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

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7469.770 (Published 30 September 2004) Cite this as: BMJ 2004;329:770

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Hierarchy through humiliation

Having worked as a research fellow in and/or with several academic
medical departments, I would like to highlight that the process of
maintaining hierarchies through humiliation which this paper discusses are
not unique to medical student training but also at times present in
medical academia. Not only is this atmosphere abusive, even shading at
times into bullying, but also counter-productive, since, if members of a
department are treated as subordinates rather than colleagues, any real
debate is stifled.

One of the implicit, taken-for-granted rules in such situations is
often that medical doctors are superior to all other professional groups.
This is reinforced through the pay system, whereby "non-clinical"
researchers are paid significantly less than "clinical" researchers, even
when doing equivalent work. Medical students do at least have the
opportunity of eventually reaching the pinnacle of the hierarchy, but this
route is closed to all other professions.

An additional problem is the system of short-term contracts, which is
unfortunately still endemic in academia, despite government guidelines.
The consequent need for researchers to "toe the line" in order to obtain a
good reference for the next post, echoes the dependence of medical
students and junior doctors on the good will of their consultants, and
similarly inhibits open discussion of these issues.

The irony for me is that I was previously a medical student, who left
medicine in part because of my profound distaste with the "hidden
curriculum" (although at the time I was not aware of this concept).

Competing interests:
None declared

Competing interests: No competing interests

15 October 2004
Bella Vivat
Research Fellow
King's College London, Denmark Hill, London SE5 9RS