Doherty Ailish, Urwin Rachel, McMullan Ryan D, Tou Ying Yun, Westbrook Johanna I, Churruca Kate
Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, NSW 2109 Australia.
Med Sci Educ. 2024 Nov 12;35(1):415-423. doi: 10.1007/s40670-024-02208-4. eCollection 2025 Feb.
Medical students frequently experience unprofessional behaviours (e.g. incivility, bullying), adversely impacting personal and professional development. Formal reporting is rare, suggesting students manage unprofessional behaviour through alternate means. This study investigated the role of a hidden curriculum in medical students' understanding and management of unprofessional behaviours in medical education.
Third-year medical students were recruited from an Australian medical school. Semi-structured interviews were conducted, and thematic analysis was performed to identify themes in how unprofessional behaviour is experienced and managed.
All 17 participants had experienced unprofessional behaviour, and most had witnessed it directed at others. Only two participants reported these experiences. Four themes were identified. (1) Students rationalised whether an incident was reportable based on , and adjusted their personal standards. (2) They described , where senior staff committing unprofessional behaviour held sway over students' medical education. (3) This contributed to perceptions of the , that it carried a high risk of negative consequences, with unclear or no reward. (4) In , students preferred to manage unprofessional behaviour through informal peer discussions to make sense of their experiences, avoid future encounters, and collectively better understand the culture of medicine.
A hidden curriculum was identified whereby students learn to understand and respond to unprofessional behaviour based on their experiences at medical school. The culture of tolerance of unprofessional behaviour and silence in medicine must be addressed if change is to occur.
The online version contains supplementary material available at 10.1007/s40670-024-02208-4.
医学生经常遭遇不专业行为（如无礼、欺凌），这对他们的个人和职业发展产生不利影响。正式举报很少见，这表明学生通过其他方式应对不专业行为。本研究调查了隐性课程在医学生理解和管理医学教育中不专业行为方面的作用。
从一所澳大利亚医学院招募三年级医学生。进行了半结构化访谈，并进行了主题分析，以确定在不专业行为的体验和管理方面的主题。
所有17名参与者都经历过不专业行为，大多数人目睹过这种行为针对他人。只有两名参与者报告了这些经历。确定了四个主题。（1）学生根据情况合理化某事件是否可举报，并调整自己的个人标准。（2）他们描述了一种情况，即做出不专业行为的高级职员对学生的医学教育有影响力。（3）这导致了对举报的看法，即举报存在很高的负面后果风险，且回报不明确或没有回报。（4）在应对过程中，学生更倾向于通过与同龄人进行非正式讨论来管理不专业行为，以理解自己的经历、避免未来遭遇此类情况，并共同更好地理解医学文化。
确定了一种隐性课程，即学生根据自己在医学院的经历学习理解和应对不专业行为。如果要实现变革，就必须解决医学中对不专业行为的容忍文化和沉默现象。
在线版本包含可在10.1007/s40670-024-02208-4获取的补充材料。
