What non-verbal and indirect messages are students absorbing about power, gender roles, and patient autonomy?
Is there a way to systematically detect and map the hidden curriculum over time across institutions?
Eg.
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Power Dynamics Senior doctors interrupting nurses or medical students mid-sentence. Praise going only to students who mirror the attending’s style or opinions. Being discouraged from questioning senior staff, even on patient safety issues.
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Gender Roles Women more often assigned “empathetic” roles (e.g., comforting patients), while men are encouraged toward procedural or leadership tasks. Female faculty being addressed by first names; male faculty by titles. Students observing gender disparities in who leads surgeries vs. paperwork.
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Patient Autonomy Staff referring to patients by diagnosis (“the gallbladder in room 3”) rather than names. Decisions made about patients, not with them — especially in teaching rounds. Dismissive language used for certain types of patients (e.g., “drug seeker,” “non-compliant”).
These messages teach students how things “really work”, regardless of what the syllabus says.
Part 2: How to Systematically Detect and Map the Hidden Curriculum
This is the truly challenging part — but not impossible. Here are methods that could help:
1. Ethnographic Micro-Observation Trained observers watch team interactions during clinical rounds and log patterns in body language, interruptions, who speaks, and how decisions are framed. Could be cross-institutional to reveal cultural patterns.
2. Sentiment and Language Analysis of Teaching Using NLP to analyze the tone and structure of interactions in recorded lectures, bedside teaching, or debriefs. Look for patterns: who’s praised, who’s interrupted, what labels are used for patients?
3. Experience Mapping from Reflective Writing Aggregate and code thousands of student reflective essays or journaling assignments. Identify recurring themes in power, marginalization, moral distress, etc.
4. Longitudinal Surveys with Implicit Measures Combine surveys with indirect assessments (like the Implicit Association Test) over multiple years. Measure changes in student attitudes and perceptions as they progress through medical school.
5. Cross-Institutional Comparative Studies Different schools may have different cultures — mapping them can expose institutional blind spots. For example, does School A produce students who feel empowered to speak up more than School B?
Continue your suggestions and words over this!! 