Ask the expert: What is the ’hidden curriculum’?

Residency Program Insider, June 8, 2010

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We can divide the learning environment of a medical school or residency program into three distinct but interrelated arenas: the formal, the informal, and the hidden curricula (HC). The formal curriculum is your intended and your stated curriculum. Others have used terms such as the “explicit curriculum” or the “curriculum on paper”. Conversely, the informal curriculum is part of the learning that arises from (or is grounded in) the sporadic, happenstance, and idiosyncratic interactions among students or between faculty and students. The informal curriculum can happen anywhere (e.g., hallways, on-call rooms, elevators, the cafeteria, even classrooms), but the lessons, truisms, and learning pearls being advanced are not prescripted, nor are they found in a school's course catalogue, student handbook, class syllabus, or statements about learning objectives. In many respects, the informal curriculum is a curriculum “on-the-fly,” and although you cannot predict or preemptively control this kind of learning because it is so unpredictable and idiosyncratic, you can modify its impact.

The HC is neither formal nor idiosyncratic. It operates at the level of artifacts (pictures or award plaques hung on walls), within rituals such as White Coat or award ceremonies, and at the level of organizational structure and culture. The HC allows us to explore the learning that arises from being immersed in organizational culture. Although much of the HC can, and is, conveyed through the social relations and networks that exist among students and between students and faculty, the ability to differentiate between the informal curriculum and the HC allows us to better explore what medical schools and residency programs teach, even when we remove (superficially, at least) people from the equation.

This week’s question and answer are adapted from HCPro Inc.’s newest residency resource, A Practical Guide to Teaching and Assessing the ACGME Core Competencies, Second Edition.

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