The impact of the hidden curriculum on the formation of the professional identity of the physician: a qualitative study

Author(s)

Gabrielle Leite Silveira

• Document type: Master's Dissertation
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2017-10-16

Examining board members

Marco Antonio de Carvalho Filho; Egberto Ribeiro Turato; Eloisa Helena Rubello Valler Celeri; Sérgio Baldassin

• Advisor: Marco Antonio de Carvalho Filho

Abstract

Introduction: The medical training process is complex and involves the acquisition and development of different skills, competencies and attitudes. Thus, it should also contemplate the teaching of bioethics, the doctor-patient relationship and teamwork. Therefore, the curricular improvement must be continuous and approach the formation of the professional identity of the physician. In several medical schools, this dimension has been termed as the teaching of professionalism. Several pedagogical practices were proposed to deal with this issue. However, such practices are still the subject of much debate, as the focus has been on assimilating a list of desirable rules and behaviors that are often not experienced. For a new approach to teaching professionalism, some medical educators believe that it is important for the medical curriculum to appropriate the medical identity formation process. Non-formal aspects are also learned during this process, called the hidden curriculum. It is a set of unprogrammed influences and experiences that comprise the cultural, organizational, ritual, affective and professional dimensions that can influence the formation of the student. These aspects are especially important in vocational education. The aim of this study was to increase the knowledge about the impact of the hidden curriculum in the process of formation of the professional identity of medical students, starting from the conceptual scheme proposed by Cruess et al. We seek to develop a conceptual framework, based on experiences reported by the students, that can contribute to the improvement of effective pedagogical interventions, aimed at the development of a professional identity based on the precepts of what is considered a good medicine. Methodology: A qualitative study was conducted, investigative approach called 'grounded theory' aimed at conceptual development on the subject, through the speech of a large number of participants to experience the process in question. Were interviewed 102 final-year medical students divided in 13 focus groups and analyzed data based on grounded theory. Results: Were identified five domains related to hidden curriculum and professional identity formation: 1. unawareness of the process of professional identity formation; 2. affective distance and cynicism; 3. role models and mentors¿predominance of negative memories; 4. state of dissonance between personal and professional life; and 5. repetition without reflection. It was possible to notice a cathartic behavior of the students in the focus groups. Conclusion: Awareness of the process of medical identity formation can lead to an affective detachment and isolation, leading to a confrontation of personal life and professional life. At this point, models and mentors exert an important influence, leading the student to a repetition without reflection of negative examples. With this research, we seek to offer subsidies to medical educators so that they can better contribute to the development of students' medical identity. Its purpose was to support new pedagogical and institutional interventions aimed at preventing the negative influences of the hidden curriculum on the professional development of the medical student. In this context, it is believed that the offer and the guarantee of a safe environment for the expression of the experiences lived through the hidden curriculum, always accompanied by reflections guided by real professionals of the practice, is an important starting point (AU)

• FAPESP's process: 15/06534-2 - THE IMPACT OF HIDDEN CURRICULUM IN FORMATION OF PROFESSIONAL MEDICAL IDENTITY: a qualitative study
• Grantee: Gabrielle Leite Silveira
• Support Opportunities: Scholarships in Brazil - Master