Hidden curriculum of undergraduate surgical education

INTRODUCTION: It is imperative that medical graduates are prepared to manage the increasingly complex surgical patients, who account for one quarter of hospital attendances. Medical school programmes are increasingly congested, meaning that it is necessary to deliver undergraduate surgical education as efficiently as possible. Curricular reform in isolation is unlikely to ensure that students are able to manage this patient group to a high standard. This aim of this thesis is to look beyond the formal curriculum, to the hidden curriculum, to examine its influence on student learning experiences from the perspective of student learners and clinician educators. METHODS: The study design was informed by a literature review of the hidden curriculum in undergraduate surgery and a wider search of educational theory. Critical realism, with its stratified realities and appreciation of varied perceptions, influenced the design, data collection and analysis. A qualitative interview study was designed with semi-structured interviews of final year medical students and clinician educators at a single medical school. The interview guide was informed by the literature review and modified iteratively. Conventional thematic analysis was used to analyse interview transcripts and identify key themes and subthemes from each group. Ethical approval was obtained from the University of Edinburgh Medical and Veterinary Medicine Student Ethics Committee. RESULTS: Sixteen interviews were conducted with students and 14 with consultant surgeons across various specialities. Key themes, and subthemes, were identified and mapped in two separate thematic maps which demonstrated their relationships and proposed a model by which students and clinicians understand and navigate the hidden curriculum in undergraduate surgery. By comparing these, 3 key areas of agreement and dissonance emerged: Performance for Learning: Students and surgeons engaged in performative behaviours to facilitate learning; adopting favourable dispositions to meet their aims. For students this aided their assimilation into the surgical environment and team, which potentially increased learning opportunities. Clinicians found that it enabled them to more effectively engage learners and deliver the curricular aims but, despite many hours spent developing the technical skills of surgery, little resource was given to rehearsing the skills and behaviours of an effective teacher. Physical Location of Learning: A significant disparity emerged between students and clinicians regarding the optimal physical learning environment. Clinicians believed this to be small group or classroom-based learning, but to students, surgical placements and learning were synonymous with the operating theatre. Utilising cognitive load theory, it was demonstrated that this discordance could inadvertently impact the learning experience. Intersections of Institutions: Both groups interviewed occupied the interface between university and healthcare organisations, which necessitated an appreciation of these institutions, and requiring the ability to navigate macro-organisational structures as well as micro-level interpersonal interactions within these organisations, both of which convey their own messages, often unintentionally. CONCLUSIONS: This study advances our understanding of how the hidden curriculum operates, influencing both student learners and clinician educators in the context of surgical placements. It has highlighted the importance of considering its influence from multiple perspectives and understanding that whilst different groups and organisations will have their published or stated aims, they are conveying tacit messages which may or may not align with these.

Grantor dc:publisher

The University of Edinburgh

Year dc:date.issued

2025

Author dc:creator

• Mozolowski, Kirsty Louise

Advisors dc:contributor.advisor

• Wood, Morwenna
• Skinner, Janet
• Harden, Jeni
• Marson, Lorna

• Hidden curriculum
• Surgical education
• Student learning
• Clinician educators
• Curricular reform

Language dc:language.iso

en

Identifier URI

http://dx.doi.org/10.7488/era/6104

OAI identifier oai:identifier

oai:era.ed.ac.uk:1842/43570