title: Exploring the hidden curriculum: a qualitative analysis of clerks' reflections on professionalism in surgical clerkship.
abstract: BACKGROUND
  Professionalism is an important part of the hidden curriculum that is gaining attention in surgical education. McMaster University, Hamilton, Ontario, Canada, has introduced a small group discussion model using critical incident reports (CIRs) to elicit students' reflections on ethical, communication, and professionalism challenges during surgical clerkship. We described the themes identified by surgical clerks in their CIRs.
  
  
  METHODS
  Using thematic analysis, 4 investigators coded 64 CIRs iteratively until conceptual saturation. Rigor and validity were ensured throughout the process. Data were further explored to compare the CIRs of junior and senior clerks.
  
  
  RESULTS
  Twenty-seven themes and 4 relationship domains emerged: the clerk's relationship to patients, the health care team, the health care system, and self. Challenges with communication, the consent process, and breaking bad news were most commonly cited. Theme frequencies differed between junior and senior clerks.
  
  
  CONCLUSIONS
  Small group discussions of critical incident reports allow surgical clerks to reflect on their developing professional relationships. The themes that have been identified can be used to guide professionalism education and uncover the hidden curriculum.
authors: McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
authors: Tiffaney
authors: T
authors: Kittmer
authors: Jen
authors: J
authors: Hoogenes
authors: Julia
authors: J
authors: Pemberton
authors: Brian H
authors: BH
authors: Cameron
mesh_terms: D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000941:ethics / Q000379:methods*; D003142:Communication; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000941:ethics / Q000379:methods*; D013502:General Surgery / Q000193:education* / Q000941:ethics; D006126:Group Processes; D006801:Humans; D007400:Interprofessional Relations / Q000941:ethics; D009864:Ontario; D011369:Professional-Patient Relations / Q000941:ethics; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*