuals by demographic characteristics - is a pervasive problem in health professions education. Despite evidence of its prevalence, there have been few qualitative studies relating to disabled learners' experiences of differential attainment. This represents a significant gap, as understanding disabled learners' experiences is key to developing effective interventions that mitigate the impact of differential attainment.

Methods

We used critical poetic inquiry to explore the lived experiences - including emotional, cultural, and contextual dimensions - of differential attainment for disabled health professions students. We constructed poems following a secondary analysis of a large interview dataset (n = 123 participants) from one institution. We focused on students who disclosed disability (n = 18), narrowing to health professions education (n = 10).

Results

Poems reflect individuals' experiences of DA. Four themes were constructed, within which we use poems to illustrate key connections: The perseverance stereotype, Managing the hidden curriculum, Privilege and access, and Surviving, not thriving. These themes illustrate the complex interplay of systemic barriers, ableist stereotypes, and privilege in the educational journey of disabled students.

Discussion

The poems reveal the often-unseen struggles of disabled learners, challenging ableist perceptions and highlighting the necessity of inclusive practices. Our findings underscore the need for a shift in educational approaches, advocating for universal design and comprehensive support systems that consider the unique experiences of disabled learners. This study lays the groundwork for future research to develop interventions that address DA in a more inclusive and equitable manner, ensuring educational environments support all learners effectively.

How do medical students deal with the topic of racism? A qualitative analysis of group discussions in Germany

BACKGROUND

Anti-racism is part of the medical professional ethos. Nevertheless, racism pervades medicine on individual, institutional, and structural levels. The concept of habitus helps to understand deficiencies in enacting anti-racism in practice. We use a habitus-based framework to analyse how medical students in Germany deal with the topic of racism. The research questions are: What are medical students' understandings of racism? How do they deal with the topic in discussions? What difficulties do they face in such discussions?

METHODS

In a qualitative-explorative research design, we conducted six online group discussions with 32 medical students from medical schools all over Germany. Data analysis combined qualitative methods from thematic qualitative content analysis and the documentary method.

RESULTS

We identified five typical ways of dealing with the topic of racism in discussions. The first one ('scientistic') orientates action towards the idea of medicine as an objective science, justifies the use of racial categories as scientific, and defines racism based on intention. The second ('pragmatic') orientates action towards tacit rules of clinical practice, justifies the use of racialised categories as practical and defines racism as an interpersonal problem. The third ('subjectivist') lacks a clear orientation of action for dealing with the topic of racism and instead displays uncertainty and subjectivism in understanding racialised categorisations as well as racism. The fourth ('interculturalist') orientates action towards an ideal of intercultural exchange, understands racialised categorisations as representing cultural differences and interprets racism as prejudice against cultures. The fifth ('critical') orientates action towards sociological scholarship, understands racialised categorisations as social constructs and views racism as a structural problem.

CONCLUSION

The results presented help to understand preconditions of enacting anti-racism in medicine and point to difficulties and learning needs. The heterogenous ways of dealing with the topic require a differentiated approach in medical education.

Assessing the hidden curriculum in medical education: a scoping review and residency program's reflection

Background

While the hidden curriculum (HC) is becoming recognized as an important component of medical education, ideal methods of assessing the HC are not well known. The aim of this study was to review the literature for methods of assessing the HC in the context of healthcare education.

Methods

We conducted a scoping review on methods to measure or assess the HC in accordance with the JBI Manual for Evidence Synthesis. Ovid MEDLINE, Ovid EMBASE, and ProQuest ERIC databases were searched from inception until August 2023. Studies which focused on healthcare education, including medicine, as well as other professions such as nursing, social work, pharmacy were included. We then obtained stakeholder feedback utilizing the results of this review to inform the ongoing HC assessment process within our own medical education program.

Results

Of 141 studies included for full text review, 41 were included for analysis and data extraction. Most studies were conducted in North America and qualitative in nature. Physician education was best represented with most studies set in undergraduate medical education (n = 21, 51%). Assessment techniques included interviews (n = 19, 46%), cross-sectional surveys (n = 14, 34%), written reflections (n = 7, 17%), and direct observation of the working environment (n = 2, 5%). While attempts to create standardized HC evaluation methods were identified, there were no examples of implementation into an educational program formally or longitudinally. No studies reported on actions taken based on evaluation results. Confidential stakeholder feedback was obtained from postgraduate medical learners in our program, and this feedback was then used to modify our longitudinal HC assessment process.

Conclusions

While the HC has as increasing presence in the medical education community, the ideal way to practically assess it within a healthcare education context remains unclear. We described the HC assessment process utilized at our program, which may be informative for other institutions attempting to implement a similar technique. Future attempts and studies would benefit from reporting longitudinal data and impacts of assessment results.

Medical student perceptions of gender and pain: a systematic review of the literature

BACKGROUND

Gender bias exists in healthcare and affects how pain is assessed and managed. This bias affects patient outcomes and their trust in healthcare professionals. We also know that future clinicians develop their attitudes early in training. Medical school is therefore an opportunity to shape the values of future doctors and to combat systemic gender bias in healthcare. This systematic review aims to explore medical student perceptions of the relationship between patients' gender and their pain, so that recommendations can be made for developing medical education.

METHODS

Embase, MEDLINE, PsychINFO, LILACS, Global Index Medicus, PakMediNet and ERIC were searched for articles relating to medical student perceptions of gender and pain, with no geographical or language limitations. Quality was assessed using the Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist.

RESULTS

Nine publications were identified, two qualitative and seven quantitative. All studies had methodological limitations. Many different study designs were used, although most involved simulated patients. All studies referred to gender as binary. Multiple studies found that women's pain is more likely to be underestimated by medical students and that the patient's gender drives different approaches during clinical history taking, examination and management in these simulated situations. Only one study found no effect of patients' gender on students' perception of their pain.

CONCLUSIONS

Whilst there is a paucity of high-quality studies in this area, patients' gender was found to affect how their pain is perceived by medical students. No studies explored where students' attitudes towards gender and pain arise from, and few involved 'real life situations'. We propose that further work into medical student perceptions in 'real situations' is needed. This will help to inform how undergraduate medical education can be developed to tackle gender bias, and ultimately improve outcomes for patients.

Diversity Audit of Medical School Examination Questions

Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.

Medical students' initial experiences of the dissection room and interaction with body donors: A qualitative study of professional identity formation, educational benefits, and the experience of Pasifika students

The first experience of medical students in the dissecting room (DR) likely influences professional identity formation (PIF). Sparse data exist exploring how exposure to the DR and body donors without undertaking dissection influences PIF, or how culture may influence this experience. This qualitative study explored students' first, non-dissection DR experience to determine how this contributes to PIF, including the impact of culture through a Pasifika-student lens. It also explored student perspectives on what learning opportunities are unique to this experience. Medical students with no prior DR experience were recruited and then interviewed after initial engagement with the DR and body donors. Questions included participant experiences, cultural perspectives, and how the DR differed from other teaching experiences. Interviews were recorded, transcribed, and analyzed thematically. Twenty students were interviewed (mean age 22 years, 12 females; 8 Pasifika) resulting in 520 min of audio recording (mean 26 min). Four primary themes were identified: professional identity formation, educational elements, death and spirituality, and cultural perspectives. Three subthemes including student experiences, behaviors, and environment were developed within each theme. Findings indicate development of PIF likely occurs from a single engagement with body donors without undertaking dissection, including recognition of professional role. Culture can play an important role for students, with several Pasifika students viewing the DR as a "cultural purgatory". Unique learning experiences are identified, such as cultural awareness around behaviors with the dead. The experience is an educational "threshold concept" where students likely undergo substantial developments in PIF, and educational initiatives to support students are outlined.

Negative faculty role modelling - is it a reflection of deteriorating societal values?

BACKGROUND

Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan.

METHODS

This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category.

RESULTS

Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels.

CONCLUSIONS

In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.

Exploring the perceptions of senior medical students on gender and pain: a qualitative study of the interplay between formal and hidden curricula

OBJECTIVE

Explore the perceptions of senior medical students on the relationship between gender and pain and examine how formal and hidden curricula in medical education shape their experiences.

DESIGN

We conducted a cross-sectional qualitative interview study, using individual semistructured interviews and adhering to interpretative description methodology. We used Braun and Clarke's reflexive approach to thematic analysis to analyse our data.

SETTING

Six medical schools across the UK. Data collection occurred between the autumn of 2022 and the spring of 2023.

PARTICIPANTS

14 senior (penultimate or final year) medical students.

RESULTS

We created three themes, which describe key educational forces shaping students' experiences of the relationship between gender and pain. These are (1) the sociocultural influencer, (2) the pedagogical influencer and (3) the professorial influencer. Our findings highlight the influence of both wider societal norms and students' own identities on their experiences. Further, we explore the nature and detrimental role of formal curricular gaps, and negative role modelling as a key mechanism by which a hidden curriculum relating to gender and pain exerts its influence.

CONCLUSIONS

These findings have several educational implications, including the need for a more holistic, person-centred approach to pain management within medical school curricula. Additionally, we recommend the creation of reflective spaces to engage students in critical thinking around bias and advocacy from the early stages of their training. We present actionable insights for medical educators to address issues of gender bias and pain management.

Impact of group work on the hidden curriculum that induces students' unprofessional behavior toward faculty

BACKGROUND

Hidden curriculum (HC) can limit the effects of professionalism education. However, the research on how HC triggers unprofessional behavior among medical students is scant. Furthermore, there is no established approach for how faculty members may create a context, such as an educational environment and education system, that prevents students' unprofessional behavior. This study aimed to develop an educational approach to prevent unprofessional behavior and clarify how faculty members consider HC that triggers students' unprofessional behavior.

METHODS

The study sample comprised 44 faculty members and eight medical students from the Chiba University School of Medicine. The participants were divided into groups and asked the following question: "What attitudes, statements, and behaviors of senior students, physicians, and faculty members trigger medical students' unprofessional behavior?" The responses were collected using the affinity diagram method. The group members discussed the causes and countermeasures for the selected attitudes, statements, and behaviors of senior students, physicians, and faculty members based on the affinity diagram. The impact of the group work on the faculty members was surveyed using questionnaires immediately after its completion and six months later. Furthermore, the cards in the group work were analyzed using content analysis.

RESULTS

The responses to the questionnaire on group work indicated that some faculty members (43.8%) improved HC, while others suggested conducting group work with more participants. The content analysis revealed six categories - inappropriate attitude/behavior, behavior encouraging unprofessional behavior, lack of compliance with regulations, harassment of other medical staff, inappropriate educational environment/supervisor, and inappropriate self-control - and 46 subcategories.

CONCLUSIONS

The HC that triggers students' unprofessional behavior includes the words and actions of the educator, organizational culture, and educational environment. Group work makes faculty members aware of the HC that triggers unprofessional behavior, and induces behavioral change for HC improvement in the educational activities. Educators should refrain from using words and actions that encourage unprofessional behavior, such as personal anecdotes, as they reduce students' learning motivation.

Exploring the Experiences of Undergraduate Medical Students on Surgical Placement - A Qualitative Study

OBJECTIVE

Multiple elements in the clinical learning environment have been found to influence medical students' learning experiences. A rich area of research, many factors are already known to influence students' experiences of learning which go on to impact later training choices. However, there is a knowledge gap specifically related to undergraduate medical students' experiences of surgical placement. This study aims to explore the lived experiences of medical students in their surgery rotation(s).

DESIGN

A phenomenological study using semistructured interviews was conducted. Transcribed interview recordings were thematically analyzed using an iterative approach.

SETTING

Participants were studying in a large medical school in the north of England.

PARTICIPANTS

Fitting with the method, 6 undergraduate medical students, with at least 1 surgery placement took part in the study.

RESULTS

Participants described issues including knowing the details of clinical opportunities, the clinical environment, and the portfolio; having a sense of involvement and previous surgical experiences; teaching and assessments; observation; and interactions. These experiences were also found to influence later career aspirations.

CONCLUSIONS

The findings suggest that undergraduate surgical learning experiences can be influenced by various themes: knowing the details of progression, the clinical environment, having a sense of involvement and previous experiences, constructive alignment of teaching and assessment, and professional identity formation. Future studies can explore methods such as personalized learning outcomes to enhance the overall learning experience of medical students.

How to be a good clerk on the clinical teaching team: a scoping review

Background

As medical institutions shift towards Competency Based Education, more effort is being directed towards understanding how healthcare teams' function competently. While many have studied the competencies required to be a successful clerk, few have examined this question within the context of team function and integration. Our primary objective is to identify how medical clerks successfully integrate and contribute to clinical teaching teams.

Methods

We performed a scoping review of the literature using the Ovid MEDLINE database. Data was extracted and thematically analysed in accordance with Arksey and O'Malley's (2005) approach to descriptive analysis.

Results

Out of 1368 papers returned by our search, 12 studies were included in this review. Seven main themes were identified amongst the included studies: (1) Communication (2) Taking Responsibility and Appropriate Autonomy (3) Humility and Knowing When to Ask for Help (4) Identity as a Team Member, (5) Self-Efficacy (6) Rapport and Relationship Building (7) Patient Advocacy.

Conclusion

Analysis of these themes revealed four major findings: (i) The importance of documentation skills and communication towards team contribution (ii) The important connection between professional identity development and self-efficacy (iii) The impact of rapport on the reciprocity of trust between team members (iv) The role of clerks as patient advocates is poorly understood. This review also illustrates that there is a relative dearth of literature in this area. Future studies are needed to develop clear guidance on how clerks should perform these competencies in the context of team function and integration.

The hidden curriculum across medical disciplines: an examination of scope, impact, and context

Background

While research suggests that manifestations of the hidden curriculum (HC) phenomenon have the potential to reinforce or undermine the values of an institution, very few studies have comprehensively measured its scope, impact, and the varied clinical teaching and learning contexts within which they occur. We explored the HC and examined the validity of newly developed constructs and determined the influence of context on the HC.

Methods

We surveyed medical students (n =182), residents (n =148), and faculty (n = 140) from all disciplines at our institution between 2019 and 2020. Based on prior research and expertise, we measured participants' experience with the HC including perceptions of respect and disrespect for different medical disciplines, settings in which the HC is experienced, impact of the HC, personal actions, efficacy, and their institutional perceptions. We examined the factor structure, reliability, and validity of the HC constructs using exploratory factor analysis Cronbach's alpha, regression analysis and Pearson's correlations.

Results

Expert judges (physician faculty and medical learners) confirmed the content validity of the items used and the analysis revealed new HC constructs reflecting negative expressions, positive impacts and expressions, negative impacts, personal actions, and positive institutional perceptions of the HC. Evidence for criterion validity was found for the negative impacts and the personal actions constructs and were significantly associated with the stage of respondents' career and gender. Support for convergent validity was obtained for HC constructs that were significantly correlated with certain contexts within which the HC occurs.

Conclusion

More unique dimensions and contexts of the HC exist than have been previously documented. The findings demonstrate that specific clinical contexts can be targeted to improve negative expressions and impacts of the HC.

Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care

OBJECTIVE

Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school.

DESIGN

We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis.

SETTING

One research-intensive medical school based in the UK. Data collection occurred in 2021-2022.

PARTICIPANTS

12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year.

RESULTS

We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning.

CONCLUSIONS

The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.

Elements and Determinants of Professional Identity During the Pandemic: A Hermeneutic Qualitative Study

Phenomenon: The construct of professionalism in undergraduate medical education is a core outcome that is included in the wider concept of professional identity formation. The former is grounded in the more general concept of identity, intended as an internalized set of role expectations. Some have proposed frameworks based on psychological or sociological approaches, but empirical research is still scarce and often limited to the exploration of the role of specific learning activities. The pandemic imposed adaptations that produced an artificial setting for a social experiment, suitable to observe how the deprivation of the social component of a student's life, such as in presence teaching and practical training, unveiled the elements and determinants of the developing identity of medical students. Approach: This research was the extension of a previous phenomenological study about medical students' lived experience of distance learning during the lockdown phase in Italy. We adopted a hermeneutic approach to furtherly deepen the analysis of the phenomenon at stake, in dialogue with the relevant literature. Eight 6th year medical students underwent an in-depth interview, themes were inductively generated and used to identify elements and determinants of the developing identities. Findings: Four themes developed, synthetized in the overarching theme "From crawling to standing on your feet and walking toward an uncertain future". The themes were: "social places and practices that make me feel like a student and a medical student", "toward self-regulation", "an emotional journey", "threats to the identity". The elements of the perceived identity as a medical student were autonomy and learning self-regulation, professional knowledge, competence, and sense of belonging to a community. The determinant factors which influenced the identity as a medical student were living environment, learning spaces and architectures, the social networks, the attendance of the healthcare facilities, the relationship with teachers, the social acknowledgement as a medical student, and as a doctor. Insights: It was possible to identify the generation of both constitutive elements of identity and determinants influencing identity development and this distinction is an added value of the research. According Gilles Deleuze's concept of "empty square" (the sudden lack of an object one used to have at hand: sociality in this case), this research highlighted the ambivalent nature of identity. Individualization and socialization are the "uneven sides" of that same paradoxical object which is identity.

Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey

BACKGROUND

Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems.

OBJECTIVE

The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties.

DESIGN AND PARTICIPANTS

A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used.

RESULTS

An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day.

CONCLUSIONS

Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.

Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa

The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.

Psychological Predictors of Medical Students' Involvement in Pro Bono

THEORY

Medical pro bono, in which medical professionals provide no (or low) cost services, is one approach to addressing unmet healthcare needs. Prior efforts to understand who chooses to take part in pro bono and why they might do so have been primarily atheoretical in their approach. The current investigation focuses on students in medical school and draws on relevant theory and research in psychology to identify predictors of their intentions to engage in medical pro bono service during and after medical school.Hypotheses:Four major approaches to identifying predictors of medical pro bono are examined: the role of demographic variables as predictors of medical pro bono, conceptualizing medical pro bono as a form of volunteerism, viewing medical pro bono as an expression of personality, and medical pro bono as a reflection of role identities and expectations. Each of these approaches can be characterized as being about medical students' individual attributes or aspects of the situation they are in.

METHODS

A total of 278 medical students from 15 different medical schools in the United States of America completed a web-based survey (8/4/2020-9/22/2020). The students completed measures of pro bono identity and expectations, intentions to engage in medical pro bono activities, prosocial personality, volunteer motivation, exposure to volunteering, general traits of personality, and demographic variables (in this order). We used linear regression analyses to separately predict three measures of intentions (general medical school intentions, intentions toward medical pro bono trips during medical school, and general post medical school intentions).

RESULTS

The strongest predictors of intentions to engage in medical pro bono were one's identity and expectations related to pro bono. Medical students who had incorporated medical pro bono into aspects of their identity and/or considered medical pro bono to be an expectation indicated higher intentions to engage in medical pro bono work. Conversely, volunteer motivation/exposure, personality, and demographic variables were much weaker predictors of medical pro bono.

CONCLUSIONS

The findings of the present study have implications for ways that medically oriented volunteering may be increased by individual-level interventions and/or changes in medical education. Individual-level interventions could leverage the importance of identity and expectations to craft persuasive messaging to appeal to identity and expectations as drivers of engagement in medical pro bono. Program level interventions could work toward the institutionalization of medical pro bono by the inclusion/promotion of medical pro bono into the program's co-curricular and/or extracurricular activities.

Role modelling in professional identity formation: a systematic scoping review

BACKGROUND

Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP).

METHODS

A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices.

RESULTS

12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences.

CONCLUSION

Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.

"Preparing them for the profession": An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education.

Beyond 'born not made': challenging character, emotions and professionalism in undergraduate medical education

In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific 'character'. In the late nineteenth century, an ideal of the medical student as 'born not made' was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of 'character' becomes 'characteristics'. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors' education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.

The Best Laid Plans? A Qualitative Investigation of How Resident Physicians Plan Their Learning

PURPOSE

Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning.

METHOD

Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory.

RESULTS

Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills.

CONCLUSIONS

Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.

Motivating change in resident language use through narrative medicine workshops

BACKGROUND

There are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19-20 about their experiences both in participating in narrative medicine workshops and giving patient care.

METHODS

The framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18-19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed.

RESULTS

We found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews.

CONCLUSIONS

Our research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.

Awareness, perceptions, and characteristics of internal medicine residents as role models

BACKGROUND

Role modelling is an essential component of medical education in which trainees incorporate observed characteristics into their personal behaviour and practice style. Data on residents as role models is limited. There are no previous quantitative studies addressing residents as role models from the resident's perspective.

OBJECTIVE

This study aimed to dissect the awareness, perception, and positive characteristics of internal medicine (IM) residents as role models.

METHODS

This was a cross sectional study, in which 59 medical students (MS) and 64 IM residents from Medstar Georgetown University Hospital completed a questionnaire on role modelling. Descriptive and comparative analyses between both groups were conducted.

FINDINGS

Most participants perceived IM residents as role models, but MS were more likely to report that IM residents lack awareness of their role model status. While MS perceived spending more hours with residents, the residents perceived dedicating more of the time spent together to teaching. Most participants denied previous training in role modelling but expressed interest in receiving formal role modelling training. Most participants reported MS behaviours were modified based on their observations of IM residents; however, while most of these behaviours were positive, there were also negative behaviours reported.

CONCLUSION

There was a discrepancy between perception and awareness of residents as role models. This characterisation of IM residents as role models sets the ground for the design of interventions to increase awareness and create educational interventions aimed to support residents in their teaching role.

Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture

BACKGROUND

Professional identity formation (PIF) has been recognized as an integral part of professional development in medical education. PIF is dynamic: it occurs longitudinally and requires immersion in the socialization process. Consequently, in the medical education context, it is vital to foster a nurturing learning environment that facilitates PIF.

AIM

This study assesses PIF among medical students in various stages of study and explores their perceptions of PIF, with its contributing and inhibiting factors.

METHOD

This mixed-methods study uses a sequential explanatory approach with undergraduate (years 2, 4, and 6) and postgraduate medical students in Indonesia. We examine the subjects by administering an adapted questionnaire on PIF. We completed a series of FGDs following questionnaire administration. Quantitative and thematic analyses were conducted sequentially.

RESULTS & DISCUSSION

A total of 433 respondents completed the questionnaire. There were statistically significant differences among subjects on the subscales "Recognition and internalization of professional roles" and "Self-control in professional behavior"; the more senior students had higher scores. We conducted 6 FGDs in total. The results characterize PIF as a complex, dynamic, and longitudinal journey to becoming a medical doctor that is closely related to a student's motivation. The FGDs also highlight the importance of both internal factors (students' values, attributes, and personal circumstances) and external factors (curriculum, the learning environment, workplace-based learning, and external expectations) for PIF in medical education.

CONCLUSION

Higher-level students show higher scores in some aspects of PIF, which further validates the potential use of the questionnaire to monitor PIF, a dynamic process influenced by internal and external factors. Generating awareness among medical students and encouraging reflection on their PIF stage may be crucial for PIF processes.

Assessment of safety attitudes, professionalism and exploration of medical students' experiences

BACKGROUND

The present study was conducted to examine the interns' perceptions of safety attitude and professionalism and to explore their experiences about adherence to the principles during the COVID-19 pandemic.

METHOD

The present study was a mixed-method that was performed in two quantitative and qualitative stages. The medical interns at X University (n = 140) were entered. In the quantitative phase, the assessment of the interns' Safety Attitudes and Professionalism was conducted by a survey. In the qualitative phase, data were gathered by semi-structured interviews. The experiences of participants were analyzed by the inductive content analysis approach of Graneheim and Lundman.

RESULTS

Participants' perception scores on safety attitude and professionalism were 98.02 (14.78). The results were explained in a theme of "weakness in systemic accountability in compliance with professionalism and safety". The theme included three categories: 'support system inadequacy', and 'null curriculum in safety and professionalism education'.

CONCLUSION

The present results showed participants' perception scores on safety attitude and professionalism were below the moderate level. The systemic issues were explored as influencing factors in the occurrence of unsafe and unprofessional behaviors. They reported the weakness of the support system (individual, teamwork, mental health, well-being, management, and culture), and the null curriculum in education of professional, and safety principles effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, it is recommended to create mechanisms to support the development of professionalism of healthcare workers, especially, novice providers and students, and pay attention to the safety and professionalism in formal and informal educational programs.

Connection and conflict: influence of the hidden curriculum on veterinary residents' professional identities within the specialty of laboratory animal medicine

OBJECTIVE

To explore the role of the hidden curriculum in residents' development of professional identity during postgraduate training in laboratory animal medicine.

SAMPLE

24 residents enrolled in 1 of 7 laboratory animal medicine training programs in the eastern US.

PROCEDURE

24 qualitative, semistructured interviews were conducted and recorded. Deidentified transcriptions were analyzed by each author using open and axial coding. Constant comparative methodology was used to develop themes and subthemes. Member checks were performed to verify trustability of the conclusions drawn.

RESULTS

3 themes and their related subthemes emerged from the qualitative analysis: 1) building relationships through competent communication (building rapport, practicing clinical empathy, overcoming language barriers, communicating in the "authorized" way, and navigating email limitations), 2) tension within the process of identity formation (acting as the middleman among stakeholders, overcoming the stigma of the policing role, experiencing a lack of power to impact change, and managing a culture of conditional value of veterinary knowledge), and 3) outlets for tension in identity formation (reliance on residency mates, limitations of venting).

EDUCATIONAL RELEVANCE

Our findings suggest that residents are navigating professional identity formation under challenging circumstances that include conflicting stakeholder needs, conditional value of veterinary knowledge, and lack of power to influence change. Residents have limited outlets for relieving the discord between their ideal professional role and their lived experiences. These results provide an important background for refining curricula and creating effective support systems for residents.

An analysis of student essays on medical leadership and its educational implications in South Korea

To examine medical students' perceptions of leadership and explore their implications for medical leadership education. We conducted a qualitative analysis of the essays submitted by students in the medical leadership course from 2015 to 2019. We categorised the essays by the characteristics of the selected model leaders (N = 563) and types of leadership (N = 605). A statistically significant proportion of students selected leaders who were of the same gender as themselves (P < 0.001), graduate track students chose leaders in science (P = 0.005), while; military track students chose leaders in the military (P < 0.001). Although the highest proportion of students chose politicians as their model leaders (22.7%), this number decreased over time (P < 0.001), and a wider range of occupational groups were represented between 2015 and 2019. Charismatic leadership was the most frequently selected (31.9%), and over time there was a statistically significant (P = 0.004) increase in the selection of transformational leadership. Students tended to choose individuals whose acts of leadership could be seen and applied. Medical leadership education should account for students' changing perceptions and present a feasible leadership model, introducing specific examples to illustrate these leadership skills.

A Novel Curricular Design Exposing Clinical Medical Students to the Hidden Curriculum

BACKGROUNDS

The Curriculum Committee of a medical school introduced a longitudinal course for clinical medical students addressing the hidden curriculum as a way to enhance the overall learning environment in undergraduate medical education.

METHODS

This novel design included podcasts, virtual online sessions, and self-reflection videos.

OUTCOMES

Students and faculty viewed it as successful.

Current challenges for women in orthopaedics

Orthopaedics has been left behind in the worldwide drive towards diversity and inclusion. In the UK, only 7% of orthopaedic consultants are female. There is growing evidence that diversity increases innovation as well as patient outcomes. This paper has reviewed the literature to identify some of the common issues affecting female surgeons in orthopaedics, and ways in which we can address them: there is a wealth of evidence documenting the differences in the journey of men and women towards a consultant role. We also look at lessons learned from research in the business sector and the military. The 'Hidden Curriculum' is out of date and needs to enter the 21st century: microaggressions in the workplace must be challenged; we need to consider more flexible training options and support trainees who wish to become pregnant; mentors, both male and female, are imperative to provide support for trainees. The world has changed, and we need to consider how we can improve diversity to stay relevant and effective. Cite this article: Bone Jt Open 2021;2-10:893-899.

Student Perceptions of a Reflective Writing-based Wellness Course: "Good in Theory, But..."

To offset disconcerting trends showing alarming rates of burnout and other types of psychological distress among medical students, many medical schools have implemented wellness initiatives for first year students as they are first adjusting to the rigors of medical school. This study examines students' attitudes toward a reflective writing-based wellness course. We conducted a thematic analysis of 97 writings that students wrote in response to a prompt asking them what they thought of the wellness course at an American Midwestern medical school. The most consistent perception that students expressed was that while they were deeply appreciative of the effort to integrate wellness into the curriculum (what we call Good in Theory…), they did not think it was implemented efficaciously and even, in some cases, felt that the wellness course contributed to their distress rather than alleviated it (what we call …But…). Specifically, while the wellness course helped them prioritize wellness and fostered connection between fellow medical students, it also conflicted with their individualized notions of health and was a burden on their limited time. We discuss the findings in the context of their implications for medical education and argue that the implicit messages students internalized from the mere existence of a wellness program-that the university/faculty cares about them, they do not need to feel guilt when taking a break from medicine, they are not alone, and it is acceptable to express emotions-are all important for their professional socialization and personal well-being.

Perceptions of medical students towards the practice of professionalism at the Arabian Gulf University

BACKGROUND

To enhance the development of a curriculum in professionalism for medical students, the aim of this research was to evaluate medical students' responses regarding professionalism teaching and behaviors in their clinical experience at the Arabian Gulf University (AGU).

METHODS

A retrospective cross-sectional, questionnaire-based study involving Year 5 medical students at the AGU. We used a "climate of professionalism" survey that consisted of two parts. The first part asked students to rate their perceptions of the frequency of professionalism practices of their peers (medical students), residents, and faculty. The response choices included: "mostly", "sometimes", and "rarely". The second part asked the students to assess their perceptions of the professionalism teaching and behaviors of the faculty. The response choices included: "mostly", "sometimes", and "rarely". We calculated an overall score for the responses in both parts of the questionnaire by assigning 3, 2, and 1 points to the response choices, respectively. We also calculated subscale scores reflecting different professionalism constructs. We used descriptive statistics and a one-way Analysis of Variance (ANOVA) followed by multiple testing comparisons with Bonferroni correction to examine pairwise comparisons. A p < 0.05 was considered statistically significant.

RESULTS

The mean total scores of participants' ratings of professional behaviors of medical students, residents, and faculty for each academic year were approximately 60% of the total maximum score. The mean total scores of participants' rating of faculty's teaching and modeling behaviors concerning professionalism were approximately 58% of the maximum score. Compared with similar studies performed in the Arab Region, ratings regarding professional teaching and modeling of professionalism were lower.

CONCLUSION

We recommend the further evaluation of professionalism teaching and behaviors at the AGU and further discussions regarding curriculum reform.