학부의학교육의 잠재교육과정: 의과대학생의 교육에 대한 인식의 질적연구(BMJ, 2004)

학부의학교육의 잠재교육과정: 의과대학생의 교육에 대한 인식의 질적연구(BMJ, 2004)

The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching

Heidi Lempp, Clive Seale

Introduction

Methods

We undertook a qualitative investigation of the content of the hidden curriculum and how it is delivered to medical students.

Results

개인적인 격려

Personal encouragement

36 명의 학생 중 26 명은 긍정적 인 역할 모델로 46 명의 특정 스태프 멤버를 확인하여 격려와 동기 부여에 영향을 미쳤습니다. 교사, 학생, 환자 및 동료와의 의사 소통에 대한 이러한 노력은 높은 평가를 받았습니다.

Among the 36 students, 26 identified 46 specific staff members as positive role models who had an encouraging and motivating impact on them. These teachers’ commitment to teaching and to communicating with students, patients, and colleagues were highly rated.

언급 된 롤모델의 대부분은 남성 의사 (27/46)였으며, 이들은 지식, 전문 권력 및 권한과 관련하여 특히 중요하게 여겨졌다. 여성 롤모델 (19/46)은 더 많은 "인간적"특성을 보여주었고, 즉 관용, 정직, 존중, 학생에 대한 지지 등이었다.

Most of the role models mentioned were male doctors (27/46), who were seen particularly valued in relation to their knowledge, professional power, and authority. The female medical role models (19/46) were said to convey more “human” attributes: support tolerance, integrity, respectfulness, and towards students.

우연한 가르침

Haphazard teaching

대부분의 학생들 (25/36)은 임상 교수에 의한 교육의 haphazard한 특성을 언급했고, 이는 주로 특히 명시된 시간표를 무시하는 방식이었다. 20 명의 학생들은 수업 세션에 대한 예상치 못한 변화가 시간 낭비이며 매우 보편적이라고 지적했습니다. 최종 학년 학생들 (6/7)은 일부 선생님들에게 헌신이 부족하고 교수 기술이 부족한 것으로 여겨지는 것에 대해 특히 비판적이었습니다. 그럼에도 불구하고, 대부분의 학생들은 교사가 교육 세션에서 참석하지 않은 것을 위해 일련의 변명을했습니다. 임상 교사들이 가르침에 대한 열의가 부족하다는 인식으로 인해 학생들은 종종 심하게 동기부여를 상실했다. 이로 인해 학생과 교사 모두 결석이 반복되는 사이클이 반복되었습니다.

Most students (25/36) described the haphazard nature of teaching, particularly by clinical staff, who often disregarded the overt timetable. Twenty students indicated that unscheduled changes to teaching sessions were time wasting and very common. Final year students (6/7) were especially critical of what they perceived as a lack of commitment and poor teaching skills in some teachers. Despite this, most students gave a series of excuses to explain teachers’ absence from educational sessions. Often students were profoundly demotivated by their perception that many clinical teachers had a low level of commitment to teaching, and this led to a repetitive cycle of non-attendance by students and teachers alike.

위계의 중요성

Importance of hierarchy

학생들이 의학에서 위계 구조의 중요성에 대해 배운 주요 방법 중 하나는 이전 연구에서 지적 된 특징인 굴욕을 주는 교육을 통한 것입니다 .57 총 21/36 명의 학생들이 29 가지 굴욕 사건을보고했습니다.

One of the principal ways in which students learnt about the importance of hierarchy in medicine is through teaching that involved humiliation, a feature noted in previous studies.57 In total, 21/36 students reported 29 incidents of humiliation:

보고 된 거의 모든 가해자는 남성 의사 (28/29 사건)였습니다. 전형적으로 사건은 병동 회진 중에 발생했으며, 학생이 같은 반복되는 질문에 답을 못하거나(11 건) 부적절한 임상 검진에 대해서 지적받을 때(8 건)였다.

Almost all the reported perpetrators were male doctors (28/29 incidents). Typically the incidents occurred in ward rounds, when students were unable to answer the same repeated question (11 incidents) or when they were criticised for an inadequate clinical examination (8 incidents).

간호사와 조산사가 의과 대학생을 불손하게 대한다는 보고가 여러 건있었습니다 (15/23 임상 학생). 그러한 행동은 전문적인 경쟁 정도를 나타낼 수있다.

There were also several reports of nurses and midwives treating medical students disrespectfully (15/23 clinical students). Such behaviour may indicate a degree of professional rivalry.519

경쟁적이 됨으로써 앞서나가기

Getting ahead by being competitive

학생들 중 절반 (18/36)은 협력보다는 경쟁이 의학의 특성을 정의하는 것이라고 보고했다. 이는 임상 학생 (16/23)에서 비임상 학생 (2/13)보다 일반적인 관점이었다.

Half of the students (18/36) reported that competition rather than cooperation is the defining characteristic of medicine, a view that was more common among clinical students (16/23) than non-clinical students (2/13).

임상 기간 동안 학생들은 stand out 하기위해 서로에게 칼을 겨눈다. (3 학년 학생)

You notice that students during the clinical years try to stand out, stabbing each other. (Year 3 student)

Discussion

일반화가능성을 평가하려면 추가 연구가 필요함

Further studies of the hidden curriculum from other medical schools are needed, including the perspectives of clinical teachers, to assess the generalisability of our findings.

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BMJ. 2004 Oct 2;329(7469):770-3.

The hidden curriculum in undergraduate medical education: qualitative study of medicalstudents' perceptions of teaching.

Lempp H1, Seale C.

Author information

1

Academic Rheumatology, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE5 9RJ. heidi.k.lempp@kcl.ac.uk

Abstract

OBJECTIVE:

To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum.

DESIGN:

Semistructured interviews with individual students.

SETTING:

One medical school in the United Kingdom.

PARTICIPANTS:

36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame.

MAIN OUTCOME MEASURES:

Medical students' experiences and perceptions of the quality of teaching received during their undergraduatetraining.

RESULTS:

Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medicalschool, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years.

CONCLUSIONS:

Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.

PMID:

 

15459051

 

PMCID:

 

PMC520997

 

DOI:

 

10.1136/bmj.329.7469.770