You've got to know the rules to play the game: how medical students negotiate the hidden curriculum of surgical careers
You've got to know the rules to play the game: how medical students negotiate the hidden curriculum of surgical careers
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DOI：
10.1111/medu.12488
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发表时间：
2014-09-01
影响因子：
6
通讯作者：
Hart, Jo
中科院分区：
文献类型：
--
作者：
Hill, Elspeth;Bowman, Katherine;Hart, Jo
隐性课程可以被定义为在正式课程之外传递给学生的社区文化、信仰和行为。医学职业涉及不同的专业，每个专业都有不同的文化，然而医学生如何适应这些文化还没有得到充分的探索。以外科作为案例研究，我们的目的是确定，首先，是否存在针对学生的特定专业隐藏课程，其次，学生如何遇到和协商外科职业选择。方法采用建构主义扎根理论的方法，探讨学生对职业决策和手术的想法、信念和经历。一份探索性问卷通知了半结构化个人访谈的讨论时间表。有针对性地按年级、性别和外科职业意向对医学生进行抽样调查。数据收集和分析是迭代的：分析跟随每次访谈，并指导我们的讨论时间表的调整，以进一步发展我们的模型。结果学生对外科隐性课程有较清晰的认识。为了成功地谈判外科职业，学生们意识到他们必须首先建立网络，因为职业信息通过关系流动。随后，他们通过积累荣誉（“打勾”）和利用“未来外科医生”的性格（“言行一致”），将他们所学到的知识付诸实践。这使他们能够确定自己和被其他人确定为“未来的外科医生”，并获得参与外科世界的机会。然后，参与可以进一步建立网络，并在积极的反馈循环中获取职业信息。对一些人来说，谈判隐性课程更加困难，对他们来说，这使得外科职业没有吸引力或无法实现。结论：学生意识到一个明确的手术特异性隐藏课程。使用建构主义的理论方法，我们开发了一个模型，说明学生如何遇到、发现和制定这个隐藏的课程以取得成功。根据布迪厄的概念，我们讨论了隐性课程的不平等机会，这被发现排除了许多外科职业的可能性。
OBJECTIVES The hidden curriculum may be framed as the culture, beliefs and behaviours of a community that are passed to students outside formal course offerings. Medical careers involve diverse specialties, each with a different culture, yet how medical students negotiate these cultures has not been fully explored. Using surgery as a case study, we aimed to establish, first, whether a specialty-specific hidden curriculum existed for students, and second, how students encountered and negotiated surgical career options.METHODS Using a constructivist grounded theory approach, we explored students' thoughts, beliefs and experiences regarding career decisions and surgery. An exploratory questionnaire informed the discussion schedule for semi-structured individual interviews. Medical students were purposively sampled by year group, gender and career intentions in surgery. Data collection and analysis were iterative: analysis followed each interview and guided the adaptation of our discussion schedule to further our evolving model.RESULTS Students held a clear sense of a hidden curriculum in surgery. To successfully negotiate a surgical career, students perceived that they must first build networks because careers information flows through relationships. They subsequently enacted what they learned by accruing the accolades (`ticking the boxes') and appropriating the dispositions (`walking the talk') of 'future surgeons'. This allowed them to identify themselves and to be identified by others as 'future surgeons' and to gain access to participation in the surgical world. Participation then enabled further network building and access to careers information in a positive feedback loop. For some, negotiating the hidden curriculum was more difficult, which, for them, rendered a surgical career unattractive or unattainable.CONCLUSIONS Students perceive a clear surgery-specific hidden curriculum. Using a constructivist grounded theory approach, we have developed a model of how students encounter, uncover and enact this hidden curriculum to succeed. Drawing on concepts of Bourdieu, we discuss unequal access to the hidden curriculum, which was found to exclude many from the possibility of a surgical career.