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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:

The hidden curriculum in medical education

Medical education provides the means by which students begin to
develop their professional identity, defines how they must behave and the
knowledge and skills they must acquire in order to be perceived as
professionally acceptable to their teachers and fellow professionals.1
However, a current dilemma for the medical profession is to agree what
constitutes professional competence. Doctors are required to be caring,
effective communicators and team workers and at the same time to be at the
forefront of cutting-edge scientific research and able to understand and
utilise rapidly advancing technology.

For all the criticism it has received, the traditional approach to
medical education provided medical practitioners with clearly defined
roles, a strong sense of identity and has produced a highly trained and
motivated workforce capable of driving technological advancements.
However, its hierarchical and professionally insular structure has been
held responsible for failing to promote team working and communication
skills and to have contributed to the highly publicised problems faced by
the medical profession in recent years.2,3

Lempp and Seale4 highlighted a problem with medical education’s
hidden curriculum. We suggest that a clear answer to this problem and
intrinsically linked to the issue of professional identity, is the
involvement of students from different professions in interprofessional
education (IPE). Rather than taking a hierarchical and competitive
approach to medical education, IPE enables teachers and learners to
experience and appreciate the skills and competencies of other healthcare
professionals. Contrary to arguments that IPE blurrs professional
boundaries, ward-based IPE delivered by an interprofessional team can help
teachers and learners define and understand their own unique but
complementary roles.5 Effective communication and reflective practice are
integral components of this approach and the skills learned have the
additional advantage of being inherently transferable to a variety of
clinical settings and to different groups of healthcare professionals.

Ward-based IPE has been introduced in to the undergraduate medical
and nursing curricula at Queen’s University, Belfast. Teachers and
students reported that this programme had improved their ability to
communicate with patients and other healthcare professionals and had
enhanced their understanding of the need for a collaborative approach to
patient care.5 Just as the medical profession must embrace change so
medical education needs to prepare students appropriately for C21st
professional practice, and through evaluation of these changes, improve
patient care.


1. Slotnick, HB. How Doctors learn: Education and Learning across the
Medical-school-to-practice Trajectory. Academic Medicine 2001; 76:1013-

2. Department of Health. Learning from Bristol: The Report of the
Public Inquiry into Children’s heart Surgery at the Bristol Royal
Infirmary 1984-95 2001; London: TSO.

3. Department of Health. Royal Liverpool Children's Inquiry 2001;
London: Stationery Office.

4. Llempp H. and Seale C. The hidden curriculum in undergraduate
medical education: qualitative study of medical students’ perceptions of
teaching. BMJ 2004; 329: 770-773.

5. Stewart M, and Morison S. Assessing interprofessional education.
Archives of Disease in Childhood 2004; 89: (1) A27.

Competing interests:
None declared

Competing interests: No competing interests

11 November 2004
Moira C Stewart
Consultant Paediatrician/Senior Lecturer in Child Health
Susan L Morison and John G Jenkins
Department of Child Health, Queen's University, Belfast, BT12 6BJ