The hidden and implicit curricula in cultural context: new insights from Doha and New York.

The authors report their longitudinal experience teaching a clerkship in clinical ethics and palliative care at the Weill Cornell Medical College campuses in New York and Doha. This course uses participant observation and reflective practice to counteract the hidden curriculum when learning about clinical ethics and end-of-life care. The authors consider how this formal element of the curriculum is influenced by the implicit and hidden curricula in different cultural contexts and how these differing venues affect communication and information exchange, using the anthropological concept of high- and low-context societies. The authors' analysis provides additional information on Weill Cornell's educational efforts in the medical humanities, bioethics, and palliative care across the curriculum and across cultural settings. By contrasting high-context Doha, where much information is culturally embedded and seemingly hidden, with low-context New York, where information is made overt, the authors theorize that in each setting, the proportion of implicit and explicit curricular elements is determined by the extramural cultural environment. They argue that there are many hidden and implicit curricula and that each is dependent on modes of communication in any given setting. They assert that these variations can be seen not only across differing societies but also, for example, among individual U.S. medical schools because of local custom, history, or mission. Because these contextual factors influence the relative importance of what is implicit and explicit in the student's educational experience, medical educators need to be aware of their local cultural contexts in order to engage in effective pedagogy.