‘I know my place’- The hidden curriculum of professional hierarchy in a South African undergraduate medical program: A Qualitative Study

Abstract

Background The hidden curriculum of professional hierarchy refers a tacitly acquired perception of a power differential between medical students and their clinical teachers. This power gradient is enforced and maintained by means of humiliation and race- and gender prejudices. The consequences of these pedagogical approaches include disillusionment, anxiety, depression and suicide among student populations. Little is known about this phenomenon in the post- colonial African setting.ObjectivesThe aim of this study was to explore the hidden curriculum of professional hierarchy as it is perceived by medical students. The objective was to define how it manifests and to describe the mechanism that enforce and maintain it.MethodsAn ethnographic study was conducted at a South African University. Through twelve in- depth interviews and 6 months’ participant observations in the clinical setting an understanding of the students’ experience was explored. NVivo software was used to perform a thematic analysis using an open coding method. The themes were then progressively refocussed as broader themes emerged and a deeper understanding of the hidden curriculum developed.ResultsFrom the interviews and the observations, we found that humiliation of students, racism and sexism was used to enforce the professional hierarchy between clinical teachers and students. Students felt discouraged and demotivated by such encounters.ConclusionsThe hidden curriculum of professional hierarchy plays a significant role in how students understand and find their place in the clinical setting. Humiliation continues to play a role despite institutional policies and guidelines and the transition to a democratic dispensation in 1994 in South Africa. Our findings resonated with the findings of international studies exploring the hidden curriculum. Using a historical perspective of the medical school where the study was conducted, the post-colonial lens offers a useful local analysis of the hidden curriculum in the local context of continued gender-based violence, racial, socio-political and economic inequalities in South Africa. It may allow for a more critical engagement with the students’ experience and hopefully assists in exploring institutional values in more profound ways.

Developing indicators for monitoring and evaluating the primary healthcare approach in health sciences education at the University of Cape Town, South Africa, using a Delphi technique

“…There is also a hidden curriculum that needs to be addressed when working for social accountability. [16] It is therefore pertinent that the teaching philosophy encompasses a caring space where coping skills and resilience are prioritised. [15] Healthcare user needs Indicators of the needs of healthcare users were derived exclusively from the PHC principles and included continuity of care; providing evidence-based, acceptable, holistic and accessible care; and respecting human rights.…”