Influence of hierarchy on medical students training: what the hidden curriculum can teach us

Abstract

Introduction: The hidden curriculum (HC) is influenced by the cultural and social environment in which it occurs and may not be directly linked to the formal curriculum, contributing significantly to the medical student's training. Among the most frequently cited elements of the HC is hierarchy; it is "alive" in the medical world, despite contrary discourse, and it can have both positive and negative aspects.

Objective: To identify, describe and analyze how hierarchy influences the training of medical students

Materials and Methods: A cross-sectional, observational study with qualitative analysis was conducted with 28 medical students (11 females/17 males) from the medical program of a public university in Ribeirão Preto (SP, Brazil). Six focus groups (FGs) were held and 28 written narratives (WNs) were collected. The FGs and WNs were conducted during the student’s clerkship in Pediatrics and Family and Community Medicine rotations. The WNs and the FGs' discourses were analyzed to identify patterns of tacit influences related to hierarchy experienced by participants within the context of primary health care training. Content analysis, considering Bardin's methodology, has been used to evaluate both the WNs' and the FGs' discourses.

Results: Among the observed HC elements, hierarchy mostly negatively influenced interpersonal relationships, resulting in obstacles to the students' socialization process, hindering both learning and the provision of humanized care to the patient. To a lesser extent, hierarchy was viewed positively, particularly regarding service organization when carried out in a respectful and "horizontal" manner.

Conclusion: The hierarchy, a common element of the HC, is actively present in the academic environment, predominantly exerting a negative influence on socialization process of medical students, resulting in losses in both learning and the provision of humanized care to the patient.