School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
Med Educ. 2013 Feb;47(2):134-43. doi: 10.1111/medu.12072.
Major influences on learning about medical professionalism come from the hidden curriculum. These influences can contribute positively or negatively towards the professional enculturation of clinical students. The fact that there is no validated method for identifying the components of the hidden curriculum poses problems for educators considering professionalism. The aim of this study was to analyse whether a cultural web, adapted from a business context, might assist in the identification of elements of the hidden curriculum at a UK veterinary school.
A qualitative approach was used. Seven focus groups consisting of three staff groups and four student groups were organised. Questioning was framed using the cultural web, which is a model used by business owners to assess their environment and consider how it affects their employees and customers. The focus group discussions were recorded, transcribed and analysed thematically using a combination of a priori and emergent themes.
The cultural web identified elements of the hidden curriculum for both students and staff. These included: core assumptions; routines; rituals; control systems; organisational factors; power structures, and symbols. Discussions occurred about how and where these issues may affect students' professional identity development.
The cultural web framework functioned well to help participants identify elements of the hidden curriculum. These aspects aligned broadly with previously described factors such as role models and institutional slang. The influence of these issues on a student's development of a professional identity requires discussion amongst faculty staff, and could be used to develop learning opportunities for students. The framework is promising for the analysis of the hidden curriculum and could be developed as an instrument for implementation in other clinical teaching environments.
医学职业素养的学习主要受到隐性课程的影响。这些影响可能对临床学生的专业文化有积极或消极的作用。由于目前还没有经过验证的方法可以确定隐性课程的组成部分，这给考虑医学职业素养教育的教育工作者带来了问题。本研究的目的是分析从商业环境中改编的文化网络是否可以帮助识别英国兽医学校隐性课程的要素。
采用定性研究方法。组织了七个焦点小组，由三组工作人员和四组学生组成。问题的提出采用了文化网络，这是一种商业所有者用来评估其环境并考虑其对员工和客户的影响的模型。对焦点小组讨论进行了记录、转录，并使用先验和新兴主题的组合进行了主题分析。
文化网络确定了学生和教职员工隐性课程的要素。这些要素包括：核心假设、常规、仪式、控制系统、组织因素、权力结构和符号。讨论了这些问题如何以及在何处可能影响学生的专业身份发展。
文化网络框架很好地帮助参与者确定了隐性课程的要素。这些方面与先前描述的因素（如榜样和机构俚语）大致一致。这些问题对学生专业身份发展的影响需要教师讨论，并可用于为学生提供学习机会。该框架有望用于分析隐性课程，并可以作为在其他临床教学环境中实施的工具进行开发。
