Intended for healthcare professionals


The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching

BMJ 2004; 329 doi: (Published 30 September 2004) Cite this as: BMJ 2004;329:770
  1. Heidi Lempp, senior qualitative researcher (heidi.k.lempp{at},
  2. Clive Seale, professor of sociology2
  1. 1 Academic Rheumatology, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE5 9RJ
  2. 2 Department of Human Sciences, Brunel University, Uxbridge UB8 3PH
  1. Correspondence to: H Lempp


    Objective To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum.

    Design Semistructured interviews with individual students.

    Setting One medical school in the United Kingdom.

    Participants 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame.

    Main outcome measures Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training.

    Results Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years.

    Conclusions Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.


    • Embedded Image The semistructured interview is on

      We are grateful to all the students who participated in the study, for their time and openness. We also acknowledge the valuable contributions of the senior staff at the medical school who supported this research. This study was carried out while HL was a PhD student in the Department of Sociology, Goldmiths College, University of London.

    • Contributors HL designed the study and carried out interviews and the data analysis. CS advised on study design and dataanalysis. Both wrote the paper. Caroline Ramazanoglu assisted at an early stage of the study, Kate Nash provided invaluable advice and support, and Floss Chittenden provided unfailing support with the transcriptions of the interviews. HL is guarantor.

    • Funding None.

    • Competing interests None declared.

    • Ethical approval The full relevant requirements for the ethical conduct of research, as set out by the British Sociology Association (, were strictly adhered to.

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