title: Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship.
abstract: Changing the culture of medicine through the education of medical students has been proposed as a solution to the intractable problems of our profession. Yet few have explored the issues associated with making students partners in this change. There is a powerful hidden curriculum that perpetuates not only desired attitudes and behaviors but also those that are less than desirable. So, how do we educate medical students to resist adopting unprofessional practices they see modeled by supervisors and mentors in the clinical environment? This paper explores these issues and, informed by the literature, we propose a specific set of reflective competencies for medical students as they transition from classroom curricula to clinical practice in a four-step approach: (1) Priming-students about hidden curriculum in their clinical environment and their motivations to conform or comply with external pressures; (2) Noticing-educating students to be aware of their motivations and actions in situations where they experience pressures to conform to practices that they may view as unprofessional; (3) Processing-guiding students to analyze their experiences in collaborative reflective exercises and finally; (4) Choosing-supporting students in selecting behaviors that validate and reinforce their aspirations to develop their best professional identity.
authors.affiliation: UBC Department of Medicine and Center for Health Education Scholarship, UBC Southern Medical Program, Clinical Academic Campus, 2nd Floor, 2312 Pandosy Street, Kelowna, BC, V1Y 1T3, Canada. Cheryl.Holmes@ubc.ca.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holmes
authors.affiliation: Department of Medical Education, College of Medicine at Chicago, University of Illinois, Chicago, IL, USA.
authors.forename: Ilene B
authors.initials: IB
authors.lastname: Harris
authors.affiliation: Department of Medical Education, College of Medicine at Chicago, University of Illinois, Chicago, IL, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Schwartz
authors.affiliation: Department of Surgery and Center for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
mesh_terms: D001291:Attitude of Health Personnel; D001519:Behavior; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D015279:Organizational Culture; D000068616:Professionalism
keywords: Clinical clerkship; Hidden curriculum; Medical education; Patient safety; Professional identify formation; Reflection