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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

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Graduate Medical Students More Likely to Recognise Humiliation Tactics

Now almost at the end of my undergraduate medical training, I have
been reflecting on my experiences at medical school. One that comes to
mind in particular is that of our first simulated patient consultation.
My group consisted of the younger (straight from school) and slightly
older graduate students. As a group we all had varying levels of
anxieties at having our communication styles recorded on video tape and
critically reviewed. We all responded differently to comments from our
tutors – some thought that the tutor had been too strict, others believed
that the assessment was fair. What I do recall is that overall the older
students having a more questioning approach to their feedback.

It has been reported that graduate students feel significantly less
anxious and more prepared than their undergraduate colleagues at the
transitional stage of getting into fulltime clinical attachments.(1)
Graduate students by virtue of their age are far more likely to have dealt
with challenging life situations and thus maybe are better prepared to
cope with and question the validity of remarks made by teachers.

Thus, I wonder if this observation maybe of use in interpreting a
recent study that reported of a hierarchical and competitive atmosphere
where teaching is frequently haphazard and often involved humiliation by
professors.(2) One of the reasons why medical students feel that they are
being humiliated maybe because of a change in perception.

Of course this goes without saying that some medical educators have
not quite understood the breed known as a graduate entrant to medicine.
Often these students have excelled in other areas of professional and
personal development, have experienced what life has to offer and thus
expect more respect as individuals for their commitment to medicine. This
acknowledgment need not be more than a few well placed words of
encouragement. Speaking to this type of student in a condescending tone
(as is often done in medical teaching rounds) may be easily perceived as a
humiliation tactic.

I note the difference in my younger colleagues now and how some of
them have really ‘grown up’ and started to question the appropriateness of
certain teaching styles. With the increasing numbers of graduate entrants
to medicine, what might have been accepted as the norm in terms of how
medical educators interact with students is fast changing towards
empowering the medical student in taking responsibility for one’s

1. Hayes K, Feather A, Hall A, Sedgwick P, Wannan G, Wessier-Smith A,
et al. Anxiety in medical students: is preparation for full-time clinical
attachments more dependent upon differences in maturity or on educational
programmes for undergraduate and graduate entry students? Med Educ

2. Lempp H, Seale C. The hidden curriculum in undergraduate medical
education: qualitative study of medical students' perceptions of teaching.
Bmj 2004;329(7469):770-3.

Competing interests:
Graduate entrant to Medicine

Competing interests: No competing interests

07 December 2004
Minha Rajput
Medical student
University of Dundee