The informal curriculum of family medicine – what does it entail and how is it taught to residents? A systematic review

Abstract

Background: The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term "the hidden curriculum" is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners, our aim was to explore the area further, with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed? Methods: We conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results. Results: Twenty articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across other medical disciplines as well. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general, the quality of the few interventional studies found was low. Conclusions: Important aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor's preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum. Trial registration: The systematic review was registered with Prospero; registration number CRD42018104819.

Virtual patients reflecting the clinical reality of primary care – a useful tool to improve cultural competence

“…The residents could not clearly recall whether cultural competence had been taught during medical school; likewise, the students interviewed felt that it was not an area prioritized in their current curriculum. This tallies with previous studies, indicating that residents in family medicine learn cultural competence through the informal curriculum [ 9 , 19 ]. Although most medical schools today include the topic in the formal curriculum, it is often taught cursorily and students have difficulties applying what they have been taught [ 18 , 51 ].…”

“…Exploring the validity and reliability of the VPs in a structured manner would also be of interest. Other areas to consider for future use of VPs would be medical professionalism and dealing with uncertainty, which today, in primary care, just like cultural competence, seem to be taught largely through the informal curriculum [ 19 ].…”

“…Cultural competence is a complex concept and despite the ongoing debate on its appropriateness in medical education and health care, it is to date probably the most established concept, and will therefore be used in this article [ 9 , 14 , 18 ]. Cultural competence is often a part of the informal curriculum in post-graduate education in primary care; with learning taking place experientially in the workplace and formal learning activities being scarce [ 9 , 19 – 21 ]. Meanwhile, studies have indicated that resident physicians often perceive intercultural consultations as challenging, due to lack of both confidence and skills [ 22 – 24 ], and there has been an increased demand for education in cultural competence [ 16 , 25 ].…”

Residents’ Perception of the Educational Program “Family Medicine” in Kazakhstan: A Focus Group Study

“…More attention and effort should be given, especially to the points with poor scores in this study. We recommend continuous evaluation and redesign of the FM program and such results can be a tool that can help create a better and stronger educational program [7]. This study made it possible to identify the needs of the residents, which had not previously been taken into account sufficiently.…”

“…Identification of factors that can significantly affect the conduct and results of training is the main goal of such an analysis [5]. This includes studying the organizational context; defining the characteristics and requirements of the respective work tasks; and defining who the FM residents are and what their characteristics, competencies, and training needs are [6], [7].…”