Zhou Shannon Y, Kabir Raeesa, Cripps Courtney
University of Minnesota Medical School, Minneapolis, Minnesota.
Division of Plastic and Reconstructive Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
J Surg Educ. 2025 Sep;82(9):103579. doi: 10.1016/j.jsurg.2025.103579. Epub 2025 Jun 19.
To summarize and evaluate interventions addressing the hidden curriculum (HC) within surgical training, identify HC themes addressed, and to share strategies that have demonstrated efficacy so that educators may more easily adopt effective approaches.
A scoping review was performed using 5 databases. Studies were included if they implemented an intervention to address the HC within surgical training and evaluated efficacy. Data extraction included the surgical specialty, HC theme, solutions, and outcomes.
This review includes research conducted within surgical education programs in academic medical centers.
An estimated 2345 trainees in surgical specialties participated in initiatives aimed at addressing the HC, including 2040 medical students, 303 residents, and 2 fellows.
Nine studies met inclusion criteria. Interventions focused on the following HC themes: surgical culture, professionalism, ethics, power dynamics, medical errors, and mistreatment. The most common methods employed included group discussions, reflective writing, readings, mentorship, and skills workshops, among others. Successful programs often combined multiple teaching strategies. Most interventions increased trainees' awareness of the HC and even single workshops increased their ability to recognize and feel empowered to address the HC. However, quality of evidence was often limited by small sample sizes, subjective outcomes, and lack of long-term follow-up.
Reviewed studies support that explicitly addressing the HC and combining multiple teaching methods (e.g. group discussion and reflection) can increase trainee awareness of the HC and bolster confidence in addressing it. However, despite some promising results, evidence remains limited by methodological weaknesses, such as reliance on subjective measures, and conclusions about sustained cultural change cannot yet be drawn. Future studies may consider including objective evaluation methods, sustained follow-up, and delving into both negative and positive influences of the HC to better inform the development of more effective and inclusive surgical training environments.
总结和评估针对外科培训中隐性课程（HC）的干预措施，确定所涉及的HC主题，并分享已证明有效的策略，以便教育工作者能够更轻松地采用有效的方法。
使用5个数据库进行范围综述。如果研究实施了针对外科培训中HC的干预措施并评估了效果，则纳入研究。数据提取包括外科专业、HC主题、解决方案和结果。
本综述包括在学术医学中心的外科教育项目中进行的研究。
估计有2345名外科专业学员参与了旨在解决HC的倡议，包括2040名医学生、303名住院医师和2名研究员。
9项研究符合纳入标准。干预措施侧重于以下HC主题：外科文化、职业素养、伦理、权力动态、医疗差错和虐待。最常用的方法包括小组讨论、反思性写作、阅读、指导和技能研讨会等。成功的项目通常结合多种教学策略。大多数干预措施提高了学员对HC的认识，甚至单个研讨会也提高了他们识别和处理HC的能力。然而，证据质量往往受到样本量小、主观结果和缺乏长期随访的限制。
综述研究支持明确解决HC并结合多种教学方法（如小组讨论和反思）可以提高学员对HC的认识并增强处理HC的信心。然而，尽管取得了一些有希望的结果，但证据仍受到方法学弱点的限制，如依赖主观测量，并且尚未得出关于持续文化变革的结论。未来的研究可能会考虑纳入客观评估方法、持续随访，并深入研究HC的负面和正面影响，以更好地为更有效和包容的外科培训环境的发展提供信息。
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