Formal, Informal, and Hidden Curricula of a Psychiatry Clerkship

Both the hidden and informal curriculum take place after or next to the theoretical teaching, the formal teaching and has an important part in the shaping of the medical students’ professionalism and professional values. Moreover, these forms of the curriculum have a major impact on the learning potential of med students. Yet little is known about this subject. A lot has been written but only from a theoretical stand point. I’ve written about the hidden and informal curriculum in a previous post. Most of the research to date has been generally focused on the undergraduate and graduate medical curricula in general. This time we’ll talk about the formal, informal, and hidden curricula of a psychiatry clerkship.

During clerkship medical students are confronted the most with the informal and hidden curriculum. In this research the researchers conducted six focus groups , four with medical students during their psychiatry rotation, one with psychiatry residents and one with teaching faculty of the psychiatry department.

After providing several examples of the kinds of curriculum phenomena we sought to identify, we asked participants a series of open-ended questions designed to prompt thinking about how they perceived and experienced the various enactments of the formal, informal, and hidden curricula reflected in the teaching environment of the psychiatry department.

The formal curriculum during psychiatry clerkship was mostly perceived by all three groups besides the formal curriculum as the time with high value placed on building relationships with patients. All three groups didn’t distinguish between the informal and hidden curriculum (the informal curriculum “is the process by which a learner’s knowledge and skills become situated in the context of daily work”, hidden curriculum, which includes the ideological and subliminal messages of both the formal and informal curricula).

All three groups were similar in their perceptions of the formal curriculum. Which is amazing when you think of it. The attendings were the role models with the most significant influence on the students and residents belief about the practice of psychiatry. For students the most influential role models were the attendings, more than residents. Students and residents had no trouble in distinguishing positive and negative role models.

Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings’ role modeling, as the nature and amount of time attendings spend with patients, and as attendings’ advice arising from experience and intuition versus “textbook learning.”

This again proves the importance of increasing the number of role model physicians in medical education. This again proofs that medical education is in need of full time faculty members with good professional qualities performing interaction with patients in the presence of students and residents. They should be devoted to teaching students and residents. But who will pay for their precious time?
Wear D, & Skillicorn J (2009). Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship. Academic medicine : journal of the Association of American Medical Colleges, 84 (4), 451-8 PMID: 19318777