The impact of hidden curriculum factors on professional adaptability | BMC Medical Education

The present study investigated the relationship between hidden curriculum components and professional adaptability among medical students at Jundishapur University of Medical Sciences in Ahvaz. The findings revealed several critical insights: There was a statistically significant positive correlation between hidden curriculum components (such as informal learning environments, peer interactions, and extracurricular activities) and professional adaptability. This suggests that elements outside the formal curriculum play a crucial role in shaping the professional competencies and adaptability of medical students. Another component, Peer interactions emerged as a particularly strong predictor of professional adaptability. Medical students who actively engaged with their peers in academic and non-academic settings demonstrated higher levels of adaptability. This aligns with the social learning theory, which posits that individuals learn and adapt behaviors through observation and interaction with their peers [9].

Hafferty and Castellani ‘s research highlighted that the hidden curriculum plays a crucial role in the formation of professional identity among medical students. They found that informal interactions and experiences significantly contribute to students’ understanding of professional norms and values [10]. Our study corroborates these findings by demonstrating a positive correlation between hidden curriculum components and professional adaptability. This indicates that the hidden curriculum not only aids in identity formation but also equips students with the skills needed to adapt to various professional contexts. Lempp and Seale ‘s study found that the hidden curriculum positively impacts the development of essential soft skills, such as communication, teamwork, and empathy. These skills are often cultivated through informal interactions and extracurricular activities [11]. The strong influence of peer interactions on professional adaptability observed in our study aligns with Lempp and Seale’s findings [11]. It suggests that the hidden curriculum’s informal learning environments are pivotal in nurturing skills that are critical for professional success. Gehreke ‘s research indicated that peer support and mentorship programs embedded within the hidden curriculum significantly enhance students’ academic and professional outcomes [12]. Our study’s emphasis on the importance of peer interactions supports Gehreke’s conclusions. The positive impact of peer support and mentorship on professional adaptability underscores the value of these informal networks within medical education. Mahood ‘s study argued that the hidden curriculum often reinforces existing power structures and hierarchies within medical education, potentially leading to the perpetuation of negative behaviors and attitudes [13]. While our study focuses on the positive aspects of the hidden curriculum, it is essential to acknowledge Mahood’s perspective. The hidden curriculum can inadvertently perpetuate negative norms, which may undermine professional adaptability in certain contexts.

In the present study, the role of professor interactions as a role model in clinical departments was considered as an important factor in adaptability of medical students.

Rezvani considers the main unwanted and undesirable value burdens of the hidden curriculum to be creating a perception of formality in the lesson that lacks educational aspects, creating a negative attitude towards the lesson, creating or reinforcing the lack of connection between what is learned and real life, reinforcing the hierarchy of power, and increasing stress. The aforementioned issue shows the important role of the value perspective and interactions of teachers in the formation and internalization of value behaviors [14].

Future research should investigate these dual effects to provide a balanced understanding. Ebabuye’s research highlighted that the hidden curriculum can contribute to the exclusion of marginalized groups, leading to inequities in learning opportunities and professional development [15]. Our study did not specifically address issues of exclusion and inequity. However, it is crucial to consider that the benefits of the hidden curriculum may not be equally accessible to all students. Policies should aim to create inclusive environments that mitigate these disparities. Billings’s research found that the hidden curriculum, by imposing implicit expectations and pressures, can contribute to increased stress and burnout among medical students [16]. While we observed positive outcomes related to professional adaptability, it is important to balance these findings with the potential negative impacts highlighted by Billings. The hidden curriculum’s implicit demands may lead to stress, which could adversely affect students’ overall well-being and long-term professional adaptability.

The contrasting perspectives on the hidden curriculum highlight the complexity of its impact on medical education. On one hand, our study and others have demonstrated that the hidden curriculum positively influences professional adaptability, skill development, and identity formation. On the other hand, research also indicates potential negative effects, such as reinforcing hierarchies, excluding marginalized groups, and contributing to stress and burnout.

The study’s findings are based on a sample from a single university, which may limit the generalizability of the results. Future research should include a larger and more diverse sample across multiple institutions to validate these findings. Conducting longitudinal studies would provide deeper insights into how hidden curriculum components influence professional adaptability over time, helping to identify long-term impacts and trends. While this study focused on the positive influences of the hidden curriculum, future research should also explore its potential negative impacts, such as reinforcing stereotypes or perpetuating inequities.

The study’s findings align with Bandura’s social learning theory, which emphasizes the importance of observing and modeling behaviors, attitudes, and emotional reactions of others. The positive influence of peer interactions on professional adaptability can be understood through this theoretical lens [9]. Additionally, Lave and Wenger’s (1991) situated learning theory, which posits that learning occurs through active participation in a “community of practice,” provides a relevant framework for interpreting the results. Medical students learn professional behaviors and adaptability by engaging in the social and cultural practices of their academic community [17].

Universities can organize workshops focusing on skills such as teamwork, leadership, and communication, which are crucial for professional adaptability. Creating physical and virtual spaces that facilitate collaborative learning can help students engage more deeply with the hidden curriculum. These spaces should be designed to encourage interaction and knowledge sharing among students.

The hidden curriculum plays a pivotal role in shaping the professional attitudes and behaviors of medical students. It extends beyond formal education, influencing students’ values, ethics, and decision-making processes [10]. Examples from the study indicate that students exposed to a positive hidden curriculum demonstrate greater adaptability in clinical settings, manifested through enhanced communication skills, ethical sensitivity, and the ability to navigate complex clinical scenarios [13]. Professional adaptability is crucial for the evolving landscape of medical practice, where practitioners must continuously adjust to advancements in medical knowledge and technology (Frenk et al., 2010) [18]. The study’s findings suggest that medical students who are adept at interpreting and internalizing the hidden curriculum are better equipped to handle the dynamic nature of healthcare environments, exhibiting resilience, innovative thinking, and a proactive approach to lifelong learning.

Medical educators should acknowledge and integrate the hidden curriculum into formal educational strategies. This integration can be achieved by fostering an institutional culture that emphasizes reflective practice, mentorship, and ethical discourse [19]. Implementing structured programs that address the hidden curriculum can enhance students’ awareness and critical reflection on the implicit lessons they encounter. For instance, reflective journals, mentorship programs, and ethics workshops can serve as platforms for students to engage with and learn from the hidden curriculum.

Policies should be designed to enhance the positive aspects of the hidden curriculum while minimizing its negative impacts. This can be achieved by creating inclusive, supportive, and transparent learning environments. For example, implementing peer support programs that are accessible to all students, regardless of their background, can improve professional adaptability and promote equity.

The results of this study have several important policy implications: Educational policymakers should consider integrating aspects of the hidden curriculum into formal educational frameworks. This could involve promoting group-based learning activities, peer mentoring programs, and fostering a collaborative learning environment. Universities should invest in extracurricular programs that encourage professional skill development. Activities such as student-led workshops, seminars, and professional development clubs can significantly enhance students’ adaptability. Faculty development programs should include components on recognizing and leveraging the hidden curriculum to support students’ professional growth. Educators should be equipped to guide students in navigating informal learning experiences effectively.

Faculty members should be trained to recognize both the positive and negative elements of the hidden curriculum. This awareness will enable them to guide students more effectively. For instance, professional development programs can include modules on identifying and addressing implicit biases and power dynamics within the hidden curriculum.

Implementing structured mentorship programs, where senior students or professionals mentor junior students, can enhance professional adaptability. These programs should be designed to provide both academic and professional guidance. Additionally, policies that foster inclusive and collaborative learning environments can strengthen the positive aspects of the hidden curriculum. This includes creating spaces for informal student interaction and encouraging diversity in group-based learning activities.

Promoting a positive institutional culture that aligns with the core values of medical professionalism is imperative. Institutions should cultivate an environment that supports open communication, mutual respect, and collaborative learning [20]. Leadership within medical schools should model behaviors that exemplify the desired attributes of medical professionals, setting a standard for students to emulate and reinforcing the lessons of the hidden curriculum.

Future research should focus on longitudinal studies to track the long-term impact of the hidden curriculum on professional adaptability. Such studies can provide deeper insights into how early exposures influence career trajectories and professional development [21]. Additionally, comparative studies across different medical schools and cultural contexts can shed light on the universal and context-specific elements of the hidden curriculum, enriching the global discourse on medical education.

A successful example of peer mentoring implementation was at the University of California, San Francisco, in the Department of Surgery, which developed and implemented a formal peer mentoring program consisting of quarterly small group lessons led by a surgical peer teacher and individual surgical support team mentoring sessions covering surgical curriculum topics for medical students at an academic medical school. This structured peer mentoring model provides a mechanism to demystify surgical culture, increase early access to surgical mentoring, and develop mentoring skills among students [22].

Limitation

While the findings of this study provide valuable insights into the role of hidden curriculum components in shaping the professional adaptability of medical students, several limitations must be acknowledged to contextualize the results. The reliance on self-reported data introduces potential bias, as participants may have provided responses influenced by their personal perceptions or the desire to conform to perceived social norms. This self-reporting bias could compromise the accuracy of the measured relationships.

Additionally, the study did not account for various potential confounding variables, such as individual personality traits, prior educational experiences, and external stressors, which may have influenced the outcomes. The homogeneity of the sample, comprised solely of medical students from a single institution, further limits the generalizability of the findings to diverse educational settings or broader populations. This limitation is exacerbated by the cross-sectional design of the study, which prevents the establishment of causal relationships between hidden curriculum components and professional adaptability.

Finally, the contextual variables shaped by the unique institutional and cultural environment of Ahvaz Jundishapur University of Medical Sciences may not be representative of other medical schools. Future research should address these limitations by employing longitudinal designs, incorporating more diverse and heterogeneous samples, and considering additional contextual and confounding factors. Such efforts will contribute to a more comprehensive understanding of the impact of hidden curricula on professional adaptability in medical education .