Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Med Educ. 2012 Sep;46(9):887-93. doi: 10.1111/j.1365-2923.2012.04316.x.
In this qualitative study we examine how teachers' egalitarian or discriminatory behaviours and values at odds with those of the individual learner or the institution are perceived and absorbed by students, and how this hidden curriculum shapes the doctors students become.
During 2011, a total of 120 randomly selected medical students from each class at three Canadian medical schools were electronically asked for examples of teachers' words, attitudes or behaviours that discriminated against or promoted equality towards a group or groups of doctors or patients. We examined the content of participants' examples of unexpected messages and their reactions to these. Responses were aggregated, sorted and coded for conceptual themes. An independent qualitative researcher repeated the analytic process and then engaged in discussion with us to reach consensus on themes and meanings.
The 76 (63%) respondents noted that attitudes in keeping with universally held, institutional values of equality towards, for example, homosexuals or marginalised populations were expressed, but also described role-modelling at odds with this. Patient characteristics such as obesity, drug abuse, mental illness and poverty were presented as signs of individual weakness or moral failing. Some teachers assumed immigrant status based on a student's or patient's skin colour or last name. Respondents described how women in medicine were maligned as potential surgeons and were expected to put family before career. Teachers denigrated doctors from specialties other than their own. Students reacted to discordant role-modelling by challenging, dissociating themselves, with silence or with confusion followed by attempts at individual transformation to realign careers and behaviours with those of teachers.
When teaching contradicts institutional or learners' values, or is particularly inspiring, students notice and may be influenced to the extent that they rethink personal beliefs and plans to fit their future doctor selves to these models.
在这项定性研究中，我们探讨了教师与个体学习者或机构价值观相悖的平等或歧视行为和价值观是如何被学生感知和接受的，以及这种隐性课程如何塑造医学生的成长。
在 2011 年，我们从加拿大三所医学院的每个班级中随机选择了 120 名医学生，通过电子方式请他们举例说明教师歧视或促进医生或患者群体平等的言语、态度或行为。我们研究了参与者对意外信息的内容及其对此的反应。对回应进行了汇总、分类和概念主题编码。一位独立的定性研究人员重复了分析过程，然后与我们进行了讨论，以就主题和含义达成共识。
76 名（63%）受访者指出，他们表达了对同性恋者或边缘化群体等普遍持有的、机构平等的态度，但也描述了与这种态度相悖的模范行为。患者的特征，如肥胖、药物滥用、精神疾病和贫困，被视为个人弱点或道德失败的迹象。一些教师根据学生或患者的肤色或姓氏来假设其移民身份。受访者描述了在医学领域，女性如何被诋毁为潜在的外科医生，并被期望将家庭置于事业之前。教师贬低来自自己专业以外的医生。学生对不一致的模范行为做出了反应，例如挑战、与自己保持距离、保持沉默或困惑，然后试图通过个人转变来调整职业和行为，以适应教师的模式。
当教学与机构或学习者的价值观相矛盾，或者特别鼓舞人心时，学生会注意到这些，并可能受到影响，以至于他们重新思考个人信念，并计划将未来的医生自我与这些模式相匹配。
