Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Is competitiveness a negative trait?

Dear Sir – Lempp and Seale suggest competitiveness is a negative
aspect of the “hidden curriculum”(1). To enter medical school one needs
to pass exams, have the requisite experience and perform well at
interview, in direct competition with other students. The majority of
medical students are caring, compassionate but also likely ambitious
individuals. Is it really surprising that this competitiveness is
continued into medical education?

It is clearly a concern when half of students questioned in this
study feel that competition is the defining characteristic of medicine.
This is a worrying finding given the importance of team working in
clinical practice, especially as it was the clinical students who
identified competition more readily. Team working in education may be as
important as it is in clinical medicine, especially with the advent of the
“problem based learning” curriculum. Competitiveness is in itself not a
bar to good team working. I would suggest that this study was carried out
in a Medical School with a “traditional” curriculum with more
“traditional” values. It would be interesting to know if these data were
comparable with data obtained from students enrolled in a “problem based
learning” curriculum, given the negative article published recently with
regard to the problem based learning curriculum(2).

The real question is whether this competitiveness is
counterproductive. The answer is that it is not… In moderation.
Competition is healthy and natural. And after all it seems unlikely that
competitive spirits will, or should, be eliminated from students since
they will be forced to compete with each other intermittently throughout
their careers.

1. Lempp L, Searle C. The hidden curriculum in undergraduate medical
education: qualitative study of medical students' perceptions of teaching.
BMJ 2004;329:770-773.

2. Williams G, Lau A. Reform of undergraduate medical teaching in the
United Kingdom: a triumph of evangelism over common sense. BMJ 2004;329:92

Competing interests:
IAR is a recent graduate from a problem based learning curriculum.

Competing interests: No competing interests

10 October 2004
Ian A Rowe
Senior House Officer in General Medicine
University Hospital Nottingham, Nottingham, NG7 1UH