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The Hidden Ethics Curriculum in Two Canadian Psychiatry Residency Programs: A Qualitative Study

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Abstract

Objective

The authors describe the hidden ethics curriculum in two postgraduate psychiatry programs.

Methods

Researchers investigated the formal, informal, and hidden ethics curricula at two demographically different postgraduate psychiatry programs in Canada. Using a case study design, they compared three sources: individual interviews with residents and with faculty and a semi-structured review of program documents. They identified the formal, informal, and hidden curricula at each program for six ethics topics and grouped the topics under two thematic areas. They tested the applicability of the themes against the specific examples under each topic. Results pertaining to one of the themes and its three topics are reported here.

Results

Divergences occurred between the curricula for each topic. The nature of these divergences differed according to local program characteristics. Yet, in both programs, choices for action in ethically challenging situations were mediated by a minimum standard of ethics that led individuals to avoid trouble even if this meant their behavior fell short of the accepted ideal.

Conclusions

Effective ethics education in postgraduate psychiatry training will require addressing the hidden curriculum. In addition to profession-wide efforts to articulate high-level values, program-specific action on locally relevant issues constitutes a necessary mechanism for handling the impact of the hidden curriculum.

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References

  1. Online bioethics curriculum. Available at: http://www.royalcollege.ca/portal/page/portal/rc/resources/bioethics. Accessed June 14, 2014.

  2. Accreditation Committee Discussion Paper Biomedical Ethics. Available at: http://www.royalcollege.ca/portal/page/portal/rc/common/documents/accreditation/biomedical_ethics_e.pdf. Accessed June 15, 2014.

  3. Forrow L, Arnold RM, Frader J. Teaching clinical ethics in the residency years: preparing competent professionals. J Med Philos. 1991;16:93–112.

    Article  CAS  PubMed  Google Scholar 

  4. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.

    Article  CAS  PubMed  Google Scholar 

  5. Hafferty FW. Beyond curriculum reform: confronting Medicine’s hidden curriculum. Acad Med. 1998;73:403–7.

    Article  CAS  PubMed  Google Scholar 

  6. Feudtner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad Med. 1994;69:670–9.

    Article  CAS  PubMed  Google Scholar 

  7. Igartua KJ. The impact of impaired supervisors on residents. Acad Psychiatry. 2000;24:188–94.

    Article  Google Scholar 

  8. Patenaude J, Niyonsenga T, Fafard D. Changes in students’ moral development during medical school: a cohort study. CMAJ. 2003;168:840–4.

    PubMed  PubMed Central  Google Scholar 

  9. Hundert EM. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:624–33.

    Article  CAS  PubMed  Google Scholar 

  10. The Future of Medical Education - Postgraduate Project Report: A Collective Vision for Postgraduate Medical Education. 2012. Available at: http://www.afmc.ca/future-of-medical-education-in-canada/postgraduate-project/pdf/FMEC_PG_Final-Report_EN.pdf [Accessed 26 November, 2014], pp 17.

  11. Karnieli T, Vu R, Holtman M, Clyman SG, Inui TS. Medical students' professionalism narratives: a window on the informal and hidden curriculum. Acad Med. 2010;85:124–33.

    Article  Google Scholar 

  12. Lamiani G, Leone D, Meyer EC, Moja EA. How Italian students learn to become physicians: a qualitative study of the hidden curriculum. Med Teach. 2011;33:989–96.

    Article  PubMed  Google Scholar 

  13. Wear D, Skillicorn J. Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship. Acad Med. 2009;84:451–8.

    Article  PubMed  Google Scholar 

  14. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. BMJ. 2004;329:770–3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Van Deven T, Hibbert K, Faden L, Chhem RK. The hidden curriculum in radiology residency programs: a path to isolation or integration? Eur J Radiol. 2013;82:883–7.

    Article  PubMed  Google Scholar 

  16. Hafferty FW, Hafler JP. The hidden curriculum, structural disconnects, and the socialization of new professionals. In: Hafler JP, editor. Exemplary learning in the workplace. New York: Springer; 2010. p. 17–35.

    Google Scholar 

  17. Michalec B, Hafferty FW. Stunting professionalism: the potency and durability of the hidden curriculum within medical education. Soc Theory Health. 2013;11:388–406.

    Article  Google Scholar 

  18. Michalec B. The pursuit of medical knowledge and the potential consequences of the hidden curriculum. Health. 2011;16:267–81.

    PubMed  Google Scholar 

  19. Haidet P, Stein H. The role of the student-teacher relationship in the formation of physicians: the hidden curriculum as process. J Gen Intern Med. 2006;21:S16–20.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Creswell JW. Educational research: planning, conducting, and evaluating quantitative and qualitative research. 2nd ed. Upper Saddle River, New Jersey: Prentice Hall; 2005.

    Google Scholar 

  21. Hatch JA. Doing qualitative research in education settings. Albany: State University of New York Press; 2002.

    Google Scholar 

  22. Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qual Rep. 2008;13:544–59.

    Google Scholar 

  23. Stake RE. The art of case study research. Thousand Oaks, CA: Sage; 1995.

    Google Scholar 

  24. Yin RK. Case study research: design and methods. 3rd ed. Thousand Oaks, California: Sage Publications; 2003.

    Google Scholar 

  25. Bogden RC, Bilken SK. Qualitative research in education: an introduction to theories and methods. 4th ed. New York: Allyn and Bacon; 2003.

    Google Scholar 

  26. Creswell JW. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks, California: Sage Publications; 1997.

    Google Scholar 

  27. Miles MB, Huberman AM. Qualitative data analysis: an expanded source book. 2nd ed. Thousand Oaks, California: Sage Publications; 1994.

    Google Scholar 

  28. Department of Psychiatry Task Force Report: Interactions with the Pharmaceutical Industry (PDF). Available at: http://www.medicine.utoronto.ca/research/ethics-policies-and-guidelines. Accessed June 15, 2014.

  29. Knapp SJ, VandeCreek LD. Practical ethics for psychologists: a positive approach. 2nd ed. Washington, DC: American Psychological Association; 2012. p. 1–14.

    Google Scholar 

  30. Scott C. Why law pervades medicine: an essay on ethics in healthcare. Notre Dame J Law Ethics Public Policy. 2000;14:245–303.

    CAS  PubMed  Google Scholar 

  31. Kuczewski M. The problem with evaluating professionalism: the case against the current dogma. In: Wear D, Aultman JM, editors. Professionalism in medicine: critical perspectives. New York: Springer; 2006. p. 185–98.

    Chapter  Google Scholar 

  32. Brainard AH, Brislen HC. Learning professionalism: a view from the trenches. Acad Med. 2007;82:1010–4.

    Article  PubMed  Google Scholar 

  33. Baernstein A, Amies Oelschlager AE, Chang TA, Wenrich MD. Learning professionalism: perspectives of preclinical medical students. Acad Med. 2009;84:574–81.

    Article  PubMed  Google Scholar 

  34. Kenny NP, Mann KV, MacLeod H. Role modeling in physicians’ professional formation: reconsidering and essential but untapped educational strategy. Acad Med. 2003;78:1203–10.

    Article  PubMed  Google Scholar 

  35. Hicks LK, Robertson DW, Robinson DL, Woodrow SI. Understanding the clinical dilemmas that shape medical students’ ethical development: questionnaire survey and focus group study. BMJ. 2001;322:709–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. l’Université de Montréal, Montréal, QC, Canada

    Mona Gupta

  2. The University of Queensland Centre for Clinical Research, St Lucia, QLD, Australia

    Cynthia Forlini

  3. McGill University, Montréal, QC, Canada

    Keith Lenton

  4. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Raquel Duchen

  5. McMaster University, Hamilton, ON, Canada

    Lynne Lohfeld

Authors
  1. Mona Gupta
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  2. Cynthia Forlini
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  3. Keith Lenton
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  4. Raquel Duchen
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  5. Lynne Lohfeld
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Corresponding author

Correspondence to Mona Gupta.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding Source

Royal College of Physicians and Surgeons of Canada.

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Gupta, M., Forlini, C., Lenton, K. et al. The Hidden Ethics Curriculum in Two Canadian Psychiatry Residency Programs: A Qualitative Study. Acad Psychiatry 40, 592–599 (2016). https://doi.org/10.1007/s40596-015-0456-0

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  • DOI: https://doi.org/10.1007/s40596-015-0456-0

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